The Hunt for health savings: prevention is better than cure
The new federal Minister for Health, Greg Hunt, comes into the role with a large set of challenges – mostly driven by increasing costs and increasing demand for services.
At the same time, on health and health care, Labor has dominated the never-ending rhetorical campaign. Bill Shorten and his team focus relentlessly on Medicare and the Coalition has been on the back foot with regard to the health portfolio for many months.
The arrival of a new minister provides an opportunity for the Coalition government to develop a clear message on how to improve the health and well-being of Australians and support our health system.
Both parties acknowledge the challenges of health spending which has increased by 74 per cent over the past decade. And on Q&A last September, recently retired NSW Premier Mike Baird declared that "health funding" was what kept him awake at night.
Despite this rhetoric, the major parties have largely overlooked the most logical opportunity to reduce health spending and improve the health of Australians: prevention.
Amid the debates on whether rebates should go up or be fixed, about whether hospitals need more beds and about whether more doctors are needed in rural communities, there has been almost no mention of large-scale efforts to reduce the demand for such expenditure in the first place. As Bill Gates has stated "treatment without prevention is simply unsustainable".
All the rhetoric coming out of the major parties focuses on care for people once they are already sick. That is very late – there is much we can do to prevent illness from emerging or at least delaying it by many years.
Preventing disease and illness has long been neglected in Australian health policy. It may seem hard to believe but most analysis suggests that less than 2 per cent of Australian health expenditure is targeted towards prevention with the rest being directed to curative services. This compares with 7 per cent of the total health expenditure that New Zealand and Canada spend on preventing illness among its citizens. Even the United States spends twice as much as we do on prevention. Promotion of health and well-being in our communities is bizarrely somehow seen as less important and valuable. But it does not have to be that way.
Well-planned and well-executed prevention programs save lives and improve quality of life. Immunisation in children and adults leads to lower rates of infectious diseases. Addressing air pollution reduces respiratory illness and preventing food contamination lowers the risk of gastroenteritis and similar conditions. Preventing skin cancer has a return on investment of $3.60 for every prevention dollar spent.
There is ample evidence that supporting individuals to reduce smoking rates, lower alcohol consumption, improve diets, lose weight and increase physical activity is associated with lower rates of chronic disease such as heart disease, cancer and diabetes. Such lifestyle modification programs have been shown to reduce diabetes rates by up to 58 per cent.
Diabetes Australia reports that the annual healthcare cost of an individual with diabetes exceeds $4500 – so the cost-effective interventions available to us, multiplied by the hundreds of thousands of Australians who could be reached by programs – would save Australia millions per year for diabetes alone. As Benjamin Franklin declared "an ounce of prevention is worth a pound of cure".
The value for money argument for prevention is strong but investing in prevention is not just about budget savings. It is really about building stronger families and communities. It improves people's well-being, keeps them out of hospitals, and allows them to spend more time doing what they love. And we have the means and knowledge to make this happen. If there was a drug that had this level of efficacy, there would be clamouring to get it included on the Pharmaceutical Benefits Scheme.
A focus on prevention aligns with liberal values of efficiency, cost-savings and supporting individuals to make good decisions. We can provide a platform to encourage our community to exercise more and eat well – the way to do that is through ensuring availability of parks and bike lanes, ensuring access to healthy foods and creating a culture of activity.
And the private health insurance industry – which Hunt highlighted as a focus area in his first press conference in his new role – should be solidly behind prevention to stop, or at least delay, people from getting sick and requiring payouts.
So why is there so much less focus on prevention programs that can reduce illness so effectively and efficiently?
Our pollies love cutting ribbons – on new hospitals or new clinics or new machines – but they cannot cut ribbons on a thousand cases of stroke prevented or an outbreak of gastro averted in Brisbane. The announcement culture that pervades our politics makes a prevention agenda less appealing.
In addition, prevention spending is like infrastructure spending in that its benefit is beyond the life of the three-year parliament. Saving money for the benefit of a future government does not appeal to our here and now agenda.
Australia did flirt with prevention with the establishment of the Australian National Preventive Health Agency in 2011. Its abolition in June 2014 shut the door on the prevention agenda.
If our governments are fair dinkum about reducing health spending, about strengthening the Australian family and workforce and about building a sustainable health system, then prevention needs to stop being a dirty word and become the headline of our national agenda.