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Some ideas for health reform that could happen NOW: cancer chief

The National Health and Hospitals Reform Commission’s final report made numerous recommendations, many of which require a great deal more work before they could be considered ready for implementation. It seems unlikely that changes will happen quickly.

However, Professor Ian Olver, CEO of Cancer Council Australia, has a few suggestions for reforms that could be introduced without waiting for further reviews and reports and consultations.  He writes:

“In responding to the National Health and Hospitals Reform Commission A Healthier Future For All Australians: Final Report it would be trite to simply say that its impact will depend on  the detail of what the Government implements. Will we just see fiddling around the edges of health, or major reform, even as dramatic as a federal takeover of state hospitals?

Having waited for over half of the Government’s first term in office to see these recommendations, do we now have to wait for the establishment of a National Health Promotion and Prevention Agency to implement public health initiatives which are already backed by strong evidence?

In cancer prevention, for example, there is extensive evidence that the most effective way of decreasing the incidence of smoking with its positive health outcomes, is to increase the tax on tobacco. This measure could be implemented tomorrow.

Thirty lives could be saved each week by a fully implemented bowel screening program in Australia targeting everyone aged 50 and over. The evidence has shown this for more than 10 years, yet the current program provides only one-off screening to people turning 50, 55 and 65.

Clinicians in public hospitals already know about the inequities in drug availability and the wastage that occurs because of cost shifting, between the federal and state systems. High cost drugs, such as anti-cancer chemotherapy are being sourced by state hospitals from outside pharmacies. State hospitals provide minimal discharge medications, forcing patients to go immediately to their GPs for a prescription, ensuring the drugs are funded by the federal Pharmaceutical Benefits Scheme. In many cases it’s an unnecessary GP consultation, simply to save the hospital from funding the drugs. These measures shift the cost from the state to the Commonwealth, even though it’s the same taxpayer picking up the tab.

For high-cost drugs not listed on the PBS, patients are part of the lottery of either being wealthy enough to afford them, having some state hospital drug committees agree to fund them (usually on the advice of clinicians presenting research evidence), or relying on the sporadic generosity of health insurers or the repatriation system to fund drugs for individual clients.

There have been limited trials of federal funding of drugs in state hospitals, but federal funding of all drugs irrespective of public, private, inpatient or outpatient status would remove the inequities and the wastage in time and money of cost shifting.

Can we see such a commonsense measure implemented within the Government’s first term of office, without waiting for further agencies, reviews or consultations and more delay of such obvious health reforms?”

Comments 1

  1. Trevor Kerr says:

    A submission by ‘Private Cancer Physicians of Australia and Haematology and Oncology Clinics of Australia’ to Performance of Public and Private Hospital Systems inquiry does not go into actual costs (overall, or out-of-pocket) billed to people undergoing treatment.
    Harold Pollack, at The New Republic (If Reform Dies, So Will Thousands of Women) wrote “Women in other industrial democracies do not go bankrupt because they have breast cancer.”
    Surely, we ought to be aiming at Zero out-of-pocket costs for cancer treatments while striving to prevent unrestrained US-style billing. But first we need to know what are the costs and who is collecting the benefits. I guess that’s what the PC inquiry is about.
    Since it is not possible to compare costs (between public and private systems), until the PC sets out a framework, it would seem the ethical course for medical specialists in all disciplines is to lay off the emotional blackmail. (I do not mean to imply the Cancer Council does that).

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