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Stewardship and the road ahead for health financing

As the new Chair of Health Financing and Economics Committee (HFE), I am looking forward to the challenges ahead for health financing and how HFE’s work can assist the AMA to advocate and achieve the best outcomes for AMA members and our patients.

The dust has yet to settle on the outcomes of the 2016 Federal Election, but it is clear that the campaign focus on health, Medicare and affordability resonated with the Australian public.

There has never been a more important opportunity to have a national discussion about the future of the Australian health care system. As both consumers and providers, we know that our health care system needs strategic, systematic reform. We understand that it must be efficient, equitable and sustainable. We also understand that Australians see access to ‘Medicare’ (a universal public health insurance scheme) as being non-negotiable. With major reviews underway into the Medicare Benefits Schedule and private health insurance, and calls to reform private health insurance and limit excessive fees to patients, it is imperative that health reform is coordinated, integrated and not victim to short term political expediency or reactiveness.

There will be a continuing, even increasing, pressure to constrain growth in health expenditure. Changing health demographics and an increased burden of complex and chronic disease strain existing systems and resources. Emerging technologies threaten to further increase health care costs unless new technologies and information systems can be used to support primary health care and preventive health care measures and streamline accessible, affordable and appropriate specialist care.

There are cost savings to be had within the system, but these must not be generated by simply ‘shifting’ costs within the system or passing these costs onto consumers.

HFE has recognised that ‘stewardship’ is an important and useful approach for clinicians to take an influential role in these issues and decisions. 

Earlier this year, HFE developed an AMA position statement on Doctors’ role in stewardship of healthcare financing and funding arrangements 2016. This complements the AMA position statement developed through Ethics and Medico-Legal Committee on The Doctor’s role in Stewardship of Health Care Resources 2016, which focuses on the role of the individual doctor in stewardship of health care resources in the clinical setting. 

Stewardship in relation to health financing and funding means ensuring health funding is directed to achieving health outcomes, does not have adverse impacts or involve wasteful expenditure, and is sustainable and able to meet future needs.

Why do doctors have a role in stewardship of heath financing?

Health care financing and funding arrangements and decisions need to be appropriately managed to ensure health funding enables all patients to continue to receive the best quality care, now and in the future.

As individual doctors we affect health care expenditure through our clinical recommendations and decisions regarding patient treatment. As doctors we also bring a practical and informed perspective from the real world of our clinical practice to health financing and funding decisions.

When major decisions affecting health care are taken without such clinical involvement, the results are often sub-optimal and unsustainable. Recent examples include GP co-payments, MBS indexation freeze, fee reductions, and public hospital funding.

We have yet to see how the post-election health policy and health financing climate unfolds. The AMA must develop its own credible health economic narrative and contribute to collaborative processes where the input of the medical profession is both sought after and listened to in the development of health policy. The alternative clearly hasn’t worked.

Australia has an enviable health care system. Reform is required to ensure that, in the face of changing health demographics and new health care developments, it remains ‘fit for purpose’ and meets the needs of all Australians.

Where decisions involving the allocation of health care resources are being made, doctors have a responsibility to advocate for the best interests of patients, the improvement of health outcomes, and the sustainable use of resources.