AMA Vice President, Dr Gary Speck at the AMA's National Conference - Health Under Labor: Reform or Nationalisation
Good afternoon everyone.
I would like to thank the Minister for Health and Ageing for her presentation this morning. I want to assure the Minister that as much as the AMA might appear to be a constant objector to her Government's health policies, the AMA, and the medical profession always have our patients and the best interests of all Australians at the forefront of our minds.
I am very pleased that Dr Bennett could attend our National Conference today and I would like to thank her for her contribution to this session.
NHHRC
I'd like to start out by saying that Dr Bennett and the National Health and Hospitals Reform Commissioners have a unique opportunity to look forward and set the foundations for the Australian health system of the future.
Our health system is certainly set for a number of significant challenges in the future: the ageing population; new technologies; high rates of chronic disease; and truly turning the health of our indigenous peoples around. All of these will inevitably lead to higher spending.
We here at the AMA are very keen to work with the Commission. We are delighted that the past President of the AMA, Dr Mukesh Haikerwal has been appointed as a Commissioner. Mukesh will no doubt provide his usual sage and engaging perspective on the health system - and of course, give his views on opportunities for improvement.
I am sure that Dr Bennett and the Commissioners see the value of the AMA's contribution to the shaping of the health system of the future. Our members work in the health system each and every day and see and truly understand its problems.
The Right Changes
A change of government means inevitably a change in the shape of our health system and new opportunities for us all. However, no government wants to hear that it will have to spend more on health.
So Federal Labor is looking for policies that change the system but reduce the chances of higher spending.
But can the system afford to have change for change's sake? With the new Labor government, we have a real opportunity to make the right changes - changes for the long-term vitality and robustness of our health system.
Today, I'd like to speak about four main aspects of the Australian health system that I believe need real change. And as I just said, now is the time to make the right changes - changes that are critical to ensure our health system is well positioned for the future and all its challenges.
Capacity
The first aspect of our health system, and I believe, the most obvious and critical, is capacity. Our public hospitals simply do not have enough resources. We can set all sorts of accountability and performance benchmarks, but at the end of the day, we know that our public hospitals need more beds, more doctors and more nurses to cope with today's demands, let alone tomorrow's demand. Right now, we need at least 3,750 more beds in our five biggest states. Tomorrow, the figure will be higher still.
In plain English, our public hospitals are seriously under capacity and I don't think I'm saying anything that any of you don't already know. We just have to find the right answer to this serious problem and make the right changes.
If we were to have a single accountability benchmark, it would be bed occupancy.
No Government can ignore the risk to patient safety that comes with hospitals consistently running at above 85 per cent capacity.
This is the day-to-day reality of our public hospitals. Is it inefficiency generated by cost-shifting, blame-shifting and buck-passing? No. It is pure and simple under resourcing. Australians need and will continue to need, and expect, timely access to quality acute care.
While I am on the topic of capacity, the same is true for primary care. Our general practitioners are stretched to the limit. And yet, from both levels of government, there is an expectation that GPs are able to do more: more chronic disease management; more screening for chronic disease; and more after hours clinics to take the load off emergency departments. And at the same time, their practices are expected to do more of what used to be the work of government, like processing Medicare claims.
Whether we like it or not, if Australians are to continue to enjoy the high-quality health care they have received up until now, Australian governments and the Australian people will have to spend more money on health care.
If all the predictions about the impacts of the ageing population and the prevalence of chronic disease and obesity are correct, prevention will not be the cure.
2 - The balance between the public and private sectors
The second critical aspect of our health system is the very delicate balance between the public and private sectors. Each must be equally strong in order to support the other. But one could very well topple over.
The Government has sent a very strong message to Australians that it is okay to drop private health insurance. The AMA has made its predictions about what impact the changes to the Medicare Levy Surcharge thresholds will have on this delicate balance. Can the country afford to sit back and wait to see who is right in the end?
3 - Workforce Shortages
Number three on my list is workforce shortages and the distribution of the health workforce. These issues will continue to plague the health care system into the future.
With the signing of the Intergovernmental Agreement for the national registration and accreditation scheme, Labor governments have shown that they think they have the solution for the health workforce of the future.
Labor believes that introducing new types of health workers and redistributing tasks amongst health workers is the way to respond to the expected demand for health services. Labor sees this as necessary reform. We are yet to see the evidence that this reform will not compromise patient safety and quality health care.
The reform framework set by the IGA is based on the idea that the different health professions are close substitutes for each other. The medical profession knows this is not the case at all. On the contrary, we know the various health professions have roles and responsibilities that are complementary to each other and that high-quality health care requires very strong teamwork with each profession enabled to do what it does best. The AMA believes these health care teams should be led by medical practitioners.
The predominant workforce reform agenda that underpins the national registration and accreditation scheme is problematic. It assumes that non-medical health professionals won't have the same issues that the medical profession has with working in rural and remote areas.
We know first-hand why medical practitioners are reluctant to work in rural and remote areas. I doubt very much that these same reasons won't apply to non-medical health professionals.
Improving health outcomes for rural communities will happen when we provide real incentives and support for people to work in those communities. If I can echo the President, "the biggest waiting room of them all is rural Australia". Australians who live in rural communities should not have to expect, and do not deserve, poorer health and less access to care than their city cousins.
4 - Financing options
Coming in at number four on my list, is the need for broader financing options. The health system of the future needs more than Medicare and private health insurance offers. We simply cannot rely on Governments being prepared to fund their promises through Medicare. And we all know that private health insurers are forecasting doom and gloom, so we can't rely on private health insurance to remain as stable as it has been for the past eight years. Perhaps there is a greater role for individuals to contribute in much the same way we have seen through superannuation.
Quite simply, patient out-of-pocket costs will continue to grow while Medicare rebates are indexed at much lower rates than average weekly earnings, CPI increases and average premium increases for private health insurance.
As a profession, we have shielded patients from higher out-of-pocket costs by maintaining high levels of bulk billing. Are we, and Australia's future doctors prepared to see our training, skills and expertise be systematically undervalued?
I won't say more on that other than to urge the National Health and Hospitals Reform Commission to ponder these long-term structural challenges.
Of course, there are other issues that warrant consideration.
The AMA welcomes the Labor Government's commitment to closing the gap for indigenous Australians. That commitment now needs to be translated into specific health targets, funding and concrete action. Primary care and infrastructure are ongoing areas of need in indigenous health. The AMA believes that $500 million a year is necessary to address these. We look forward to the Government continuing its efforts to work in partnership with indigenous people, their representative health organisations and the AMA to ensure an effective, sustainable and culturally appropriate response for the long-term.
We have to turn the tide on obesity and chronic disease. But the medical profession cannot do this alone. The factors that contribute to obesity are complex and diverse.
The AMA believes that responsibility for addressing the obesity epidemic is a 'whole-of-society' responsibility - which includes governments, the food industry, the health and education sectors, and individuals. Interventions and programs to address obesity must go beyond 'public education programs' and include legislation, tax measures, urban planning regulations and changes to food marketing.
So you can see that there is a much bigger picture to consider when introducing policies to address specific problems.
In searching for reform options, we must ensure that policies involve spending more on health delivery and less on health bureaucracy.
Reform policies must not over-correct past wrongs. We all know the problem with medical training numbers being cut back too far in 1996. Now we have the opposite problem - a huge influx of medical trainees with nowhere to go for their vocational training. The AMA hopes we don't see that sort of pendulum policy swing again.
Nationalisation
Now, let me move on to another type of reform - nationalisation. Doctors understand nationalisation of medical practice. Most of our doctors have experienced the public nationalisation you get in the UK and the private managed care you can get in the USA. Choice keeps the system alive and on its toes. If you get rid of choice, you get coagulation or COAG as we call it.
Australia has always favoured more of a mix in its health system. We have always supported a well funded, strong public system alongside a bouyant private system. This is the best way to preserve choice and keep the system on its toes. We have doctors working in the private system and doctors in the the public system and doctors in both. That is the most common arrangement. Doctors work in a fee for service environment, as VMOs, on salaries, as practice principals and as independent contractors, associates, partners. The greater the variety, the happier we should be.
Governments need to help and encourage and facilitate and fund. It's not their role to make the system grind to a halt with bureaucracy and red tape. It's all too handy for governments to duplicate particular regulatory models for convenience. Under the COAG scheme, we will see a national agency for health professional standards. Just recently, the Health Ministers ticked off on a Safety and Quality Commission proposal for a national body to coordinate (and presumably enforce) safety and quality accreditation. Looks like it would be a nice little add on for the COAG national agency.
We are yet to see how much these additional national agencies will cost - a cost that will be passed on to the medical profession. Time will tell if these bureaucratic structures will make a real difference to the standards of health care.
The AMA and the medical profession might be accused of holding steadfastly onto our 'professional turf' but when Australians get sick they need to - and want to - see a doctor. As long as we maintain our good relationship with the patient and give them good service, a proper diagnosis and sound treatment, it will be electoral suicide for any Government to seek to interfere or substitute or "manage" this relationship.
Doctors know what is going on in the health system. Every day, we see what healthcare people need to keep well or get better.
Sometimes, the AMA gets bad press because we speak our minds about Government proposals. I believe we must speak up because, through our members, the AMA is well placed to comment on the merits and shortcomings of proposals to change the health system.
We are and want to be part of the health debate. We want policies to truly make a difference to the delivery of health care but we cannot, and will not, stand by and watch costs be cut in an already overstretched system or just ignore the quality of patient care being lowered.
We might object sometimes but we are not the enemy. We are informed critics. We want to engage in and be part of health policy development and implementation. The AMA is willing to work with all levels of government to implement health policies. Indeed, a great many of our members, devote many hours to government committees trying to get things right for the health system.
If the Minister will forgive me, I'd like to be opportunistic and give her a take home list of the key health issues for Labor to tackle in its first term of government:
First, understand and be realistic about the capacity of the health system and the health needs of Australia. Our public hospitals and the primary care sector must be appropriately resourced to meet demand. Of themselves, preventative measures will not be the panacea to the current state of our public hospitals.
In the next Australian Health Care Agreements we absolutely need significantly more funding for public hospitals from both levels of government. Benchmarks should be about obligations to ensure public hospitals have the capacity to not only meet demand, but also to provide safe, high-quality care and treatment.
Australia has one of the best health systems in the world but it could be so much better and the Federal Government can afford to make it better. I look forward to poring over the Budget documents next year on the Tuesday night and seeing the line that brings this about.
Secondon my list - Labor must not go down in history as twice presiding over a serious decline in the private health insurance participation rates. Short-term tax breaks might be attractive in the context of short-term election cycles but for the health care system, they are short sighted. The public/private mix of the Australian health care system is finely balanced. We cannot afford to tip that balance too far and bear the inevitable consequences. It will take too long to re-stabilise.
Now more than ever, Australians need to understand the importance of taking responsibility for the own health and to plan for their future health care needs. Our health system cannot withstand policy pendulum swings as it has done in the past. I urge the Minister to rethink the raising of the Medicare Levy Surcharge income thresholds. The AMA believes that $70,000 and $140,000 thresholds will achieve the government's policy objectives in terms of tax breaks, without tipping the health system scales too far.
We must maintain and grow a strong primary care workforce if we are going to tackle chronic disease, preventative health and improve care for the elderly. More GP training places are needed. The Medicare Schedule needs to better support patients through rebates that reflect the work of today's general practice.
Australia's fine and enviable health system is supported by a highly-trained and skilled medical workforce. That medical workforce, us, is best placed to provide government with solutions to the challenges we face today to ensure a fine and enviable system well into the future.
Thank you
ENDS