The cry of “nanny state” is often used to oppose public health measures that are in the public interest but threaten powerful private interests.
Perhaps the cry of “class warfare” falls into the same category when it comes to social reforms that are in the broader public interest.
That is one question arising from suggestions the Government is unlikely to act on Gonksi’s recommendations for a more equitable, rational basis for funding schools, for fear of being accused of “class warfare”.
As Stephen Long, the ABC’s economics correspondent, wrote at The Drum: “The sad truth is that the “class warfare” is being waged in the opposite direction – as public money disproportionately subsidises wealthy schools, while the disabled, the disadvantaged, and sons and daughters of low-to-middle income earners are left to languish in underfunded schools denied a fair share of the pie.”
But education reformers have at least one advantage over their counterparts in health. Health reform advocate John Menadue has been arguing for quite a while that one of the reasons for the failings of health reforms to date is that they have largely been driven by health industry insiders.
Perhaps we would be in a different place today if there had been Gonski-style leadership of health reform.
In the article below, Carol Bennett, CEO of the Consumers Health Forum, argues that the health system has much to learn from Gonski’s recommendations.
The health system needs a Gonski
Carol Bennett, CEO of the Consumers Health Forum, writes:
From a public health perspective, the Gonski report provides a completely different lens through which to view, measure and fund service systems.
It is a view that is almost completely counter to the way governments and policy makers currently approach health systems.
The most fundamental difference is that Gonski begins with a focus on student achievement or real education outcomes.
In health, we are still stuck trying to look at throughputs and costs – an almost entirely provider focused approach where actual health outcomes are not even measured.
We are trying to run the system more efficiently, but take no real account of health outcomes.
Gonski looks at funding allocation that addresses a wide-range of social determinants and barriers to educational achievement including English language proficiency, indigeneity, location, disability and special needs, and disadvantage such as socioeconomic status.
In health these variables are not even factored into many of the system incentives and payment approaches.
A GP is rewarded for seeing more people – more consultations – rather than seeing those most in need. Whether a consultation or specialist procedure actually achieves health benefits is not even measured.
Equally Gonski considers the role of support provided by families, parents, communities and other institutions as partners in the education process contributing to real outcomes – i.e. student learning.
In health care we struggle to get the various body part specialist to even establish linkages with community support options, let alone take into account the role of carers, families, employers and others who often determine how our health issues actually impact on our lives.
The Gonski report does something for education that no report into health has done in the last 30 years – it takes an outcomes approach that places students at the centre of the system and considers how best they learn and achieve. It then talks about how the system can best service the needs of students.
Whether or not you agree with the Gonski recommendations, the approach is to be commended.
In health we spend most of our time tinkering around the edges of a system based on a mixture of crisis intervention and throughput driven incentives with no measures of real health outcomes or patient experience of care.
The unfortunate reality is that those who benefit most from the existing system are the ones who seem to have the loudest voice in health policy making.
Until health adopts a more Gonski like approach, our policy discussion will continue to be dominated by vested interests who have become very effective at resisting any change that might diminish their income or their role.
The hardest policy battles are about trying to work out how to retro fit new parts onto the existing system (like ehealth) and any discussion of improving health outcomes or the needs of health consumers is largely treated as decorative rhetoric.
Taking a Gonski approach would mean we put health and the needs of health consumers at the centre of health system design. If only!
Agreed. The difficulty is, in both health and education, overcoming the systemic inertia that protects the “status quo” before the real reform can start.
Agreed also. And putting ‘health outcomes’ at the centre of health funding, would bring Australia’s newly privatised health sector under some much needed scrutiny. How many people realise that private patients frequently end up in their GP’s office needing the extensive support and follow up that public patients take for granted? Private doctors can indulge in outdated practices like refusing to education their patients, leading to high rates of drop out of treatments and increased risk of disease relapse. High rates of post procedure infections and poor control of side effects of medical treatments like chemotherapy are common by products of poor nursing care by unsupervised and unqualified nursing staff in many private hospitals. An open debate of health costs paid by tax payers for actual quality of care received by patients, would be very embarrassing to many (newly) wealthy private doctors. And also very timely. http://www.cancerquestions.com.au