“The unbearable weirdness of healthcare” was the title of one of the first slides shown at the 8th National Reform Summit in Canberra – by Ian McAuley of the Centre for Policy Development.
As Australian Health Care Reform Alliance (AHCRA) chair Jennifer Doggett later commented, this title reflects many peoples’ experiences of health care, as the system is failing us both individually and collectively.
But the catchy title was also a reminder of a key challenge for health reformers – how to better communicate with politicians and the general public about their concerns, as well as the solutions.
As one tweep commented, “The Department of the Social Determinants of Health doesn’t really roll off the tongue.”
However, it seems that Catherine King, the Shadow Minister for Health and Medicare, has at least taken on board the importance of a health in all policies (HiAP) approach:
Another key takeaway was that so much can be learnt from Aboriginal and Torres Strait Islander people’s understandings of health, as well as from the Aboriginal community controlled health sector, including the importance of centring relationships and action on the social determinants of health.
Below are some reflections on the main takeaways from the discussions, which were informed by the conference theme Equity, Efficiency and Sustainability. A selection of key tweets and #AHCRA2018 selfies follow.
“People want health, not healthcare”
Jennifer Doggett, AHCRA chair, contributing editor at Croakey
The ‘unbearable weirdness of healthcare’ reflects many people’s experience of health care. The health system fails people and fails us as a community.
People want health, not health care.
Universality as a core principle should guide all our health reform efforts.
Lived experience of health care, people’s stories are vital to informing what we know about what works and what things should look like.
Health reform needs to be centred on consumer needs and priorities and driven by consumer engagement and relationships. Consumers and the community need to define what they mean by health – this is not the same as what health professionals, policy makers and ‘experts’ want from health.
Reform is difficult – not because there is a lack of solutions, data or evidence but because reform threatens existing power structures, and change is confronting.
Part of reform is re-imagining what we mean by health – as a well-being model centred on the social determinants of health.
Advocacy is a key component of reform. This requires ongoing sustained and collaborative efforts, via the media, politics and the bureaucracy.
Some ‘no brainers’ include: getting rid of fee-for-service, private health insurance, and getting care out of hospitals wherever possible.
We need an explicit conversation about equity and social justice. We need to accept that delivering equitable care is expensive and that there sometimes needs to be a trade-off between equity and efficiency. We shouldn’t be afraid of this.
We can learn a lot from Aboriginal Community Controlled Health Services in terms of integration, relationship-driven care, moving beyond fee-for-service, addressing the social determinants of health etc.
Improving health literacy is a key issue.
There is a key role for AHCRA in driving the health reform agenda.
We need a long-term vision plus shorter-term interim goals. We won’t get there overnight and radical short-term changes frighten politicians. We need time to build confidence in the public system.
It’s our time to make a difference.
Three key issues: consumers, cash and causes
Aram Hosie, Executive, Public Affairs, at cohealth
“The unbearable weirdness of healthcare.” So opened the Australian Health Reform Alliance’s 2018 Summit. Australia’s health care system – if we agree to call it a system – is a strange beast.
Our gross indicators (such as life expectancy) tell a promising story, and there are many things we do well.
And yet other aspects of health care in Australia desperately need fixing, whilst still others are so broken as to be beyond all repair.
As with so many areas of public policy, there is no shortage of research, evidence, and international best practice available to inform the kinds of reform needed to create a health system that truly serves Australia’s health needs.
From today’s discussion there were three key priorities that particularly stood out for me: consumers, cash and causes.
Our future health system must be consumer focused and driven. We need to focus on people (less so sickness and disease types) and ensure consumer participation and codesign.
On the cash front, reforms are needed to health financing – both in terms of how we fund services, and the relative allocation of financial resources.
Working within a community health setting, I am especially keen to see an equity lens applied to Medicare item numbers and rebates, taking into account social complexity and providing funding for the required level of support and intervention required.
And wrapped around and under everything we do, we must seek to address the causes of ill-health and health inequality – the social determinants of health, and in particular issues relating to income, welfare and poverty.
Knowing what needs to be done, the challenge is one of implementation.
As a sector, our challenge is to find effective ways to communicate about and advocate for our ideas. Our decision makers, meanwhile, need to find the political courage to act.
Be brave
Frank Meany, One Vision
The main take away was that governments need to be brave and step up to the difficult job of funding the health sector as a whole system, instead of silos and segments and quarrelling over who does what.
Independent body needed
Annette Panzera, Director of Health Policy at Catholic Health Australia, and Executive Member of AHCRA.
The current political environment sees the health sector needs ebb and flow with political and vested industry interests.
For real and enduring reform to come into effect, we need a strong independent body with a systems perspective to implement health reforms to direct the planning and financing of health services.
In establishing this body, politicians should be mindful to embed the architecture permanently into the health system. In seeking to advocate for equitable health outcomes in our system, a ‘health in all policies’ approach is needed which strategically works across all sectors to address the social determinants of health.
Poverty, remoteness, housing, education, Indigenous or ethnic status, workforce and other factors all impact on the health status of individuals and communities. If we can communicate the impact of the social determinants of health through an economic lens, we can engage government and other stakeholders across all sectors to be able to effect change.
Health justice partnerships – a useful model
Tessa Boyd-Caine, CEO, Health Justice Australia
Key messages: Firstly, the lack of a clear system driver is the main barrier to reforming Australia’s health system; ie the range of funders, policy-makers, providers and data sources/researchers don’t come together to work towards a shared outcome/s such as equity of access.
And that underpins the second key message – that the health system is still a long way from being focused on people’s needs, in all their diversity.
We see that everyday in HJAs work, building health justice partnerships between health and legal services so that they’re better able to respond to the many different issues that effect people’s health.
These issues might be straightforward problems like mould in public housing driving respiratory problems or debts that create anxiety and prevent people meeting their health costs.
The health system has become good at recognising the underlying causes of these problems. Through health justice partnerships, we’re now providing the health system with the levers to fix those problems.
We’re also working on more acute problems such as poor mental health, drug and alcohol dependency or family violence that result in children being removed from their mothers at birth.
Health justice partnerships are enabling us to provide opportunities for early intervention, working w those parents to create a safe, health environment at home for them and, critically, their children.
These partnerships have been practitioner-led in the absence of a systemic approach to integrating services around community needs – but Health Justice Australia is working to build that systemic approach now.
Transforming the narrative
Dr Tim Senior, GP and Croakey contributing editor
A “weird industry”
Ian McAuley, Centre for Policy Development
Encouraging advocacy
Catherine King, Shadow Minister for Health & Medicare
And other tweet reports
Professor Sharon Friel, Professor of Health Equity, Australian National University
Andrew Wilson, Professor and Director, Menzies Centre for Health Policy, University of Sydney
Martin Laverty, Royal Flying Doctor Service
Emeritus Professor John Dwyer, AHCRA founder, Emeritus Professor of Medicine UNSW
Jane Hall,Professor of Health Economics and Director of Strategy, Centre for Health Economics Research and Evaluation, University of Technology
Professor Nick Graves, Academic Director, Queensland University of Technology
#AHCRA2018 selfies and snaps
Warm thanks to all tweeps
*** This post was updated with more tweets on 28 March ***
