Introduction by Croakey: The Greens health policies have received the highest rating in an assessment by the Consumers’ Health Forum of Australia that spans eight domains, including consumer leadership, action on the social determinants of health, prevention, and integrated primary care reform.
Next came Labor, while the LNP lagged far behind.
The scores measured how well the parties’ health policies supported the CHF priorities for the election.
Overall, the scorecard suggests that all parties could do much more to lift their game on health policy: out of a potential maximum score of 37, The Greens policies explicitly met 21 of the CHF’s priorities, while Labor’s met 16, and the LNP’s met seven.
The scorecard, reported in detail below, also included a second tier of evaluation, for when policies partially supported the CHF’s priorities but had gaps. On this metric, The Greens supported an additional 12 CHF priorities, while Labor supported an additional 10 priorities, and the LNP supported an additional nine.
The Greens scored five out of five for their policies on prevention, while Labor scored two and the LNP scored nil. On the social determinants of health, The Greens met three of the CHF’s six priorities, while Labor met one, and the LNP did not meet any of the CHF’s priorities on prevention.
On Aboriginal and Torres Strait Islander health, The Greens met one of the CHF’s three priorities, Labor met two, and the LNP met nil.
The Consumers Health Forum of Australia writes:
CHF developed its priorities for Election 2019 from extensive consultation across its membership. They were also informed by recommendations generated by policy round-tables we hosted throughout 2016-2018 and the results of our Consumer Sentiment Survey which we undertook to try to find out how people viewed the health system.
The survey told us that, overall, Australians think we have a high-quality health system but there are some major gaps.
In summary, CHF was looking for:
- leadership with a vision for what our health system might look like and how to get there
- measures that moved us along the path to a consumer-centred health system with consumers being involved in the design and implementation of the futurehealth system
- early action in three main priority areas: childhood obesity, primary care and dental reform.
When it comes to primary care, we welcome the commitments from all parties to making the system universal and improving access through the pillars of Medicare and the Pharmaceutical Benefits Scheme.
More of the same
But we see this as more of the same: it offers nothing new and, more importantly, nothing to move the system into a new paradigm that will make it fit-for-purpose and sustainable in the future. Announcements addressing elective surgery waiting lists and emergency department waiting times predominated.
Health is more than hospitals: what is needed is a major strengthening and investment in primary health care, including enhanced access to mental health care in the community.
We note that the ALP has made a commitment to match all health promises in the 2019 Federal Budget in addition to their $7.5 billion health spending pledges.
To their credit, the Coalition has continued the journey towards patient and family centred health care homes. A new funding and service model will support GPs to provide enhanced care to Australians over 70 who enter into a new type of agreement with their general practice to receive more personalised coordinated care. This will help modernise Medicare by paying for consultations by email, FaceTime and Skype. This is to be matched by the ALP.
However, the absence of a transformational agenda for primary care is a missed opportunity this election. For example, it is disappointing that there was silence from all parties about the potentially powerful role Primary Health Networks could play in accelerating improvement and innovation in primary care and implementing local solutions to Emergency Department and hospital demand and avoidable hospital admissions given the significant investment in setting up this regional infrastructure.
It is clear the time has come to ensure oral and dental health is treated like any other form of health. The Coalition offered nothing new for dental health other than a continuation of the Child Dental Benefits Scheme, and in their response to us see it sitting firmly in the private arena with private health insurance as the funding mechanism.
The ALP’s Pensioner Dental Plan has taken welcome first steps with a targeted program for older people but this falls well short of what is needed although we note it was described as “the next step towards Labor’s vision of universal access to dental care in Australia”.
This, combined with the ALP’s pledge to negotiate with the states to maintain their existing spending on public dental health services, will substantially increase access.
Prevention remains the poor cousin
For too long prevention has been the poor cousin in terms of health investment. This election has seen some new investments pledged from all parties, although very different approaches are taken.
Some focus on tackling obesity. The Greens look to a governance solution in the form of an Independent Preventative Health Commission. The ALP presents us with a menu of initiatives targeting obesity, sun safety, bowel and lung cancers and consumption of tobacco and alcohol.
Australia needs a stronger focus on prevention and the Coalition have some well targeted measures too although many of their promises are for secondary prevention measures, not public health focused actions.
Despite these promises neither the ALP or the Coalition commit to spending five percent of the health budget on prevention–a goal that is universally recommended by leading Australian public health advocates.
All parties acknowledge and make various pledges to address the urgent need to prevent suicide in the Australian community, particularly among high risk groups.
However, the Coalition are reluctant to use arguably powerful regulatory levers (such as industry food reformulation targets and advertising restrictions on alcohol products) to prevent chronic condition risk factors and address the burden that growing rates of obesity will inevitably have on our system.
Both the Coalition and ALP offered little for patient leadership with the exception of a welcome bipartisan commitment to a Youth Health Forum to bring young voices in national health policy discussions.
There is still a long way to go for consumers to be viewed as equal partners in the health system and, importantly, for them to be supported with leadership and capability to do so, whether that be through shared decision making and support to better self-manage at the point of care or leadership development, so they can act with more impact and influence in shaping policy and services.
The Greens offered the most hope with commitments to patient leadership and some major developments around dental care, prevention and the social determinants.
A key issue missing from both the Coalition and ALP is a commitment to addressing the social determinants of health, particularly measures to alleviate poverty, and measures to reduce health inequality. The evidence around the importance of housing, education, income on health outcomes is unequivocal.
If these are not addressed, the risk is that many of the initiatives and expenditure promised across the parties will be wasted.
1. On patient leadership
CHF is committed to moving to a consumer-centred health system. We are pleased that the Australian Greens indicated specific support for a Patient Leadership Academy and Collaborative Pairs Australia. We also like their overall commitment to legislate for consumer groups and citizens to be involved in meaningful discussions, and to ensure young people/organisations and bodies representing them are heard and provided with support.
In an article published in The Australian, the ALP expressed concern that the Health Peak and Advisory Bodies Programme was unindexed and indicated an intention to address this.
It is disappointing that we have not seen any commitment from the two major parties to prioritise consumer involvement in discussions about reforms and priorities for health in Australia. We see promise in the ALP’s proposed Australian Health Reform Commission; however, the response from the ALP does not include any mention of how consumer leaders will be involved.
We would be looking for strong patient leadership; for example, appointing consumer commissioners and for a clear commitment to consumer insights shaping the early priorities of the Commission.
It is pleasing to see the Coalition have announced funding for the National Child and Youth Health Action Plan 2020-2030, including funding for CHF’s Youth Health Forum. This has bipartisan support.
All parties have made significant announcements about mental health and yet none have made a commitment to an independent national voice for mental health consumers. Such a voice is critical to ensuring the system and services are people centred, designed by people for people.
2. On primary and integrated care reform
Both the ALP and the Greens have committed to establishing a national centre to steward and test health system reform and address the fragmented health journey experienced by many Australians.
This commitment would ideally be supported by initiatives, training and resources for primary health care providers to better deliver and measure patient-centred care, and to better support patient activation and self-management.
There is across the board support for some action to improve integration of services which is important as it should deliver a smoother patient journey, reduce consumer frustrations and save the system money.
Equally there is a strong appetite across all parties to shift away from fee-for-service funding arrangements for general practice and primary health care –a recognition that this is better for comprehensive coordinated care.
The support for a primary health care data set from the ALP and Greens is welcome as we need any changes to be evidence driven and without good data we don’t have the evidence. The AIHW is developing a primary health care data asset under a previous Budget commitment.
3. On prevention
Prevention is key to making the health system sustainable in the longer-term. It has tended to be underdone in policy promises and initiatives in the past.
This time round there are some promises.
The Greens demonstrate a strong commitment to prevention through their Independent Preventative Health Commission and plans to address some of Australia’s biggest health concerns such as obesity through comprehensive strategies.
We welcome Labor’s commitment to public health initiatives targeting obesity, sun safety, bowel and lung cancers and consumption of tobacco and alcohol.
Australia needs a stronger focus on prevention and we would like to see firmer commitment from them on industry food reformulation targets and advertising.
CHF was disappointed by the lack of preventative focus in the 2019 Federal Budget and by any substantive measures from the Coalition since then.
There was $1.4 billion worth of measures badged as prevention in the Federal Budget and they are all worthy in their own right. However, most of these, with the exception of the anti-smoking campaign, some immunisation measures and physical activity programs, were targeted secondary prevention focused initiatives, not population-level primary prevention-oriented programs.
All parties underscore and make various pledges to address the urgent need to prevent suicide in the Australian community, particularly among high risk groups.
On patient activation, self-management and health literacy
CHF would like to see consumers involved in making changes to ensure the system is easier to understand and navigate and that health literacy and self-management is prioritised across all areas of the health system.
Transformational reform, particularly in primary care, needs more than change to the way services are funded. We also need to implement the evidence that better outcomes and experiences, as well as reduced health inequities, are possible when people have the opportunity to actively shape their care and support – when people can exercise more choice and control in their health and care.
The reforms proposed by the Greens show a commitment to making the health system more patient-centred and is explicit in involving consumers in planning and funding processes to improve service delivery and experiences at the point of care. In particular, the Greens were the only party to acknowledge that the integration of shared decision-making, social prescribing, supported self-management and a service coordinator workforce would add value to new ways to deliver primary health care.
The ALP and the Coalition’s initiatives are silent on this critical area. They fail to acknowledge and embrace the importance of consumers taking control of their own health care.
As with patient leadership this is a fundamental part of a consumer-centred health system. The ALP has made some limited commitments to help patients navigate certain parts of the health system e.g. a national standard for informed financial consent for surgery and cancer care, and additional support services for cancer patients.
On the social determinants of health
It is important to reduce the inequities in health outcomes and to do this there needs to be changes to the broader social supports that contribute to health and wellbeing, not just the health system.
The responses from the both the Coalition and ALP are disappointing and this is clearly an area which needs more action from the incoming government.
Prioritising Aboriginal and Torres Strait Islander health
Bipartisan support for the Closing the Gap Partnership Agreement has been a positive step. The support from the ALP and Greens for the Uluru Statement from the Heart seeking constitutional recognition and achieving meaningful reform for First Nations peoples is an important step.
There has been good commitment from all parties to action on preventable diseases that are overrepresented in communities.
However, we would like to see a firmer commitment to Aboriginal and Torres Strait Islander-led research into the social determinants of health that are leading to the prevalence of these in communities.
We are pleased that the Greens have provided in principle support to this priority.
Oral and dental health
Oral and dental health is the most neglected area of health care and needs a long-term commitment to address inequity of access to services in Australia.
There is some action on this front with the Greens policy to achieve Medicare-funded dental for all Australians phased in by 2025.
The ALP targeted funding for essential dental care for eligible seniors and pensioners is a step in the right direction accompanied by pledges to negotiate with the states and territories to maintain spending levels to increase overall access.
The ALP’s commitment is that this is a first step towards their vision of universal access under Medicare for all Australians.
The Coalition has nothing additional to offer on this important issue other than a continuation of the Child Dental Benefits Schedule.
Early childhood, youth and family
Child and youth health have not received the attention it deserves for some time.
All parties are increasingly taking a life course approach and acknowledge the importance of improving services for children and young people to lay the foundations for better health later on. There are significant pledges across the board on the need to improve access to mental health services for young people 18-25 years, although there is some variation in early intervention services available in early childhood.
Young people’s needs of and experiences with the health system are quite different from older adults.
A consumer-centred health system needs to ensure it caters for diversity and consumers of all ages and backgrounds.
The transitions of care between paediatric and adult services is a major issue raised by CHF’s Youth Health Forum.
CHF is pleased that all parties are committed to including the youth voice in national policy setting and program/service design although the mechanisms they are suggesting are quite different.
• See all of our Federal election 2019 coverage here.