Health's chance in a sick economy
17 February 2009
Rahm Emanuel, Barack Obama's chief of staff, is reported to have said two weeks after the presidential election: "You never want a serious crisis to go to waste. What I mean is that it's an opportunity to do things you could not do before."
With the interim report of the National Health and Hospitals Reform Commission published yesterday the time for implementing reform could hardly be better. In Australia the decision to fund infrastructure renewal and development as part of the Federal Government's response to the economic downturn creates opportunities for the health system.
Investment in a reformed, publicly funded health-care system could be matched to both short- and long-term economic recovery. The report considers several opportunities for immediate investment. Looking further ahead, investment in research and prevention infrastructure could position Australia to develop solutions to long-term health problems such as mental disorders, dementia, heart disease and cancer.
The report suggests several specific changes in health care practice that could be tied to efforts to revive the economy.
First, although Australian health care is outstanding by international standards, the commission has detected several hot spots in need of reform. They include better care for people with chronic health problems by expanding opportunities for them to receive multi-service health care from one-stop shops and super clinics. Funding to provide infrastructure for integrated general practice and primary care in the community as part of Mr Rudd's stimulus package would improve the efficacy of our response to chronic disease, though care is needed to ensure existing general practitioner arrangements are not destroyed in the rush for super clinics.
The lack of connectedness that many patients find troublesome would be helped immensely if plans for electronic records for patients were funded. The sections of the report that promote plans for indigenous, rural, dental (Denticare, by a small increase in the Medicare levy) and mental health are thoughtful and will provoke useful debate, although the much higher frequency of physical ailments among those with mental illness is not considered. These proposals call for investment such as increasing the number of successful Aboriginal Community Controlled Health Services and an Aboriginal and Torres Strait Islander authority that would purchase health services for them. Health workforce problems, so notoriously difficult to solve, and a proposal to establish a national agency to oversee this area (and another to oversee safety and quality) deserve serious attention.
Second, for a decade our commitment to humane care for all has sagged at the knees partly because the system has lacked the money and infrastructure to respond. Waiting times in understaffed and overcrowded emergency departments and unpaid debtors' bills are merely the public face of this distress.
It is not clear whether the commission appreciates the size of the need for more funding for hospitals, speaking instead of access targets, bonuses to hospitals that perform well and suggesting ways for handling elective surgery difficulties. Much more needs to be said, and specifically, about who pays for what to fix hospitals.
Third, comparable investment in prevention would enable future generations to enjoy better health. The commission accepts this proposition and proposes action. Prevention must address effectively the health problems of our lifestyle. We can encourage and enable individual responsibility and support social structural modifications, including fresh food affordability and availability, better public transport options and urban design. We can invest in research to achieve a better understanding of the nature of mental and physical illness, which may have long-term pay-offs. In the short term, we can stimulate the economy by building new laboratories and research facilities.
The lack of a dedicated funding stream for prevention has always meant that it is the last item to be listed in a budget and the first to be dropped. The report proposes a national agency to stimulate prevention, an idea that we may hope is developed more fully when another taskforce, devoted entirely to prevention, reports later this year.
This moment of economic crisis gives us an opportunity to consider proposals for health reform that have both short- and long-term pay-offs for better health, as well as helping to heal our economy.
The interim report points us in several directions where health gains might be achieved, but this will only occur if supported by wise and generous investment. We may well be on the move again in health.
Stephen Leeder is director of the Menzies Centre for Health Policy.
Contact: Sarah Stock
Phone: 02 9114 0748