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Kevin Rudd's health plan needs more work

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Rachel Siewert 14 Apr 2010

In an effort to break the Senate deadlock on private health insurance legislation this year I moved an amendment to put an additional $145 million into mental health services - exactly the programs Australian of the Year Patrick McGorry says are needed if we are to tackle the biggest cause of death for under 45-year-olds.

It would have been a win-win outcome - a massive boost to mental health and potential circuit breaker that could have freed up $1.7 billion for public hospitals.

But the Government rejected the Greens' constructive pro-public health approach.

Let's hope the Prime Minister doesn't take the same take-it-or-leave-it approach to its health and hospital package.

The Australian Greens will be working in the Senate not to oppose or to give a blank cheque to the government's proposals.

Kevin Rudd believes the way to start fixing the health system is by sorting out hospital finances but he misses the point. Isn't it better to keep people well in the first place? If we take care of people's wellbeing via the primary health system, look after their mental health, their dental health, and provide appropriate support for the ageing, then we won't need as many hospital beds. Yes we need to fix hospitals but in the context of the overall health system.

A single fundholder sounds attractive in trying to end the buck-passing of financial responsibilities for health outcomes. Removing a layer of bureaucracy from the health system also sounds attractive, as does encouraging local decision making; however, the government's plans to reform our hospitals leaves many questions unanswered and doesn't assure people that the government can improve the delivery of health services in Australia.

The Greens believe that preventive health is the best way to reduce costs in our nation's hospitals and improve our health outcomes. The real problems faced by the health system lie in the management of chronic illness in an ageing society and the challenge of linking preventive and primary care to enable better management of illness in the community, not in the hospitals. But neither Kevin Rudd nor Tony Abbott had anything to say about these issues in the recent health debate.

Hospitals, specialists and shiny new machines may give a politician a photo opportunity, and something to show for their efforts while they're in office, but they are also far more expensive and far less effective than the low technology interventions of primary care. The problem with politicising health is that it isn't conducive to smart thinking. The preventive path delivers benefits further down the track - not something that works if your focus is on getting elected in the short term.

The National Health and Hospitals Reform Commission clearly identified a range of major problems that should be the focus of any proposed changes. These included a lack of access to key services, specifically highlighting mental health, dental and aged care services, which have once again been left out of the picture. The Rudd plan is a start at fixing some of the divided responsibilities for care, (between the federal government and the states), but what about the private-public and hospital-community sectors? His proposals say nothing about growing health service inequalities, notably affecting Indigenous peoples and those who live in rural and regional communities. And there's a worrying lack of understanding on both sides of the political spectrum when it comes to the lack of continuity of health care that results in poor quality, high cost and largely ineffective forms of care for those with chronic illnesses.

The Greens have long championed equity in our health system, greater investment in public health - not private health insurance - and have called for accurate data monitoring to drive increased clinical and financial accountability. These are some of the areas we want to see addressed by this government.

Sadly, the Prime Minister's plan has almost no details on how much of it will work. Take for example the local hospital networks: there's an apparent disconnect between the 150 local hospital networks and primary health providers. It looks like primary care will be organised over much larger areas than those proposed by the Prime Minister's local hospital networks. The proposed new model won't work if the local hospital networks only include big, viable hospitals rather than the associated community and home care that many patients require. A better approach surely is local health networks, not networks of hospitals in isolation. These networks could be organised in support of, and include, primary health care.

If we don't improve at managing chronic disease, providing required rehabilitation and preventing complex conditions from becoming worse, then the health system will continue to stagger from crisis to crisis, regardless of who manages it or how it is funded.

The Prime Minister talks about ending the blame game and planning for the growing and changing health needs of our population but his plan says nothing about who will be responsible for making sure that each community and region across Australia gets its fair share of funding.

The Prime Minister's faith in the capacity of efficiencies to drive reform is going to need an army of bureaucrats to measure the number of discharges, complex surgical operations and outpatient appointments completed and multiply that by the amount of money invested in treatment and buildings. Yet you could argue that pressure for efficiencies are already present in the system in the form of hard budgets, growing demand and full capacity.

The government's method of paying for hospital activities is by setting a national efficiency price for those activities, however, these might bring in other problems such as ghost wards and the temptation to treat people more quickly, and who have become unnecessarily sicker, to do more with less. Will we see hospital networks being taken over by Rudd's bureaucrats if they don't meet targets? Will they be closed down? Some local hospital networks might have to merge with their neighbours in order to achieve greater efficiencies and if so, who will pick up the cost for all those merger and acquisition fees? Will regional centres be left without their local hospital?

Who will pay the inevitable gap between the efficiency price and what it ends up costing? Will the Commonwealth simply hand over its 60 per cent funding if a state can't find its 40 per cent contribution? Perhaps this has been deliberately left unclear.

Australian of the Year, Professor Patrick McGorry has called for significant increases in mental health funding as a "low-risk reform strategy with rapid and dramatic benefits in health gain and cost savings". He says the implications for not dealing with the problem now will consign a generation of young Australians to unnecessary disability as well as premature death from suicide and cardiovascular disease.

Where does aged care fit into the government's plans? Older people who are unnecessarily in acute care because there aren't enough beds in residential aged care facilities cost the hospital system hundreds of millions of dollars. Ensuring that Australia has adequate aged care services and facilities will not only free up hospital beds but also provide better care for older Australians.

Where are the plans for dental care? We know that access to dental care is essential for better health outcomes yet the government has made no announcement on this vital area of our health system.

The government has announced only a fraction of the health reform necessary, yet seems to want the States to sign off on partial and obviously incomplete reform - these are just some of the questions that need to be answered before the COAG meeting on April 19.

Originally posted here

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