Following on from the previous post, this is the second article in a Croakey health policy election series:
Carol Bennett, executive director of the Consumers Health Forum, writes:
Comparing health policies released during an election campaign is something of a challenge.
For opposition parties, it is often about making promises that they may not have to keep but which will maximise votes – particularly in marginal seats. For incumbent governments, it is about showing their policy strengths while at the same time trying to avoid major blunders.
It is also true that incumbent governments, with access to the vast resources of the public service and ready input from professional advocacy organisations and academia, are always at an advantage when it comes to developing and articulating health reform.
All of this is done under the intense and sometimes unreasonable scrutiny of a modern media where every promise or mistake is instant news, often presented without time for thoughtful analysis and comparison.
Likewise, elections are a time when the comments and demands of advocacy and lobby groups become magnified and take on an importance that is sometimes beyond what they would warrant during the normal political cycle.
In this election, CHF has had some tangible success in its pursuit of genuine consumer involvement across the wide range of health reforms, particularly at a local and regional level where many of the important day-to-day health issues are delivered.
Last Wednesday (August 11th) Health Minister Nicola Roxon announced funding of $2.9 m for structured training of consumers to participate in Local Hospital Networks and Medicare locals.
Better structured consumer engagement – as studies around the world have shown – will only benefit the health system overall. This long overdue, commonsense proposal should be supported by all political parties.
Turning to health policies:
The current Labor Government has made health an important priority, putting forward a series of reforms that have been largely supported by health consumers. Government policy has been outlined in a series of pre-election commitments, including in the 2010-11 Federal Budget.
Some of the areas that CHF is particularly keen to see further developments in include:
CHF believes that substantial investment in a national eHealth network, with sufficient privacy protection capability, is a vital part of upgrading our creaking health system. As noted above, the Labor Government has made a substantial investment of $466.7 million over two years to implement the NEHTA business case and introduce person controlled electronic health records by 1 July 2012.
While CHF welcomes the Coalition’s promised $1.5 billion for mental health services, the stripping out of money allocated by the Government to eHealth is a concern. Reference to eHealth was absent from their policy announcements on hospitals and nursing and GP services. We look forward to hearing further about their policies on this issue.
The Greens’ healthcare plan does not make specific reference to eHealth records.
Primary health care
An improved primary healthcare system is vital to the future of healthcare in Australia. Obviously a strong primary health care workforce is essential to the delivery of effective primary health care services. The Government’s health reform package included an increased focus on primary health care, with funding for Medicare Locals and better after-hours general practice access, new GP super clinics, more practice, and diabetes programs. The Government has also committed funding to the training of health professionals.
The Coalition has released a policy to ‘Boost GP Services’. This policy includes funding for more after hours GP services; support for family GPs to provide complex and chronic care; Medicare rebates for practice nurses; improved timeliness of diagnosis and treatment; and development of existing family GP practices. They have also released a regional health workforce plan, including an increase in the number of medical rural bonded scholarships and a pilot of a similar scheme for rural and regional dentists; scholarships for nurse practitioners in regional and remote areas; and annual financial incentives to nurse practitioners in remote regional towns with no resident medical practitioner. The Coalition’s focus is largely on the hospital system, with a $3.6 billion investment over four years in policies around hospitals and nursing. However, consumers have strongly indicated that what they want is more investment in the primary and community health sector.
The Greens have not released a specific policy on primary health care, though they clearly state in their healthcare plan that they recognise that keeping people out of hospital is the main challenge for health systems today, and that this is best achieved through better funded primary health care services. There are also strong primary health care elements in the dental care and mental health aspects of their healthcare plan.
Prevention is a focus for the Australian Greens’ health policy, which includes initiatives such as a levy on junk food and alcohol advertising; ‘traffic light’ food labelling; a floor price on cigarettes and an independent National Preventive Health Agency. The Labor Government’s 2010-11 Federal Budget included a $131.8 million investment in new initiatives including anti-smoking and binge drinking campaigns.
CHF believes there is much more to do in some areas, particularly dental and mental health. Labor has made a campaign promise of an extra $276.9 million for mental health services (supplementing other health commitments including 1300 new subacute beds that are likely to benefit people with a mental illness), but this is just a fraction of what is needed to bring these services to a level that matches those available for people with physical complaints.
The Coalition has promised to spend $1.5 billion on mental health services, but would pay for this by stripping money out of eHealth and primary health care reforms announced by Labor.
The Australian Greens have also made a commitment to mental health, including additional funding of $350 million per annum over the next four years and a greater emphasis on making the service system responsive to need, including through the establishment of an independent National Mental Health Commission and a Minister for Mental Health.
While extra money is needed, more programs alone is not reform. Real reform in systems like mental health requires a change in the way the system responds at a local level to its community, to people with mental health problems and to their families and carers.
CHF is still waiting to see a serious funding commitment to dental care. Dental problems are widespread in Australia and are known to be a key indicator of social disadvantage and associated chronic health problems. However, we also acknowledge that, like mental health, this kind of significant system reform would require a long term investment and the need to tackle some complex and inherent system difficulties. Only the Greens have come out with a clear policy on dental care, calling for a universal dental care scheme at a cost of $4.3 billion per annum. How this will be funded is not clear.
Other areas of need
More also needs to be done in the areas of Indigenous health and rural and regional health. As noted above, the Coalition has committed to a regional workforce strategy, and the Government has previously announced incentives to attract health practitioners to regional areas. The Greens’ policy also includes strategies to build the regional dental workforce. But rural and remote health issues are not limited to workforce.
We are still waiting for clear policies on Indigenous health. The Labor Government has committed to closing the unacceptable life expectancy gap for Indigenous Australians but the detail of how this is to be delivered is unclear. The Greens’ healthcare plan includes strategies for Indigenous hearing and dental health. The Coalition has yet to release policies on Indigenous health.
Access to health services for older Australians is also an ongoing issue. The Coalition’s Aged Care Policy includes funding to support certainty of care for people accessing aged care services and to reduce pressure on the public hospital system, as well as strategies to enhance older Australians’ health and wellbeing. The Labor Government has also committed to increasing numbers of aged care beds and taking over funding for aged care.
We eagerly await further announcements on health and opportunities for reform of the system to ensure it can meet the future needs of all Australians.