We're all in the waiting room on the federal government's health policy
28 April 2014
Since coming to power last year, the federal government has not offered the community a health policy or even a story about what it intends to do. Instead, we are saturated with pronouncements that healthcare as we know it is unsustainable, meaning that the annual costs grow at a rate faster than our growth in productivity.
Although proclaimed as news, "unsustainability" in this sense has been about for decades and we have not fallen off the edge of a flat earth because of it. While the search for efficiency makes good sense, the thought that the current financial arrangements for healthcare pose a threat comparable to a new strain of virulent bird flu lacks credibility. We can be thoughtful about how we handle this problem and not panicked.
The unsustainability mantra has been accompanied by several wild swipes at gnats in the system. The proposal of adding a $6 fee to all bulk-billed general practice consultations has received extraordinary airplay. Perhaps it is because it carries an aura of Medicare-bashing, or perhaps because of latent class warfare; it's muscular to wallop those people whom we consider to overuse the system, generally those who live west of where we do. But the meagre revenue collected from this novelty, not counting transaction costs in its collection, would be without impact on the costs of healthcare. Not much policy sense there, I'm afraid.
The next swipe is at the least well-defended sector of the health system: general practice. After only four years of a new organisational arrangement to bring general practitioners together in more functional relationships with hospitals and community services, the aggregate organisations called Medicare Locals are under threat. Three years is a short time in the history of most institutions. No policy has been announced that concerns these entities and no analysis of their performance has been made public. Instead, we are informed by pre-budget leaks that they are likely to "go", to be replaced by ill-defined arrangements that may involve private health insurers. In the absence of policy, we are presented with proposals for action, akin in its opacity to the sullen announcements of action on the high seas in dealing with asylum seekers.
If indeed the government really wishes to achieve greater efficiency in the provision of healthcare in Australia, then a policy that considers options should be provided to voters to examine, question, debate and decide. This is more than secret cost-cutters business.
There are areas where efficiency gains could be achieved with political will. Calling all specialty groups in the medical profession to identify what things they do that don't work and that don't deserve to receive public funding would be a good beginning. This would be tough and require political skill. Taking a critical look at the pricing and provision of pharmaceuticals, and the protection of drug producers and pharmacists would be another. The pricing of pharmaceuticals in Australia is hundreds of millions if not billions of dollars more than it need be, compared with expenditure in comparable countries.
Monopolies in the provision of diagnostic services could be challenged. Australia could take seriously its need for a much more effective use of information technology in healthcare and develop policies that would enable widespread telehealth provision and other efficiency gains, as can be seen in fully wired health systems in California and other parts of the US.
The health portfolio should not be an adventure playground for policy-free floaters of superficial sound bites that are a substitute for policy. Before cutting and slicing, a policy story should be written and told so that those whose health is at stake can understand and contribute to it.
Stephen Leeder is Emeritus Professor of Public Health and Community Medicine at the Menzies Centre for Health Policy, University of Sydney.