Gavin Mooney, Professor of Health Economics, University of Sydney, writes:
The key to the future of the Australian health service lies with – or ought to lie with – the people of Australia. It is our health that is involved; and it ought to be seen as our health service.
Currently the health service is provider driven; it is largely the values of clinicians that determine how resources are spent. It is with the clinicians that the power over resource allocation and deployment currently lies. Since that is the case, it is not at all surprising, even if worrying, that the cost of the health care sector continues to escalate in what is an unsustainable way.
So what I am looking for from the National Health and Hospitals Reform Commission is not yet another review of the mechanisms of health care as we have had at state level so often, but a recognition that there needs to be a shift in power in Australian health care, in essence to allow the citizens of Australia to have more say in setting the values or principles on which the service is to be based.
Informed citizens here in the West have shown that they acknowledge and accept that resources for health care are limited. They then are prepared to debate what they want and what their priorities are within resource limitations.
Primarily they want greater equity with special emphasis on meeting the needs of Aboriginal people but also higher priority for prevention and public health. They also want more say in how the health service uses its resources and sets its priorities. I have no reason to believe that in these regards they are any different from Australians in other parts of the country.
There are four main considerations that need to be taken into account to move current health care in Australia closer to meeting both the needs and the informed, resource-constrained wants of the citizenry.
First, the management of the health service must reflect better the wishes of the people as citizens and tax payers.
Second, WA (and, I am confident, Australian) citizens want greater equity than the health service currently delivers.
Third, there needs to be a more rational and explicit priority setting system, reflecting a greater acknowledgment that resources are constrained and again based on the preferences of the people, and bringing more transparency to the decision making process in health care.
This will lead to less provider-driven initiatives and to greater priority for community and primary care services and less of a focus on hospitals. In turn this will involve a shift in the power structure within the health care system away from clinicians to the people.
And fourth, there needs to be more attention given to prevention and public health.
Current health care resource allocation is inevitably based on the power structure of the existing Australian health service organisation. As it is now construed, too much power on resource allocation decision making and on priority setting rests with the medical profession and the AMA.
We clearly need doctors at the sharp end of health care and no doubt we have some truly excellent dedicated doctors – and other health care professionals.
We also need doctors’ technical expertise in helping to judge what the effectiveness would be of more resources in screening for breast cancer or of spending more on Aboriginal diabetes or of allocating more resources for palliative care.
Faced with choices between these however, then value judgments are needed. A key point of my argument is that these need to be social value judgments. They are not medical technical judgments. It is about these issues that we need to hear the voice of the Australian citizens.
We as citizens need to have more say in what our health care system as a social institution is to do for us, the Australian community.
Will the NHHRC go down this road and address these power issues? Well it is nice to dream occasionally…
* This article is based on a longer paper.