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How can we ensure a sustainable health system? Plus recent articles on surgery waiting lists, e-health and gambling reform

The Commonwealth Parliamentary Library’s FlagPost blog has published a number of articles recently that may be of interest to Croakey readers – on health expenditure, elective surgery waiting times, e-health and gambling reforms. More info below…

What is the most effective and fairest way of keeping a lid on health expenditure?

Anne-marie Boxall writes:

The sustainability of Australia’s health system is becoming a key concern for Australian governments, along with those in many other advanced economies.

But, with growing demand for high quality health care, an ageing population and rapid advances in medical technology, what can be done to keep a lid on health expenditure?

This recently published Research Paper outlines the key mechanisms the Australian government has to control health care spending, and it proposes some potential options for reform.

In a recent speech on the sustainability of the health system, the Finance Minister, Penny Wong, highlighted the problem policymakers now face: health care expenditure is projected to continue to rise, but the pool of taxpayers is shrinking.

According to The Treasury’s 2010 Intergenerational Report, health care will consume about two thirds of the projected increase in government spending over the next 40 years if current trends continue. Clearly, this is not going to happen because changes will be made. But what changes?

Slowing the growth in health care expenditure is not easy (this earlier Flagpost points out some of the challenges). Governments, however, do have some tools at their disposal.

They can:

· ensure governments fund only the highest quality and most effective health care interventions (this involves comparing different types of treatments for the same condition and ‘de-funding’ treatments found to be relatively ineffective);

· pay health care providers in different ways (there are various options, but experts consider that paying salaries, applying strict budgets and paying providers a set amount for each patient under their care are some of the best ways of containing expenditure);

· impose some costs on individuals (there is a major downside to this if it means people do not use necessary health care services when they need them);

· exert greater control over the capacity of the health system (for instance, the number of health care facilities and health professionals); and

· stimulate competition between the public and private sectors (however considerable care needs to be taken that competition does not add to costs and compromise quality).

All of these tools are currently used in Australia to control the growth in government health expenditure, but some are relied upon more heavily than others.

Successive governments have tended to rely heavily on co-payments – imposing costs on individuals – to control expenditure growth.

There is growing evidence that this is detrimental for many people on low incomes, who, incidentally, often have the greatest need for care. For this and other reasons, a high level review of Australia’s co-payment policies appears justified.

At the other end of the spectrum, governments have paid relatively little attention to the way decisions about major health infrastructure (for example hospitals, primary health care clinics and diagnostic imaging machines) affect the growth in health expenditure.

At present, there are multiple funding processes in operation, making it difficult, if not impossible, to monitor the overall impact health infrastructure decisions have. This is another area ripe for reform.

The reform agenda ahead is challenging, there is no doubt. But as Minister Wong explained in her recent speech, ensuring we have strong and sustainable health system ‘demands that we look ahead – that we consider how today’s priorities shape tomorrow’s future.’

It requires ‘making the right choices now, [so] we can ensure that future governments continue to provide the level of health care Australians deserve.’

***

Other recent FlagPost blogs that may be of interest:

Reducing elective surgery waiting times – is more money the answer?

By Rebecca de Boer

Considers the recent COAG Reform Council Progress Report and highlights that despite additional funding, long waits for elective surgery has increased since 2007-08.

***

Stalemate looms over closure of chronic disease dental scheme

By Amanda Biggs

Examines the likelihood of the chronic disease dental scheme being closed (although was written before the MYEFO – cuts to health spending speculation intensified)

***

The e health revolution – easier said than done

By Rhonda Jolly

E health is seen by some as possibly the most important revolution in healthcare since the advent of modern medicine.  E health makes use of developments in computer technology and telecommunications to deliver health information and services more effectively and efficiently. As such, it requires a different and radical way of thinking about the delivery of health services.

Since the 1990s, the potential of e health has been discussed globally, but it remains a work in progress everywhere, albeit that some countries have had more success instigating measures than others. There are many reasons for the slow adoption of e health. These include: the fragmented funding and governance of healthcare services, resistance of professions to changes in existing models of care, a lack of rigorous research evidence on the benefits that might drive change and a reluctance of politicians to be seen to be tampering with a politically-sensitive service. There may also be concerns about the costs and complexities associated with e health implementation and the need to resolve issues about how it will affect practitioners and consumers alike.

This research paper does not attempt to discuss all the aspects of e health in depth, for the subject is extensive, both technically and in policy terms. The paper provides instead an introductory overview of some of e health’s critical aspects. In so doing, it looks briefly at certain aspects of the overseas experience of e health policy development and considers some practical application case studies. For the most part, however, the paper concentrates on the evolution of e health policy in Australia.

For Australia, e health holds great potential in many areas, such as resolving the tyranny of distance or reducing the costs associated with caring for an ageing population. This notwithstanding, policy makers have discovered that there are many obstacles to developing national e health policies and programs. Some of these have been resolved; others persist; still others are only just beginning to emerge.  While the paper discusses most of these in a broad context, it also focuses on particular issues, such as concerns about how e health will affect patient privacy.
The paper concludes that e health does indeed have great potential, but harnessing that potential has, and continues to require finding and negotiating a delicate balance between many interests and issues.

***

And two papers by Amanda Biggs that investigate gambling reform:

 How many venues would be affected if mandatory pre-commitment is implemented in 2012?

Is counselling for pokie addiction an effective harm minimisation measure?

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