Part 8 of Croakey’s series on election policy comes from Professor Andrew Tonkin, head of the cardiovascular research unit at Monash University, and a longstanding contributor to national health policy.
He outlines the big picture issues that matter in health policy, which can become lost in the narrow focus of electioneering.
Andrew Tonkin writes:
Quality, access and affordability are the key elements by which healthcare should be judged. Considered in its entirety, Australia has one of the highest quality healthcare systems in the world, our average life expectancy being among the longest.
However debate, including at election time, should focus on those strategies which can address inequalities associated with barriers to access, and affordability.
All Australians should be entitled to quality health care, but there are clear access barriers for large segments of the population. Specific strategies are needed for the 30% of Australians living outside our major cities, and for those who are disadvantaged, including Aboriginal and Torres Strait Islander people and those from diverse ethnic and cultural backgrounds.
Certain disease areas need particular attention. However there are many underlying health determinants which are common across multiple chronic conditions. These frequently co-exist and together account for more than 70% of Australia’s health burden.
Affordability can be applied both to the perspective of individuals and to our society. Even in Australia, medical care may not be sought or many proven treatments not taken because their costs are considered to be prohibitive by individuals. Appropriate Medicare rebates and subsidy of pharmaceuticals which can prevent medical problems and hospitalisation make sound economic sense.
Injection of a bolus of funds into specific areas is a constancy amongst political parties. Rather than the allure of such cost injections, it is much more important that strategies and investments are considered to be “affordable” based on their benefits relative to their costs.
Stated party policies often focus on individual components of our system. These include hospital care and extra beds which can alleviate waiting lists, and enhanced capacity in the general practice environment, including nursing and other healthcare professionals. Such investments in capacity are easily understood by the electorate and are important.
However, by themselves their impact is limited if they are not accompanied by systems to support the transition between the hospital and community environment. Navigation between these components is very difficult for many patients. The necessary tools include appropriate information management systems. Their funding would almost certainly be offset by gains from more effective implementation of proven management approaches.
System reorganization is particularly relevant at a time when public hospitals are funded by the States and Territories and general practice, pharmaceuticals and other treatments by the Commonwealth. A healthy private system is important as an available choice and also relieves pressures on the public system.
Investment in prevention of ill-health is not a glamorous vote winner. It can also be too easily “privatised” by governments who simply transfer the responsibility to (frequently disadvantaged) individuals. Any reasoned approach must include a commitment by government to implement population-wide prevention strategies.
The rhetoric of governments in this area has not been translated to its great potential.
Intersectoral approaches involving not only treasury but portfolios such as education and industry as well as health should now be introduced to address the fundamental determinants of individual and Australia’s well-being.
To see the previous posts in the election series: