Dog's breakfast on health

20 August 2010

The policies are all over the place, and whoever gets in needs to get it together.

It is Bismarck who reputedly observed that those who love sausages or laws or both should not watch them being made. He could have said much the same about health policy, certainly the health policy on the table at this election. But unlike the humble sausage, whose ingredients are at least blended and packaged neatly, the offerings for the future of health and healthcare in the electoral tumult are an assortment of bread crumbs, artificial flavours and the occasional chunk of low-grade meat. We may hope that E. coli is in caretaker mode and in pity will do us no harm.

This would be fun were the issues not so serious. The incoming government, of whatever persuasion, needs to tackle several major health matters - and fast.

It must convey a sense of direction about healthcare in Australia and take account of the fact that we are facing a major demographic shift, with a substantial increase in the number of older people.

No matter how clever our preventive strategies become - and Australia has good international standing on prevention, whether in relation to HIV, road accidents, or smoking and heart attack deaths - long-term illnesses such as heart failure, complex diabetes, stroke and chronic respiratory disorders increase exponentially with age. People suffering from one or more of these conditions need extended assistance to maintain quality lives.

Our health system is configured capably, but neither brilliantly nor efficiently, to provide this care. Dozens of studies have shown that integrating care works best, yet our services are not fully integrated. Victoria has done better than other states, but even Victoria needs to brace itself for a wholly predictable future.

Labor has engaged energetically with the need for health reform. The process will take a long time because the health service is so complex, but the formation of commissions of inquiry, informed by extensive consultation, augurs well.

Recently, mental health and aged care have assumed greater importance in Labor's view of the future, as they should.

Although the Coalition's proposals for early intervention in mental health have merit, its record is one of incremental rather than substantial change - with the exception of moving billions of dollars from directly publicly funded care to care obtained through the use of private health insurance.

More recently, although the development of electronic health records has been enshrined in a Council of Australian Governments agreement, the Coalition has said that it would use the investment in achieving more care of the same sort as we have now. This requires more doctors, more hospital beds and greater local control of individual public hospitals.

The expensive health system that we have at present will need to take several nips and tucks as rising demand drives cost increases; service integration is crucial to achieving this. The Coalition has not said clearly whether it regards this as a good idea and, if so, how it would be achieved. But integrated care is the vision our political leaders must articulate if they want the support of doctors, nurses, managers and, especially, of patients and their carers.

To best equip our health service for the future, our political leaders would do well to review just how dependent our health services are on science. The immense progress we have made in care - drugs, scanners, robotics, information services and much more - comes from the intersection of healthcare with science, frequently in the form of health and medical research. And it requires proper funding.

In the wake of the anthrax scare in the US in 2001, Americans suddenly discovered that they had let their public health services fall into disrepair. The demands on healthcare in Australia's future will likewise shock us unless we take far more seriously the need to support the science of healthcare in our plans.

The agreement struck in April by COAG to implement then prime minister Kevin Rudd's reform proposals for new health regions, new forms of community-based care and general practice, and new ways of funding healthcare presumably should stand.

The agreement advances the intention of strong support for science in healthcare. If the agreement can be developed, enhanced and turned into action, then good sense will have been served.

The incoming government will need to decide what to do about the reform agenda that has been worked on thus far. It was always only a beginning. Australia must pursue health reform, but the reason for this must be much more clearly articulated. Only then will the next government be able to set an agenda for reform that achieves an efficient and integrated system of care, informed by science, that will meet the needs of an ageing Australian community.

This may seem like a big ask, but it should not be. Ours is a country blessed with excellent health and a good health system. But it is under stress and needs renewal to face the future with confidence.

Professor Stephen Leeder is director of the Menzies Centre for Health Policy.

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