Premiers and Chief Ministers will meet in Sydney tomorrow (Friday) to discuss health. The leaders must not allow the opportunity to be wasted.
The leaders would be mistaken to go into the meeting with a sense of crisis. Australia’s health system is in reasonably good shape by world standards and contains features that would be the envy of virtually every country on earth. Indeed, if you are an average citizen going to be ill, there are very few places better than Australia to be ill in.
But fine tuning is needed. So, too, is some anticipation and preventative measures. We must address the increasing costs of medical technology, the ageing population and the drift from private insurance with its attendant reduction in money going to health care.
But changes in the health system should not be done through ideological glasses. What works is what matters. Often the private sector delivers services and outcomes much more efficiently than the public sector. However, this is not the case with health care. The private health-insurance funds are nowhere near as efficient as Medicare. Private hospitals do not deliver the range and quantity of care that public hospitals do, particularly emergency care and complex procedures.
To date the Federal Government’s attempts to get more money into the system by providing incentives for private cover have been lamentably ineffective. The Government has foolishly subsidised — at very high cost — many people who were going to keep their private cover anyway. In return, it has kept only a few in private insurance who might otherwise have left and it has enticed even fewer into private insurance who did not have it before.
Tomorrow the leaders should look at raising the Medicare levy. Medicare has the advantage of universality and equity. The levy is a percentage, so the more you earn the more you pay (tax dodgers aside). Rich people should not be debarred from Medicare by mean-testing. If the rich are excluded from Medicare it will wither and lose its universality.
Costs are going up with ageing and technology. They have to be met. We all value our health and value health care. So we should pay more. There is little evidence of wastage and inefficiency in the health system, especially when compared to other industries. People are prepared to pay more taxes for health.
On the private insurance front, despite the subsidy fiasco, the Government has done two sensible things. It has allowed people who join young to get lower premiums than those who join when they are older. But its scheme is perhaps too limited. It has also allowed the funds to have at least some control over costs by allowing them to organise gap-free services in return for patients going to nominated service providers.
But more work needs to be done on the supply side. ACT Chief Minister Kate Carnell has suggested a Productivity Commission inquiry into medical specialists. It is a good idea. At present, the specialists control the admission of doctors to specialties. There is widespread suspicion that they restrict numbers not so much on the basis of medical qualifications, but on the basis of keeping numbers low and incomes up. If this is not the case the specialists would have nothing to fear from an objective Productivity Commission inquiry, rather than its present internal review.
The leaders should also look at improving information technology at GP, specialist and hospital level. Medical data should be accessible from a linked network or central database. At present a lot of medical data is on hand-written cards in GPs’ surgeries or on unlinked databases in individual hospitals. Keeping medial records (including imaging) electronically and linking the databases have huge medical advantages. It can stop duplication of tests, mis-prescriptions, mis-diagnoses and other errors caused through lack of information. This sort of information technology can also help patients in remote and regional parts of Australia. Second opinions can be sought remotely, improving care and saving on travel.
Linking of databases also enables greater attention to the effectiveness of health-care delivery. A lot of money is spent on medical research; much less is spent on researching delivery of the medical services and the effectiveness of it. Information is the key to finding out what works well on which classes of patient.
The advantages are so great that the privacy issues must be addressed rather than be used as an excuse not to do it.
It will require a national approach and it will require money. But it could be money well-spent. The trouble is that in the past decade, governments have been concentrating on reducing spending. That has been a laudable aim in most areas, but health is not one of them. It can be false economy.
Another factor the leaders must address is cost-shifting. At present, the two levels of government engage in foolish cost and blame shifting. Public hospitals (state-funded) will attempt to push as many people out to GPs (federally funded through Medicare) as possible. They will also get patients moved from hospital drug provision (state funded) to pharmacy provision (federally funded under the pharmaceutical benefits scheme) as quickly as possible. The states blame the feds and the feds blame the states for long waiting lists.
The Federal Government boosted funds for medical research last Budget. That was a good start. We need to see research as an investment. It can result in treatments that make people’s lives happier and more productive.