Health policies are out and there is little difference between the two major parties. The policies definitely help patients afford to see GPs and get medication. More GPs and more nurses will be trained. The Labor Government has signed off a hospital funding agreement with the States. It has opened more urgent care clinics. It has increased wages for aged care workers. It has funded women’s health issues better. It is paying GP registrars better (but not as well as hospital registrars). It has promised extra funding for mental health but it’s not in the budget so when will it happen? However, all these all these changes are band-aids or catch-ups. Most should have been done long ago.
What’s Missing?
Reform
To date all that has happened is that funding has increased to cope better with demand. Almost nothing has been done to address new ways of funding. Forty years ago, when a patient went to a doctor, he/she was given treatment perhaps sent to a hospital or private specialist. Health care has changed and it’s as if many politicians haven’t realised. The epidemic of chronic disease is not best managed the old way. Prevention is important but once disease occurs, patients need, physiotherapy, podiatry, psychology, education and a range of other care. None of these policies are about comprehensive care. None shake the flawed model of paying for an item of service (like a consultation) with its inevitable consequences of inadequate time for the service and unjustified, indeed often unconscionable co-payments of $80-300.
The mouth continues to be ignored even as the Minister Mark Butler admits it is part of the body and just signals a long-term intention to address dental care.
Taxes prop up the private hospital system both directly and through the private health insurance rebate ($9+ billion+/year). We are told we need the private hospitals. It’s true but only because we won’t fund public hospitals adequately.
Nothing much is suggested for mental health although being more able to afford to see a GP will help, and the recent promise of extra funding (when it happens) is welcome.
Whilst a usable My Health Record would be of huge importance to improving quality of care, Mark Butler is recently quoted in The Saturday Paper, saying,
“So, we still have a pretty antiquated My Health Record system that we’re in the process of modernising”
What Has Been Considered?
In 2022-3 Butler chaired the Strengthening Medicare Taskforce which even included conservative groups like the Australian Medical Association. It provided general recommendations including
Support general practice in management of complex chronic disease through blended funding models integrated with fee-for-service, with funding for longer consultations and incentives that better promote quality bundles of care for people who need it most.
Subsequently an Expert Advisory Panel chaired by First Assistant Secretary Mark Roddam performed a Review of General Practice Incentives. Recommendations included:
- Voluntary Patient Enrolment. This means patients commit to a general practice and should expect their needs will have some priority over unenrolled patients. This has been implemented.
- A Baseline Practice Payment, adjusted for patient needs, socio-economic status and location. This payment is intended to be the basis for a major change in the manner of funding general practice. It is a move away from the current model of paying fees for single services. This change in the funding mix is designed to facilitate the comprehensive, integrated primary health care which is now needed because the complexity of illnesses and the proliferation of multiple types of treatment requires such care.
- An Independent primary care pricing authority to set remuneration without the influence of the politics of the day or the election campaign.
To date, and presumably until next years’ May budget, nothing has or will happen with respect to the above genuine reform and the many other recommendations from the Panels.
What has not been considered but needs to be?
The Private Health Insurance rebate which costs taxpayers over $9 billion a year could be reduced rapidly and directed to public hospitals. Evidence suggests that PHI enrolment is relatively insensitive to price rises.
Access to non-GP specialists needs to be improved. The Commonwealth could fund hospitals to employ more specialists and could set up salaried specialists in community settings. Aboriginal Community Controlled Health Services, and Aged Care facilities are ideal (e.g. a session a week for a geriatrician). These specialists would then compete with private specialists many of whom charge unaffordable co-payments. Currently, these co-payments force patients to go to public hospitals where they often wait for years to be seen. This would change.
Getting the funding models right will be a challenge. That, however, is what reform is about.
Labor considered some kind of Australian Health Reform Commission in 2019. That needs to be reconsidered but with a much more ambitious brief. Such a commission needs to be independent of all governments, and lobbyists such as health care provider organisations, the Pharmacy Guild, and the pharmaceutical industry It’s first task would be an assessment of health care needs across the nation. It would then distribute funding to those organisations which provide care, including state governments, regional hospital networks, primary health care networks, and primary health care practices. The funding would come from both State and Commonwealth Governments and be pooled for distribution. This would put an end to the farcical and incredibly wasteful cost shifting and ‘blame game’.
The Commonwealth charges people for medications approved by the Pharmaceutical Benefits Scheme for subsidy. This approval is based on evidence that the drugs either improve quality of life or save lives and are cost-effective. These PBS copayments, although reduced, are a tax on illness, an impost on those in the community unlucky enough to be afflicted by illness. That is simply not fair. But worse than that it also stops patients taking prescribed medication, as numerous studies have shown. That means patients suffer more and/or die earlier because of government policy. Scotland, Wales, and more recently New Zealand have eliminated these unfair taxes. It’s time we did too.
Dental care needs to be funded like care for any other part of the body. This needs to be done within the new model of funding rather than simply putting dental into the flawed fee-for-service model.
We go to this election with some significant reform ideas about health care from Labor, but no commitment to implementation. There are no stated ideas for meaningful reform from the Coalition. The stated policies between the two major parties are similar. The Greens and Teals are way ahead on all of this, so perhaps in this as in other areas, we should be hoping for a minority Labor government.