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A comprehensive examination of the Coalition’s health policy

Dr Tim Senior, a GP working in Indigenous health, puts the Coalition’s health policy under the microscope….

“Kevin Rudd’s approach to health has been more about politics than policy” we read opening paragraph 2 of the coalition health policy. We then get a page and a half of pure politics quoting criticisms of Kevin Rudd’s previous positions on health. Good start.

Digging a bit deeper, there is some policy in there. It looks old fashioned and doctor-centric, but it’s there.

It opens up talking about hospitals, of course. The focus is on allowing local communities a say in how hospitals are run. This is a laudable aim, though I find it hard to read this without thinking about Aboriginal Community Control. Will hospitals be similarly overburdened by reporting requirements or subject to “risk assessments”? Or will ACCHOs get the same freedoms as hospitals? I suspect that it’s just not thought about at all.

The highlight for me is increased funding for GP training. Increasing the PIP for medical student training is welcome. GPs who take students usually reduce their income to do so. (They also tend to see more Indigenous patients too, and are in regional areas- see here for a comparison of teaching and non-teaching practices) The recent HWA report about the teaching settings of health professional student contained this graph, showing that the placements of medical students are far more frequently in acute (hospital) settings than general practice.

So if this funding attracts more GPs to have medical students, then that is a good thing. There’s lots missing from this approach though. There’s no thought to the quality of training, or to increasing capacity in practices to do this. I’d also add that the training of other health professionals is missing. There’s the outline of a policy to give allied health and nursing professionals scholarships for something or other.

There is also a promise to provide funding for infrastructure to practices in regional and rural areas for teaching. The details are very vague – there will be funding of up to $300,000 provided the practice can raise the same amount themselves. There have been similar initiatives recently. The process of writing grant applications for this money was time consuming and alien to general practices. Some got support for this from Medicare Locals, though it’s still unclear what will happen to Medicare Locals after a coalition government reviews them. It would seem that large corporate general practices will be best placed to source these grants. Anecdotally, these have been the practices least involved in GP teaching and training. There’s a lot more detail required to understand the effects of this policy.

Investing in resolving the issue of providing enough intern places for medical students to have a job to go into is sensible. It was predictable at the time that increasing the number of medical students without increasing the number of jobs they would go into would be a problem. This move is necessary, though probably not sufficient. It’s not clear that there’s any form of workforce planning about how these places are distributed or how training quality is guaranteed.

It also seems sensible to alter the bowel cancer screening program to align with what the evidence shows is effective. It seems strange to be boasting that a coalition government introduced it, while at the same time admitting it wasn’t done properly.

It’s good that Dental Care is in there, but the policy doesn’t say much more than “Dental Care will be in there somewhere.”

I’ll leave others to comment on the changes to clinical trials and the simplification of the Pharmaceutical Benefits Advisory Committee, except to say that making decisions on new drugs will not make a big difference to most people. Bigger gains are to be made by ensuring access to the proven medicines already available. Linking in the policy to the contribution the pharmaceutical companies make to the Australian economy worries me a little, as I would argue that safety should trump this. I’d much rather see, say, pressure applied to ensure all trial data is published.

The Coalition craftily call this a Health Services policy. I wonder, then, if we need to hold our breath for all those things missing from this policy that might make it into a Health policy. There’s no mention of Aboriginal and Torres Strait Islander health, apart from the word Indigenous in the Key Points Summary. I haven’t found what this is summarising. This is despite the recent publication of a 10 year health plan. It’s as if Aboriginal and Torres Strait Islander people will be using a completely separate system – perhaps this is metaphorical offshore processing! There’s no mention of public health (and the fate of public health in Queensland might make us quite nervous), there’s no mention of inequality or social determinants. No thought given to policy on tobacco or junk food. And, of course, no mention of climate change, the biggest threat to publish health there is. It would be nice to see a document outlining the health implications of other policies – the asylum seeker policies, environmental policies, transport policies. I don’t expect to see them.

The section “Targeting Chronic Disease – Diabetes” could act as a microcosm of the policy as a whole. This section reads like a mish-mash of thoughts. Let’s mention e-health. Let’s mention a vague strategy. Let’s put some money toward a cure for type 1 diabetes. There’s no thought to the social context or prevention, no mention of Aboriginal and Torres Strait Islander people, no mention of comorbidities. Being able to mention in the policy last week’s resignations of the National e-Health Transition Authority Clinical Leads either shows the policy is very up to date or cobbled together at the last minute.

I can’t resist quoting Barbara Starfield, with direct relevance to this “chronic disease – diabetes” policy:

Focusing primary care on selected chronic conditions is not likely to improve the health of populations and may not improve the health of individuals in general or just those with chronic illnesses. A more appropriate way to organize care is through person- (not disease-) focused health services that take into account different degrees of “morbidity burden” and different mixes of types of problems in people and populations. As recognized in the 2008 World Health Report, this requires a renewed universal emphasis on primary health care

I haven’t mentioned costings, or where the money is going to come from. I’ve realised that, despite a couple of welcome ideas, I’ve been conned into analysing this as if it was a proper health policy. It’s really a document to be waved about on the campaign trail to look like it is a health policy. For most voters out there, it is just what you’d expect a health policy to look like. It’s not really designed to appeal to those of us who want to actually improve the health of people. Perhaps in the end, the coalition is really not very much different from Labour in “having an approach to health that is much more about politics than policy.”