In a recent article, health policy analyst Jennifer Doggett argued that Labor’s election-eve pledge to establish an independent Health Reform Commission says much more about the politics of health than it does about Labor’s policy agenda.
Meanwhile, Dr Tim Woodruff, President of the Doctors Reform Society, writes in the article below that the proposed Commission lacks both the power and scope to effect the changes needed to develop a more equitable health system.
He says the proposed Commission would not stop “the nightmare” for patients and families of “multiple poorly connected pieces”, including the public hospital system, the publicly subsidised private hospital system, the GP system, the publicly subsidised private specialist system, the community care system, the publicly funded private allied health system, the mental health system, the private dental system, the publicly funded private dental system, the public dental system, the aged care system, and others.
Tim Woodruff writes:
ALP health spokesperson Catherine King recently addressed the National Press Club to expound Labor’s vision of health care changes if it wins office. Perhaps the highlight of the address was a restatement of Labor’s vision: “of a truly universal health care system in which every Australian has affordable access to the high-quality health care they need whenever they need it”.
But will such a vision be wholeheartedly pursued under a Labor Government?
King spoke of some of the problems that we all know exist in our health care. She recognised the lack of affordable and timely access to care as a major problem, although she failed to mention the seven percent or more of the population who delay or don’t fill prescriptions because of Government imposed co-payments.
Due mention was also made of the problems of chronic disease and complex needs. Examples of inequitable access and outcomes indicate Labor knows what the problems are and appreciates their importance.
Recognition of the need for reform to achieve this vision was apparent. Some of the barriers to reform were detailed: the split funding and responsibilities of Federal, State, and Local Government and the short political cycle with alternative governments trashing previous governments’ attempts at reform.
Apart from the expected pre-election rhetoric, the centrepiece of the presentation was the commitment to a permanent Health Reform Commission: “It will be a body explicitly charged with reducing health inequality and improving the universality of our health system; and “comparable to the Productivity Commission”.
Thus, it would be expected to give apolitical advice to guide the development of policy in health care, with the particular focus mentioned. Early attention to expanding public hospital outpatient clinics and primary health care models would indeed be welcome. Combined with the stated restoration of lost public hospital funding and immediate unfreezing of the Medicare rebate, this sounds like a very good direction to address the many issues of concern.
Its power will reside in the quality and acceptability of its advice. As with all Productivity Commission recommendations, the decision to act on that advice will depend entirely on our elected representatives. They will continue to fight amongst their various parties and levels of government. Changes may occur, but they may be reversed at the next election. Every concern outlined in the address regarding the disappointing history of reform will remain.
It’s worth remembering a 2012 Productivity Commission report into problem gambling. The recommendation was to progress to an Australia wide poker machine pre-commitment system – under which players could set spending limits on all poker machines – by 2016. A Senate committee recommended this be mandatory. The Gillard Labor Government watered this recommendation down to voluntary and of course the Abbott Government rescinded the lot.
The Productivity Commission has no real power. It is advisory. The suggested Health Reform Commission has no real power. It is a potential force for good only insofar as its suggestions can fit with the barriers to reform outlined by Ms King in her address, which do not look as though they will change even in the medium-term future.
But as has been pointed out by John Dwyer previously: “the Commission must have the authority to implement change and have a vision for ten years of continuous improvement”.
The vision may well be developed by such a Commission. Without such authority, however, lasting reform will be minimal. Perhaps hidden in the political strategy is an intention to consider giving such authority to the Commission as it evolves. Without such intention Labor cannot move significantly towards its stated vision.
But Labor is not even demonstrating it is interested in getting useful advice about big picture items like the private health care system. Government funds 30 percent of the costs of private hospitals (AIHW Australia’s Health 2018) but the proposed Productivity Commission ‘root-and-branch review of the entire private healthcare system’ mentioned in the presentation ignores this funding and in particular the private health insurance rebate (see my previous article on this).
As well as suggesting a basic lack of knowledge of botany, such reluctance to even seek advice does not bode well for the usefulness of the proposed Health Reform Commission.
Beyond the low bar
Labor’s health policy direction is positive. It is so much better than that of the Coalition which does, however, set a very low bar. To date, Labor has not demonstrated it is pursuing policies to achieve its vision.
With this approach we will continue to have health care but not a health system.
The perspective for our patients and their families will not change.
The nightmare for them consists of multiple poorly connected pieces: the public hospital system, the publicly subsidised private hospital system, the GP system, the publicly subsidised private specialist system, the community care system, the publicly funded private allied health system, the mental health system, the private dental system, the publicly funded private dental system, the public dental system, the aged care system, and a myriad of other pieces.
We can do better.
• Dr Tim Woodruff is president of the Doctors Reform Society, an organisation of doctors and medical students promoting measures to improve health for all, in a socially just and equitable way. On Twitter @drsreform
This article was first published at John Menadue’s site, Pearls and Irritations