A health system in crisis presents the new Federal Health Minister with a perfect opportunity for “real change that is long overdue”, writes Peter Breadon, director of the Grattan Institute’s health and aged care program.
Peter Breadon writes:
Australia’s health system is in crisis. Ask any healthcare worker, or anyone who has waited too long to get into a GP clinic or emergency department.
On the surface, the reason seems obvious: we’re living through a once-in-a-century pandemic. Healthcare workers have been working too hard, patients have missed out on important care, and there are thousands of people in hospital with COVID.
But the pandemic isn’t the whole story. Deeper issues have been festering for a long time.
Before COVID, a lot of trends were going in the wrong direction. There were GP shortages in many rural areas, wait times in emergency departments were rising, and so were costs for patients and governments. The Albanese Government needs to address the underlying problem causing all these symptoms.
While most Australians have good health and get good care, our health system looks less and less like the system we need. In a way, we’re a victim of our own success. We’re living longer, but we’re sicker during those extra years. Half of us have one chronic disease and one in five of us have two or more. Those numbers will keep going up. Without real change, a system built for quick fixes, not preventing and managing disease, will start breaking down.
Three areas for focus
Today’s pattern of disease calls for three big shifts.
First, a lot of chronic disease can be prevented. There have been big wins such as vaccination and reducing smoking, but prevention remains a low priority even as preventable disease grows each year.
Second, it needs to be easier for GPs to give people ongoing coaching and support to manage chronic conditions. GPs should be the centre of a care team that brings together the full range of expertise patients need. But GPs are still largely funded and managed as if quick one-off visits are all that matters.
Third, hospital care that can be given safely in people’s homes, community-based clinics, or online, should be moved. It’s cheaper, easier, and safer for patients, and cuts costs for the system. Hospitals could then focus on the most complex care and building a stronger partnership with primary care.
So, will the new government reshape the system?
On prevention, Labor has promised to establish a Centre for Disease Control (CDC), which would look at the full range of preventable illness – not just those caused by viruses and bacteria, but also those caused by diet and lifestyle, for example.
Labor promises to spend nearly $1 billion more on primary care, aiming to increase out-of-hours care, reduce costs for patients, and better manage chronic disease. It has also pledged 50 GP urgent-care clinics to take pressure off hospital emergency departments.
These would be positive steps, but to really change how the system works, the Government will need to go further.
The CDC could bring urgency and focus to prevention of chronic disease by laying out where to focus and what will make a difference. But to stop chronic disease before it starts, there will need to be more funding for prevention, not just a new government agency. Governments spend less than two cents in every health dollar on prevention. It’s not enough.
Investment in primary care will be welcome, but it can’t just be more money and infrastructure on top of a broken model for funding and managing the system. Instead, a clear picture of the system we’re building should guide infrastructure investment, and funding for care should follow need and reward quality and continuity of care.
A daunting debut
The hospital crisis was largely ignored in the election campaign, despite the full chorus of premiers demanding more funding. The former Prime Minister rejected these calls. The new Prime Minister has offered to talk it through, but it will be a missed opportunity if the discussion is just about money. The Federal Government will need to pay more, but this should be part of a new health deal for the nation.
To reduce cost growth and get better results for patients, all governments should sign up to shifting care out of hospitals, and to paying for better care, not just more care. The federal and state governments hold different pieces of the workforce puzzle in training, employment, and regulation. That means they will only be able to retain, expand, and support the exhausted workforce if they agree on a plan to do it together. Likewise, prevention will take shared effort, and the states should agree to coordinate their work with the new CDC.
It adds up to a daunting debut for Australia’s new health minister: a system in crisis, a federal-state stalemate on funding, and COVID cases on the rise again. But it is also the perfect time for real change that is long overdue.
Peter Breadon is the Health and Aged Care Program Director at Grattan Institute. He has worked in a wide range of senior policy and operational roles in government, most recently as Deputy Secretary of Reform and Planning at the Victorian Department of Health.
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