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The unpalatable truth is we'll pay more for health, but we can get the system we want

Toby Hall - Guardian Australia
July 2016

It’s clear from the prime minister’s post-election comments that all bets are now off when it comes to health policy. Because while the Coalition won the election war, it clearly lost the health battle.

Outside of several ongoing inquiries, we can expect the government will go back to square one in its efforts to convince Australians of its commitment to Medicare and the importance of health.

The prime minister should be congratulated on his willingness to start afresh.

But while there has been isolated cause for praise, over the last three years the Coalition’s health policies have been untargeted (unfairly transferring costs onto consumers, including low income and vulnerable); blunt (attempts to trim private profits have hit not-for-profits as well); and unsustainable (the cost-shifting of public hospital growth onto the states).

If the prime minister and his colleagues are in listening mode, here’s my advice as a frontline health service provider.

Firstly, tell us what your plans are

Throughout its term, it’s been hard to discern the Government’s ambitions in health other than to deliver savings. To what end the litany of inquiries, the unrelated policy announcements, and funding cuts?

If you’re going back to the drawing board, tell us where you want to be in three, five, and 10 years’ time.

What sort of health system do you want to achieve? How will your policies help us get there?

Take the political heat out of healthcare reform

There will always be disagreements and politics in health. I’m not so naïve as to suggest otherwise. But both sides must be more willing to find common ground.

Providers too – from doctors, to health insurers, to hospital groups like ourselves – must discuss solutions for the good of the system as a whole, not just their bottom line.

In that spirit, the Coalition should not be above cherry-picking the best ideas from Labor’s health platform.

One such policy – establishing a permanent Australian Healthcare Reform Commission – would be a smart way of eliminating some of health’s political sting.

An independent, consultative and apolitical commission – led by trusted experts from the sector – could provide the evidence-base to secure our health system’s future.

It is much harder for politicians and interest groups to throw bombs at health reforms initiated by experts rather than the Government’s razor gang.

Labor’s idea for the commission to develop, trial and propose a new Medicare payment and service delivery model is a good start.

The commission could also oversee and evaluate the Coalition’s HealthCare Homes trial.

Personally, I’d like it to examine proposals on fairly reducing public hospital costs, such as basing after-hours GPs in hospitals to address the large number of non-urgent or semi-urgent presentations (53% of the total) congesting the nation’s emergency departments.

Champion preventative health

Elsewhere, the Coalition has to re-discover the benefits of preventive health, particularly given the demands caused by chronic and mental illness.

Nationally, 6% of all hospital admissions are classified as potentially preventable.

Yet in its last term, the Coalition abolished the National Partnership on Preventive Health and made cuts to preventive health research.

The Coalition should consider Labor’s preventive health election policy, including introducing a National Alcohol Strategy and focusing its preventive health efforts on Australia’s 50 worst communities for chronic illness: it will save lives and money in the long run.

Change the aged care model

This area is ripe for painless efficiencies.

A large portion of an individual’s health care costs are expended during their last few months of life.

The Coalition should start working more closely with the states to encourage alternative models of palliative care in-the-home which have the potential to generate significant savings.

As it stands, Australia’s under-resourced palliative care system means people are funnelled into acute care which is both inappropriate and expensive.

In Queensland, almost 90% of people who die of a chronic condition had at least one admission to hospital in the last six months of life; more than 30% had four or more admissions.

These patients had an average public hospital cost of around $30,000 for the last six months of life.

And given its responsibilities in aged care, the federal government could deliver substantial savings by tackling the hundreds of thousands of older Australians in residential aged care who are hospitalised each year.

We need a model that allows for aged care residents to receive non-urgent health care on site.

Convince us to pay for the health system we want

Finally, the prime minister must find a way to convince Australians they need to pay more for the health system they want.

So far, the Coalition’s efforts in this space have often been unfair, particularly to low income Australians.

As a result, they’ve likely poisoned the well on introducing equitable co-payments – for people with the capacity to pay – for a generation.

That leaves an increase to the Medicare levy as potentially the only viable way of injecting funds into the system to meet escalating demand. 

The Coalition’s pre-election commitment of an extra $2.9bn in public hospital funding was welcome, but it’s short-term.

Given our ageing population, the public’s expectations, and the increasing costs associated with medical technology, savings and efficiencies will only go so far; it’s inevitable that Australians will have to pay more.

Arguably the PM’s hardest job will be convincing voters of this unpalatable truth, and finding a fair way of delivering it.

Paul Andrews
Group Media Manager
St Vincent’s Health Australia

Ph: (02) 9367 1138
Mob: 0409 665 495
Tw: @paulandrews2043

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