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Kellie Bisset’s insightful analysis of election health policies (don’t miss this piece)

In part 3 of Croakey’s election series, Kellie Bisset, the Co-Editor of Medical Observer, writes:

What a grand vision it was: to reform the health system, end the cost shifting blame game and bring about a healthier Australia.

Perhaps, after all the Labor reform rhetoric and the excitement over the possibility of real change, disappointment was inevitable.

On a positive note, we have had a vigorous Labor-led reform debate and a Government at least prepared to talk about the big picture.

But what are we left with as we head to the polls?

• A reform process that left us some new names – Local Area Hospital Networks and Medicare Locals – but no clear mechanism for how they will work together to achieve better integration of patient care.

• A $436 million Diabetes Management Scheme surrounded by big unanswered questions, and major concerns expressed by GPs about what appears to be an attempt to categorise and fund patient care based on disease state. Will whole patient care be the casualty here? The lack of information around the mechanics of the scheme makes it hard to determine whether it will address the acknowledged problem of fee-for-service being inappropriate for chronic disease management. GP hostility to this scheme is so intense that its chances of succeeding in its present form are doubtful.

• A lack of obvious commitment to truly reforming the Medicare Benefits Schedule to better reward longer consultations – associated with better health outcomes – and to address the issue of increasing gap payments faced by patients.

• A lot of groundwork on preventive health but not much to show for it yet. Much seems to be resting on the National Preventive Health Agency, still stuck in the Senate. Attempts to address medical workforce barriers to preventive health by spending $390 million on general practice nurses sound good in theory – but a significant number of GPs say the way these incentives are structured could actually see them losing money – and employing fewer nurses as a result.

• Glacial progress on e-health. Yes, the Healthcare Identifiers Bill has passed the Senate but so far much of the discussion has been around the personalised electronic health record as the e-health Holy Grail. The Government has committed $466 million to develop a personally controlled health record but what about a broader policy on connectivity? Where’s the grand plan for e-health? Are we expecting personalised health records to solve all our problems and if so, is this wise? There are still many questions around how patient content and clinician content will be delineated in these records – and whether doctors will trust and use the information recorded from other clinicians.

• A possible aversion to evidence-based health policy. Why tie welfare payments to the Healthy Kids’ Check that experts say is not backed by evidence? This has been known and discussed for some time. Doesn’t look like the Government has been listening.

• A super clinics policy designed to encourage a community approach to multidisciplinary care, but which is battling opposition from many local GPs, who perceive the clinics to be in competition because they have been inappropriately located. Why have most of the clinics involved a bricks and mortar approach rather than virtual linkages between services as favoured by the National Health and Hospitals Reform Commission? The Government has agreed to boost existing primary care services with $335million in infrastructure grants but much of that money pot will be allocated to new super clinics rather than expanding what we currently have.

• A nod to the incredible burden of mental illness with $277 million in funding but, according to those in the field, no real boots and all commitment.

And what of the Coalition alternative?

The major question here is whether the Coalition’s series of announcements constitutes a health policy. Where is the bigger picture? What is the main thread drawing all this together? We know what government programs they’d scrap, but what’s their vision for the future?

• The announcement that a Coalition Government would freeze the existing e-health program is astounding. Yes the $467 million saved will be spent in areas such as mental health, which is in dire need of a decent funds boost. But the care integration fostered by a functional e-health system is vital to all patients, including the mentally ill, who so often fall through the system’s cracks. Tony Abbott has in the past said e-health is a crucial piece of reform. But let’s not forget that in 2005 as Federal Health Minister he let Healthconnect lapse – the $128million plan to drive national electronic health records, replacing it with NEHTA, recently described to Medical Observer as “Never Ever Having to Achieve”.

• A tick for recognising that long consults are penalised under Medicare and an extra $350 million to fund them. But there’s no detail on how much extra per consult this will represent, no acknowledgement that the Medicare Benefits Schedule needs more wholesale reform, and no commitment to proper indexation of the Schedule. This indicates increasing patient gaps would remain a serious issue.

• $200 million for general practice infrastructure grants will find favour with GPs, many of whom will prefer this approach to a super clinics policy.

• There’s $90 million to establish local hospital boards and a commitment to funding a set proportion of the “efficient cost” of public hospital services. There’s also support for a casemix funding model.

But what about the yawning chasm between primary and hospital care and the need to not only integrate them but focus more heavily on primary care prevention initiatives?

Is the Coalition planning on ignoring the past two years of reform discussion? This would be a great shame.

How will we position ourselves for the future to cope with serious looming health challenges if we keep lurching from one day to the next?

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