COVID is putting health systems and workers under extraordinary stress, but is also creating a powerful opportunity for long overdue health reform.
Leanne Wells, CEO of the Consumers Health Forum of Australia, puts the case for real reform, ahead of a deadline of 9 November for submissions on the Consultation Draft of the Primary Health Care 10 Year Plan.
Register here for a CHF webinar on 26 October from 12 noon AEDT on primary healthcare reform.
Leanne Wells writes:
The COVID pandemic has made even more stark the signs that our health “system” is faltering and that change is needed if Australia is to continue providing quality care for all.
Australia’s recent experience with the pandemic shows that it is not necessarily money, or lack of it, that can be linked to success or failure of health services. How we organise and manage those services can be vital.
Take some examples from recent experience that have shown the fragility of the current state of affairs in health: the often-fatal failure of many aged care homes to protect residents against the pandemic, the incidence of non-communicable chronic diseases among patients with COVID, and the problems with equitable access to vaccinations.
And let’s not forget the insidious and emergent worry about the mental health impacts of the pandemic and the calls for more responsive care. These are among indicators suggesting inherent problems that come from deeper, existing causes than from COVID alone.
As the Australian Health and Hospitals Association stated recently, Australia’s response to COVID-19 has demonstrated how health care has the potential to strengthen systems resilience and tackle threats to population health, but it has also been a catalyst exposing the slow erosion of Australia’s universal health care system, with vulnerable populations being disproportionately affected by the pandemic.
This is a point CHF’s 2020 Consumer Commission made in their report Making Health Better Together.
Deeply flawed
A central problem is that once again Australia’s national health arrangements are shown not to form a coherent “system” but rather a collection of discrete, sometimes rival state entities overlaid by an only partially effective national leadership.
The latest debate between Federal, State and territory governments over hospital funding highlights once more the deep flaw in the national health system.
The rights and wrongs between the different levels of government over which side is paying its share and which isn’t are not simple to adjudicate, which itself points to a fundamental weakness.
In the latest round of the argument, the Federal Government has asserted that its hospital funding has risen by 70 percent since 2013. That’s a hefty hit, although explicable in the past 18 months at least given COVID’s extraordinary call on national budgets.
However, over the period between 2013 and 2018, the latest year for which figures are publicly available from the Australian Institute of Health and Welfare, the federal share of public hospital funding never rose above 45 percent.
That is in line with the longer-term funding arrangements for public hospitals with the states always taking a larger share of the burden.
The Federal Government’s role is to finance through Medicare the medical services provided outside hospitals.
It is these funding fault lines between the Commonwealth and states that complicate and obstruct the development of effective and efficient services.
In simple terms, there are not the funding incentives to drive community wellbeing and comprehensive health care in the community that would in turn ease demands for costly hospital care.
Drop the blame game
The time for the blame game between different level of government has well and truly passed.
A good start would be for the Federal Health Minister Greg Hunt to put in place and fund the development of a comprehensive primary care plan to match his pledge of a ten-year strategy. The signs here are promising with the recent release of a draft government response to the recommendations of the 10 Year Primary Health Care Plan Steering Group.
A more cohesive “system” to provide for the prevention and care of widespread chronic conditions like diabetes and cardiovascular conditions often caused by poor diet and low exercise would pay great dividends for the nation’s physical and fiscal health.
As an example, potentially preventable hospitalisations occupied almost three million bed-days in 2017-18, at a cost of many millions.
The President of the Australian Medical Association, Dr Omar Khorshid, has called for a big funding boost to meet the soaring costs in hospitals. He suggests that some of the solutions to meet the health and costs challenges are going to revolve around innovation – using GPs to prevent hospital admissions, and working out how we can use the primary care networks to monitor COVID-19 patients in the community and to help look after them without them having to go to hospital.
And he has said probably the most important starting point is to go back to the patient, to the average Australian, who wants to know that there’s a public hospital bed available for them if they get sick in the next couple of years. Whether it be with COVID or with some other medical condition.
We would agree that it is vital to start with the patient and consumer, to support them in being more partners in health care with their doctors.
A more comprehensive primary care system where patients and their carers are at the centre of care, particularly in chronic care cases requiring a variety of specialist health professionals will require significant changes in organisation and financing. Better engaged patients will tend to experience better health outcomes with longer term savings to health costs.
We have seen during the pandemic how shape-shifting change can come when the benefit to patients and doctors are clear and given the right support. That was telehealth, an option that has been possible for years but needed the right environment.
The right environment for even bigger scale change is now when circumstances and advances such as in digital technology can ease the way to more targeted and accessible care.
Leanne Wells is CEO of the Consumers Health Forum of Australia. Follow on Twitter.
Further reading at Croakey
Behind the headlines on hospital funding, some uncomfortable truths
See Croakey’s archive of stories about health financing.
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