It is governments, not doctors, who need to change archaic practices
The Better Bang for your Buck issue of Health Voices, the magazine of the Consumer Health Forum, includes articles from a range of commentators on health policy as well as contributions from the Coalition, Labor and Greens.
The underlying theme is that it is possible to reduce waste and improve efficiency in our health system – and it’s hard to argue with that.
Some of the articles just say what you expect them to say.
For example, Terry Barnes pushing his $6 co-payment plan again, David Baker highlighting the potential savings from greater use of generic medicines, and Jeremy Sammut resurrecting personal Health Savings Accounts. Others, including the Shadow Health Minister Catherine King and Greens health spokesman Richard Di Natale, point to the potential savings from investments in general practice and preventative health.
Nevertheless, the most interesting article comes from Federal Health Minister Peter Dutton, because it provides some insight into the current thinking of Government on health policy, and there has been little external indication of that since the election.
Given recent media coverage though, it is not surprising that it is written from the “Growth in spending on health is unsustainable” perspective, even though Australia is in the middle of OECD countries in the percentage of gross domestic product we spend on health, with predictions it will increase by only about 1 per cent in the next decade.
Key points made by the Minister include suggestions of change to Medicare now that it is 30 years old. He uses a comparison between the Kingswood and the cars of today as a way to mount his argument for change, as well as a focus on the 10 per cent of patients who account for 46 per cent of Medicare costs, and potential roles for private health insurance in primary care.
Missing from the article is any acknowledgment of the world leading health outcomes enjoyed by the average Australian, or the role that successive Commonwealth and State Governments have played in contributing to current inefficiencies.
Australia is failing to reap the potential rewards of modern information and communication technology. The Personally Controlled Electronic Health Record languishes as we wait on the outcome of the Government initiated review.
After spending more than $1 billion, there is little evidence at the point of health care delivery of its existence.
Health care is information rich, and the benefits from the secure sharing of information are clear, from increased patient safety to reduced duplication of investigations. This Government project has still to deliver its potential efficiencies.
The other great opportunity is in telehealth.
While there has been some take up, particularly for consultative services, telehealth remains greatly under-utilised, especially for a country with such a dispersed population as Australia. In particular, the potential for improved access to general practitioners for those in rural and remote communities has still to be realised.
More fundamental are the inefficiencies that arise from our Federal funding system.
Much was made of the ‘blame game’ under our previous Government but, make no mistake, duplication of services or worse – service gaps – continue.
Whether it is under-provision of aged care services (a Commonwealth responsibility), leaving elderly people in our public hospitals while they wait for a place to be available, or the interface between Local Hospital Networks and Medicare Locals, many areas of clear responsibility for funding and health service delivery still need to be resolved.
Peter Dutton’s article is titled, “Change imperative to end archaic practices”.
Here he must be referring to the public hospital sector because general practice has changed drastically over the last three decades – as small to medium size businesses, there has been no other option.
Any archaic practices – such as making a telephone call to confirm a prescription under the Authority system – are those forced upon general practice by the bureaucracy.
But even the public hospital system has made great improvements in efficiency over the three decades of Medicare.
This is reflected by much shorter hospital lengths of stay, increased used of day case admissions, implementation of hospital-in-the home and rehabilitation-in-the-home systems and, more recently, reductions in the time patients spend in our emergency departments.
Almost every clinical process has been subject to clinical service redesign, from waiting list management to the admission pathway for our unplanned admissions.
It is often forgotten that some of the ‘inefficiency’ relates to the role our public hospitals play in the teaching and training of future generations of health professions, not just medical, but also nurses and allied health.
Public hospital culture comes from the top, and there is still too much old fashioned bureaucracy here. Endless forms and documentation in a largely information technology poor environment are a familiar overhead for those working in our public hospitals. Forms needing up to six signatures for an approval are still a reality.
Well done to the Consumer Health Forum for bringing a broad range of views on health reform together. It’s a shame the AMA was not included. The AMA has a lot to contribute to the debate.
Certainly, we would always wish to contribute to Government policy positively and proactively rather than having to respond to ill-conceived policies after their public announcement.
But we reserve the right to defend both doctors and patients against poor public policy when quiet advocacy is not enough.