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Towards the federal election

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By Professor Stephen Leeder & Associate Professor Jim Gillespie

It seems unlikely that in the run-up to forthcoming federal election that health policy, or indeed any policy, will receive much attention.

The lines are drawn, the battle declared and the weapons – innuendo, insult, and necktie colour – are basic and bloody. We deserve better, and nowhere is the need more pressing than in relation to health care.

When Labour came to power, a vigorous and extensive reform program was put in place, the elements of which included a massive injection of capital from the Federal Government through the National Health and Hospitals Reform Commission, the development of an extensive preventive agenda, the formation of Medicare Locals (organisations that bring general practice and other community services into new conjunction), and the establishment of regional hospital networks with governing boards.  State governments, especially, NSW, have responded to the federal stimulus, matching it and undertaking one of the largest reforms and reorganisations for decades. 

That all of these changes have proceeded smoothly, although not without serious cost and disruption, is strong evidence of the commitment of those involved in health service provision to strive for better things.

Research has been reassessed and strengthened in NSW and federally. Implementation has not been uniform, but where the reforms have worked well, budgetary control has been achieved, clinicians have been refranchised in the chain of decisions, patients and carers have been brought closer to the services, and quality – as far as we can judge (not far) – has improved.

New lines of communication, often based on information technology, are opening in many places between hospitals and the community-based practitioners in the Medicare Locals, especially in the coordinated care of those many people who have complex illnesses that continue over years.

So much for the good news.

There seems to be complacency within the Government that they have achieved their goals, and reluctance from the Opposition to stir any attention in a policy space which has not been kind to them in the past.

In the remaining weeks before the federal election there are three major health policy challenges that it would be wonderful to hear addressed by those who now seek our vote. All are within our grasp to manage.

Firstly, the costs of health care rise each year at a rate in excess of economic growth. As a country with an explicit commitment to provide all necessary care to all who need it, without financial impediment, this requires either a shift in public policy to move these costs back to a patient’s hip pocket, or a debate about how these costs could be limited.

Our experience of fiscal restraint in health care has not been encouraging. A slow squeeze, through ‘efficiency dividends’, cuts in payments to the states or freezes in Medicare rebates – especially in general practice – have provided the easiest options: short term budgetary gains where the consequences take time to appear and blame can be shifted to others.

Either way, the erosion of Medicare’s universality that is exemplified in prohibitive co-payments for specialist services in the community, or the inaccessibility of outpatient services in many hospitals, should be addressed.

We either say that Medicare is over, or we fund it adequately and describe its purpose with fresh clarity. Policy shift by stealth hardly befits a democracy. There is a debate with several elements to be had about how we control the costs and pay for health care.

Secondly, it would be good to hear from the political contestants (or, more likely, it would be good if the winner considered in the next term) how we should manage the growing demand of people with chronic problems who require combined care from many services, private and public. Improved models of funding and care are unlikely to result in budgetary savings – the need is too large and growing. However, it would prepare the system to manage it largest future challenge.

Thirdly, there surely should be a national approach to building in our nation a capacity for intelligent conversation in the community about health and health care. True, shroud-waving clinicians moaning on TV about a pet under funded service set the cause back. They should know better. But unless the community is led (note the word) into an understanding of health and health care, we disenfranchise a major voice, which instead chatters on about waiting lists and hospital bed numbers. We can do better than this. But a story needs to be constructed and told about health care by our leaders. 

Were these matters taken seriously, we would have a policy debate worthy of the name, and worthy of the basically sound health service (warts and all) that Australia has built in the past century.