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13 Jun 2019

BY PROFESSOR STEPHEN LEEDER, EMERITUS PROFESSOR, PUBLIC HEALTH, UNIVERSITY OF SYDNEY  

Whatever your expectation of the outcome of the recent federal election, we can all celebrate another peaceful transition of government. We should not take democracy and peaceful elections for granted. Their safety and freedom were secured through powerful traditions and in part in two world wars in which Australians participated – lest we forget.

But the celebrations are over and we are back in the kitchen – and even with the help of a dishwasher there is a lot of cleaning up. One virtue – at least so it appears to those of us who live in a world of constant restructuring – is that continuity will likely prevail in federal health policy for three more years.

Yet there is plenty for the new Morrison Government to do – and plenty promised – much of it contained in the recent federal budget, to create a productive agenda. 

Stephen Duckett, at the Grattan Institute, a Melbourne think tank, and a group of expert policy critics, published in The Conversation of April 3 an analysis of that budget. A huge array of items was slated to receive increased funding, including $0.5 billion to pay for patients with diabetes to receive long-term care through general practice clinics, using “a new annual payment for each person with diabetes who signs up with a specific GP. Funding is [to be] provided for about 100,000 people to sign up – about 10% of all people with diabetes in Australia.”  In addition, Duckett et al wrote:

“The indexation freeze on all GP services on the Medicare Benefits Schedule (MBS) will lift from July 1, 2019, at a cost of $187.2 million. The freeze will be lifted on various X-ray and ultrasound MBS rebates from July 1, 2020.

“The budget announces[d] $461 million for youth mental health, including 30 new headspace centres, some of which will be in regional areas.”

MRI scans are to be more readily obtained and cheaper. More medications are to be paid for through the Pharmaceutical Benefits Scheme. 

Aged care services, the object of a Royal Commission, received increased funding.  As Hal Swerrisen, a senior health service manager and policy guru and associate at  the Grattan Institute, said:

“There is more funding for aged care. Currently, 130,000 older people are waiting for home care packages – often for a year or more. Nearly half of residential care services are losing money and there are major concerns about quality of care.

“The short-term fix is to give residential care $320 million to try to prevent services going under. The budget includes 10,000 previously announced home care packages, at a cost of $282 million, but that still leaves more than 100,000 people waiting.”

Lesley Russell, an adjunct associate professor at the Menzies Centre for Health Policy in Sydney and long-time observer of health policy, expressed disappointment about prevention in the budget.  The election promises, which came a few weeks later, provided little additional encouragement. 

“Preventable diseases and conditions are a key factor in health inequalities and rising health-care costs. The two issues looming large are obesity and its consequences, and the health impacts of climate change.

“There is $5.5 million for 2018-19 and 2019-20 for mental health services in areas affected by natural disasters, and $1.1 million over two years for the Health Star rating system – otherwise nothing for primary prevention.”

Funding for public hospital services elicited a proposal in the Coalition’s election manifesto. 

“Our new five-year public hospital agreement with the states and territories delivers $31 billion more funding for hospitals (between 2020-21 and 2024-25).

“Annual hospital funding will more than double from $13.3 billion in 2012-13 to $29.1 billion in 2024-25.

“In addition, a new $1.25 billion Community Health and Hospitals Program will improve health care specialist services including cancer treatment; drug and alcohol treatment; preventive, primary and chronic disease management; and mental health.”

All these announcements, welcome as they are, are set within the context of the prevailing health care system. For example, in a recent post-election statement, the Prime Minister nominated the prevention of youth suicide as an claiming his immediate attention. As noted, with the expansion of headspace he may see this an early win.

But large-scale reforms, especially ones in anticipation of changes in the care of patients that will follow from the genetics and ‘omics’ revolution, the massive developments occurring in the electronic management of information, and the shift to integrated hospital and community care for people with serious chronic illnesses, are barely mentioned either in the recent budget or the election promises.  Indeed, coordinated care for patients with serious and continuing illnesses so common in old age is hardly addressed at all. 

One might expect that a government priding itself on its economic management and concerned with achieving greater productivity (or efficiency) would propose changes that would enhance the productivity of health services that it supports. These would require big thinking.

McKinsey and Company, a consultancy, in a recent newsletter, considered ways in which greater productivity could be achieved in health services, which have been notoriously slow to improve on this measure. 

The neat thing about these proposed changes is that are likely to have strong appeal to those who use them. All of the strategies depend upon the judicious use of currently available technologies to extract more from patient records, decentralise care wherever possible, link patients to doctors speedily and effectively, real-time patient monitoring, improved supply chains for medical provisions and more.

Besides providing small amounts of money for incremental changes to existing services we should be thinking bold and thinking ahead.

 

 


Published: 13 Jun 2019