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Let citizens’ juries loose on the NHHRC recommendations: Gavin Mooney

Gavin Mooney, Professor of Health Economics, University of Sydney, writes:

Following on from my prediction of what would NOT be in the NHHRC’s interim report (see earlier Croakey post below), I was unfortunately right – even if some of the proposals, especially on one-stop shops for primary care and improving equity, are good. But is is pretty timid stuff as Ian McAuley has already written.

There is, in particular, no attempt to address the power of vested interests, in particular that of the AMA.

The idea of the Commonwealth taking over more of primary health care makes some sense . It would make even more sense if the Commonwealth were to take over the whole ship. Patients really do not give a damn who provides their care as long as it is provided seamlessly, efficiently and humanely. The current split and what it would look like if the NHHRC proposals were implemented certainly get in the way of the first two and sometimes the last.

Having the Commonwealth taking over all care but the services run by about 20 regional authorities round the country would be a much better way to go. Apart from anything else we might then have some good public debates about what the Australian public want by way of principles and values and priorities
instead of the very often distressing and unhelpful endless debates about mechanisms, who pays, who should have paid and who hasn’t got what.

The review represents experts’ views. Of course experts have a legitimate role to play in such deliberations but what is needed now – and is missing – is for the NHHRC to say: “OK we have got this far. Now we want to find out what the ‘ordinary’ people of Australia as citizens want from their health services. We
will set up a series of Citizens’ Juries across the country, say 20, with 15 randomly selected citizens in each of these in each of 20 regions/areas. They will be presented by experts with information on key issues of the report and have the opportunity to quiz these experts. They will then be asked to deliberate on
these proposals and come up with their recommendations and priorities for action. There might then be a ‘National Summit’ of selected jurists.”

Instead the report (p 288) recommends “Democratic participation” which they define as being “based on individual and collective participation in decision making. Strategies include: consultation; involvement in decisions; the use of personal health records; representation; consumer membership on decision-making
structures; consumer advisory structures; and accountability to consumers.”

There is a confusion here. Democracy is about citizenship and not consumers whether it is consumer membership or consumer advisory  structures or accounting to consumers.

Is my proposal simply a 20/15 process replacing the “2020 Summit”? No, it is to get informed citizens involved whereas the 2020 Summit was largely the ‘in-crowd’ who already have a say having a yet more formal structured say.

These citizens’ juries in health have been tried a few times here in the West and also once in South Australia – and they work!

Citizens have no problems in accepting that resources are scarce. They are much more interested in prevention and community care than hospital care. Indeed in all seven juries that I have been involved in, not one has given priority to hospital care!

Yet at least here in the West what do the AMA call for?  More and more beds! And with a clinician as Health Minister and a clinician as DG for Health, what are we likely to get? More and more beds!

The other thing that citizens are strong on is equity – and the vertical equity that the NHHRC has called for i.e. positive discrimination for those worse off such as Aboriginal and Torres Strait Islander peoples and those who are poor or mentally ill.

What I fear is that what are good proposals on these fronts, even if timid, will get savaged by the AMA.

Please NHHRC, allow the people to have their say on your proposals. It is after all their health that is at stake (and their dollars).

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