Croakey welcomes feedback from readers on the report, which is available here.
The consumer emphasis is welcomed by Merrilyn Walton, Assoc Prof of Medical Education at the University of Sydney.
“At last the consumer voice is on the agenda. Rather than being silent recipients of care, the NHHRC Report recommends their voice be an equal partner in both health care policy debates and health care delivery.
The recommendations around health literacy are pivotal to enabling patients to become partners in their own health care.
Missing in most reports and health care debates to date has been the need to prepare and enable patients to make real choices about their doctors or hospitals. Many patients do not make genuine choices in relation to their treatments either because of the nature of their disease or because the scope of the informational needs of patients and their obligations to provide it is under recognised.
Things have to change before patients are to have genuine choice in their health care. The current system – its structure and organisation relies on patients being passive receivers of their health care; patients are not at the centre; professionals are in control.
Most hospital organisations and health services are not patient-centred and not designed to take patient perspectives into account. Over the last century hospitals are better organised and professionalised and more complex, yet the patient’s role has remained relatively unchanged. They are admitted to wards in much the same way as a hundred years ago; they are told what is wrong with them, how, where and when their condition will be treated and by whom.
Patients are not expected to make decisions other than whether they will have the treatment or not; and sometimes this is not fully considered. If all patients being admitted to hospitals were to make inquiries about hospital infections, peer review requirements and credentialing, hospital staff would not be able to cope with the increased demand on their time.
The system is just not designed for questioning patients. If we are really going to include patients as partners, the system will need to be restructured and reorganised; this will require a major cultural change, but one worth the effort.”
The Public Health Association of Australia has given the report a big tick, calling it a “blueprint for significant improvement in the delivery of health services across the nation”.
“We welcome especially the emphasis on prevention and on other important issues such as mental health, Indigenous health, dental health and palliative care. PHAA is particularly pleased to see strong support for the establishment of a new National Preventive Health Agency,” said Professor Mike Daube, President of the PHAA.
“We also welcome the clear outline by the Prime Minister of a timeline for discussion and further decisions by the Council of Australian Governments. PHAA looks forward to taking part in further discussions on implementation of the reform agenda,” said Professor Daube.
But the rural doctors are not at all happy
The National Health and Hospitals Reform Commission has wasted a ‘once in a lifetime’ opportunity to fix the rural health crisis by ignoring the need for urgent initiatives to entice more doctors and other health professionals to the bush, the Rural Doctors Association of Australia (RDAA) said today.
“After the Commission released its interim report in February, we expressed our strong disappointment that the number one priority for fixing the rural health crisis—improving access to local healthcare by getting more health professionals into rural and remote Australia—was largely being overlooked by the Commission” RDAA President, Dr Nola Maxfield, said.
“Consequently, it is extremely unfortunate and frustrating to us that the Commission has not heeded our advice when developing its final report on health reform.
“The Commission’s final report was meant to be a report for the whole health system, but unfortunately it has a gaping hole in it—rural health. The crucial element missing from the report is any recommendation for substantial new initiatives to get more doctors and other healthcare professionals to the bush.
“In particular, we are extremely disappointed that a critical Rural Rescue Plan put forward by RDAA and the AMA has again been overlooked by the Commission. Implementation of this Plan would be a very cost-effective (and we believe hugely successful) way to get and keep more doctors in rural practice by providing real incentives and supports for them. We have already seen this type of Plan introduced in Queensland by the state government, and the ensuing increase in rural doctors there has been staggering.
“At the end of the day, the real issue for rural Australia is not about whether our nation has one health system or whether the states or Commonwealth control it, but whether there is a health system at all in the bush. The continuing, chronic shortage of health professionals in our country communities means that rural Australians are simply not able to access the healthcare they need and deserve.
“It’s all well and good for the Commission to talk about equity payments to ensure health dollars reach those who need it most, but until we get enough health professionals into rural and remote Australia it is going to be virtually impossible to translate those payments into the delivery of extra local services.
“Rural Australia is already suffering from a shortage of 17,000 health professionals including doctors, nurses and other health professionals—and this shortage will only get worse in the absence of genuine government action.
“As Prime Minister Kevin Rudd undertakes his consultation around the Commission’s final report, we urge him to get out of the cities and the big metropolitan hospitals, and instead get into the bush to talk to the healthcare professionals working on the ground there. He needs to visit many rural hospitals, rural general practices and Aboriginal Medical Services to see for himself the problems surrounding access to healthcare in the bush and what must be done to remedy the situation before it is simply too late.
“Rural health is a bit like a paddock—once the topsoil has eroded away from lack of care it is very hard to bring it back to life. Now is the time to be investing in this paddock so it will provide the harvest of rural health professionals and better access to healthcare that is so desperately required in the bush.”
The emphasis on equity is welcomed by Professor Gavin Mooney, University of Sydney
‘How good it is to see such emphasis on equity and on Aboriginal health. That has to be the firm foundation for a good report. We hear so much about hospitals but normally so little about issues of access and fairness. The NHHRC also clearly believes in trying to ‘close the gap’ in Aboriginal health.
Let’s hope that desire rubs off on Rudd and Macklin and gets them stirred up to move beyond rhetoric and take some real action to take Aboriginal health problems seriously. The NHHRC report certainly gives me hope in that direction!”
Consumers Health Forum happy about consumer focus
“Reforming health in Australia towards ‘a health system that places the needs of patients first’ will take enormous courage from government” according to Ms Carol Bennett, Executive Director of the Consumers Health Forum of Australia (CHF).
Ms Bennett was commenting on the release of the National Health and Hospitals Reform Commission (NHHRC) report today in Canberra at which the Prime Minister, Kevin Rudd, and Minister for Health and Ageing, Nicola Roxon, again highlighted the critical role to be played by health consumers in reforming the current health system.
“This report again emphasises the enormous economic and human costs of continuing with our existing health system. The report also offers solutions, and thankfully these solutions are about much more than the Commonwealth simply taking over hospitals or putting more money into the current system,” Ms Bennett said.
“It is refreshing to hear the Prime Minister talk about access to the services people need, rather than the services that the health system wants to offer. To make this happen, we are going to have to measure the experiences of people who need health services as well as measuring the access to, and quality of, the health services provided.
“If patients are to be the centre of the new health system, it is health consumers who need to be at the centre of further discussion and consultations. We don’t want the health reform debate to continue to be dominated entirely by existing health service providers and system lobbyists” Ms Bennett said.
“Now that the Government has this report, it is essential that it doesn’t get sidetracked into compromises that maintain the interests of those who benefit most from the current health system. This is an opportunity to find solutions that provide the best possible health services for all Australians.”
What about the wasteful, unfair private health insurance incentives? The Doctors Reform Society asks…
The Doctors Reform Society welcomes the many positive ideas presented in the report from the National Health and Hospitals Reform Commission,” said Dr Tim Woodruff, President, Doctors Reform Society, “but we wonder how their stated commitment to the principles of equity and efficiency has allowed them to ignore the inequitable and inefficient Private Health Insurance (PHI) rebate. Is choice more important than equity?”
“The belated recognition that dental care should be a universal entitlement is a huge step forward for many Australians who until now have had no choice but to live in pain, unable to eat properly, waiting years for treatment,” said Dr Woodruff. But the Denticare proposal is at odds with the Commission’s comment that ‘we want to translate universal entitlement into universal access’. Denticare will encourage dentists to stay in areas of relative affluence, supported by taxes. Those without teeth unfortunate enough to have limited mobility and live in poorer areas will remain toothless. Denticare also guarantees that those who have the money for private insurance can get faster access. That’s choice before equity. It should be the opposite.”
“The report clearly identifies inequities in funding and recommends regional block funding for rural and remote areas, based on need,” said Dr Woodruff, “but the report ignores this issue for inner and outer regional areas where many more Australians regularly miss out on their fair share of Government spending. They have no choice”.
“The report targets areas of marked inequity, ie serious mental illness, dental health, rural and remote regions, and Aboriginal health. This is appropriate but it is charity rather than the removal of inequity which drives this targeting,” said Dr Woodruff. “Structural reforms to address the root causes of these inequities are clearly second order priorities. Fee for service funding will predominant in the new plan despite it guaranteeing that the inverse care law, ‘those who need the least get the most, those who need the most get the least’ will continue to apply. Private health insurance will be expanded despite its striking inefficiency and inequity.”
“Our public hospitals are struggling, burdened by inadequate Commonwealth funding. The drift of doctors from public to private hospitals and the inequity of access to public hospitals is clearly identified in the report but the contribution of the PHI rebate to this inequity is ignored. Choice remains a taxpayer subsidised option for the minority of Australians who can afford PHI and can queue jump public hospital waiting lists, whilst the most needy just wait. They have no choice. Vested interests remain untouched”
“Despite the many excellent ideas within it, this report is ultimately about entrenching those vested interests, about a long term vision for health care as a commodity to be subject to competition and the market,” said Dr Woodruff. “Swine flu affects us all, We do not need a health industry, we need a health system for all. That will only happen with co-operation, not competition”.