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Is the Govt retreating from serious health reform? Ian Hickie

Are we on the verge of real health reform?

We’re not even close – and if you’re expecting anything meaningful to happen before 2020, you’re just not paying close enough attention.

That’s  the assessment of Professor Ian Hickie, executive director of the Brain and Mind Research Institute at the University of Sydney.

And he thinks the Federal health reform bandwagon now visiting a hospital near you is just a distraction from the main game.

He writes:

“As I’ve expressed in an editorial in next week’s Medical Journal of Australia, this ‘consultation’ process is a major distraction.

What is clear is that the Government (assisted by the final report of the National Health and Hospitals Reform Commission) is rapidly retreating from any serious reform agenda.

Medicare Select, the reform previously known as ‘Option C’ (i.e. competitive national social insurance) has been sent to the back-blocks of Woden for a well-earned period of long-service leave. Regional health providers (Option B) are not on the agenda either.

Inevitably, a future (and somewhat braver) Government will be forced to revisit the issue of genuine health reform (in about 2020). At that time it will dust off the NHHRC interim report and have another look at a
financing system that had some real chance of changing the way that health care is delivered in this country.

In health, as in most human endeavours in the modern world, you get the health care system you pay for. If you pay for disconnected services, a narrow focus on acute care and one-off (i.e. fee-for-service) procedures
and other interventions – then that is what you’ll get.

The really neglected areas of chronic disease management, dental care, mental health, indigenous health, youth health and coordinated aged care will remain at the bottom of the pile.

The Government has already demonstrated its real (political) priorities through its major new investments in acute care hospitals, cancer care and reducing surgical waiting lists.

While the major economic stimulus package prioritised the retail sector (do we really need two plasma screen TVs in every Australian home?) and basic educational infrastructure, the health services and medical research sectors were obviously low priorities.

In the meantime, this round of hospital-centric public relations events will keep everybody chattering till we all quit for Xmas.

Clearly it is designed principally to soften us up for another round of public ‘hospital’ reform (i.e. senior Woden officials telling the States to get their act together).

Any one who has sat through “the (powerpoint) presentation’ that goes with these hospital-based events will realise rather quickly that we are not on the precipice of major ‘health’ reform.

There is no serious discussion about changing how the money flows or opening up the sector to a new breed of regional or national health care providers.

The most likely outcome for the post-2010 election period is some more money, a lot more talk and the same old divided Federal-State delivery system.”

Comments 3

  1. jeebus says:

    The state of dental care in this country is abysmal. I don’t know how they can get away with charging $2,000 for a root canal procedure. Even a decent level of insurance won’t cover 50% of that.

    Perhaps I am slightly embittered by my recent personal experiences – after a botched first attempt by my dentist, I was forwarded ($300 later) to an endodontist who was also unable to complete the procedure, but let my wallet $400 lighter because he decided to take copious amounts of unnecessary x-rays throughout the procedure. He then shunted me back to the original dentist for a tooth extraction that cost hundreds more.

    Unless the government can find a way to reign in the hyper-inflated fees and dodgy practices, our local industry can go to hell for all I care – I’m taking up the glowing reports from my friends and getting any future work done overseas for much cheaper, with a holiday thrown in to boot.

  2. Ian Haywood says:

    The Government may have a good reason to hesitate. Both options B and C involve constructing a very expensive bureaucratic layer over the current primary care system, the essential difference between them is whether that structure is in private or public hands.
    Both are very twentieth-century solutions, the existence of a shared health record through the Internet may make this bureaucracy unnecessary to providing co-ordinated care.
    Another point is a very practical implementation one. In the public mental health system o patients are required to turn up to services through the mental health act, and doctors through the College training requirements, it doesn’t matter how dysfunctionally they are managed.
    In primary care neither control lever is available, so it’s unclear how a new system would survive in the medical labour marketplace: private clinics could always pay higher salaries as they don’t have to support the multidisciplinary team and the 10 layers of managers that go with it, and primary care patients are all voluntary, even the psychotic ones: you can’t stop them from following their doctors into the private sector.

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Australian Palliative Care Conference
2018 conferences
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