It’s looking like the Feds are going to dodge decisive early action on health reform, warns Dr Lesley Russell. who argues the US experience has some lessons for Australia. She writes:
“What does the final report from the National Health and Hospitals Reform Commission (NHHRC) tell us that we didn’t already know? What does the report recommend that has not already been discussed? The Government waited for this report for 18 months, only to tell Australia that key decisions on health care reform will not be made until next year.
We have known for years that more needs to be done in preventive health and improving access to primary care, e-health records are necessary to prevent errors and duplication, dental services are unaffordable for many Australians, tackling medical errors saves lives and money, and different funding responsibilities will improve the integration of acute and community care services.
Now we have one more report on these issues. Taking the positive approach, it’s useful to have an up-to-date analysis in a report that the new government can own, and hopefully this will serve as a common rallying point for moving forward.
However, on the negative side of the ledger, a signal has already been sent by the government that health reform is not on the fast track, and by design, this report has managed to avoid a key issue in health reform – the role of private health insurance and government support for that role. It also barely tackles a second key issue – the rapid growth in patients’ out-of-pocket costs – which affects affordable and equitable access to care.
In comparison to the US, Australia can tackle the reforms needed to give the nation the health care system it needs for the 21st century with some considerable tools already at hand. For example:
• Australia has universal health cover and health care costs are not orders of magnitude higher than those in other developed countries.
• Most Australians have a regular practitioner who can serve as the coordinator of their health care services – the ‘medical home’ that has been shown to be essential for integrated care, access to screening services, and addressing health inequalities.
• Australia has integrated cost-benefit analysis into its procedures for assessing what pharmaceutical benefits should be available and to some extent, what medical benefits should be covered. In the US, the term ‘cost effectiveness’ cannot be used without raising the spectre of the government intervening between the doctor and the patient.
However the US has a different arsenal of innovative tools to help drive health reform, and Australia could adopt some of these now, without any further delays. For example:
• The US has better (and independent) data collection, analysis and public reporting systems. These include statewide systems that report medical problems in hospitals, and a national system of registration for doctors that must be checked at the time of employment. The new health care reform legislation will require mandatory reporting by doctors of relationships with pharmaceutical and device manufacturers and financial interests in hospitals, and by hospitals and ambulatory surgical centres on health care associated infections. The House bill establishes a national medical device registry to facilitate post-marketing analysis if safety and effectiveness, and a new position of Assistant Secretary for Health Information.
• The US has committed to substantial investments in public health, with funding support for the establishment of a public health workforce corps, training programs, research and infrastructure, seeing this as a required foundation for better preventive and primary care.
• Health care funders and providers are already well down the road towards recognition that fee-for-service rewards activity and not outcomes. The best examples of quality care in the US are in places like Rochester, Minnesota, Grand Junction, Colorado, Seattle, Washington, or Durham, North Carolina – all of which have world-class hospitals and costs that fall below the national average. In these communities doctors are financially rewarded for totality of the care they deliver and the health outcomes that result. And perhaps more importantly, this is the accepted and prevailing culture among health care workers and their patients.
Roxon and Rudd now have a choice – to move forward and use the NHHRC report and its findings to strengthen their hands against those who would oppose their actions, or to prevaricate and hide behind the options the report puts forward.
Initiatives of the type outlined above and many of the important recommendations from the NHHRC report do not require a major restructure of the relationships between the commonwealth and state and territory governments, and they should not be held hostage to COAG agreements.
Health care reform is not easy. Just ask President Obama. But doing nothing is not an option, and tomorrow is not too early to start on implementation.
• Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney / Australian National University and a Research Associate at the US Studies Centre, University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington DC.