The creation of a new committee to look at out of pocket health care costs has been welcomed by stakeholders but who are the ‘real’ experts when it comes to the affordability of health care?
In the piece below, Jennifer Doggett argues for an alternative committee to address this issue – one which is made up of the people most affected by the policy vacuum on out of pocket costs.
Jennifer Doggett writes:
The announcement by the Minister for Health, Greg Hunt, that he intends to address the problem of out of pocket costs for health care, is a welcome move. However, his overall approach to developing solutions to this longstanding problem and, in particular, his idea of what constitutes ‘experts’ in this area, reflects a fundamental misconception of the problem.
Out of the ten positions on the new Ministerial Advisory Committee on Out-of-Pocket Costs, seven go to representatives of medical groups and specialties and only one to a representative of a consumer group.
It is clear from this grossly unbalanced membership that the Minister believes the most important ‘experts’ on the affordability of health care to be private medical specialists, with consumers lagging far behind.
This represents a basic misunderstanding of the issue. Out of pocket health care costs are among the most important factors influencing consumer access to health care and can only be understood and addressed through a consumer-centred approach.
The problem with out of pocket costs
The problem with out of pocket costs does not lie with individual providers (although of course, some doctors do charge more than is reasonable for their services).
The problem is also not one restricted to particular specialties (although, yes, there are some medical specialties where average out of pocket costs are unacceptably high)
The problem is that there is no overarching policy framework within which the broad and diverse way in which out of pocket costs impact on consumers, over time and across the spectrum of the health system, can be addressed.
Looking at the issue from a provider-driven, episodic, perspective will simply reinforce the approach to health care which has led to this problem in the first place. It is also unlikely to overcome the barriers to finding consumer-focussed solutions, which are generally due to a reluctance on the part of health care providers (and governments) to change the archaic and provider-centric way we pay for health care, rather than any technical or logistical difficulties.
An alternative committee
Therefore, instead of the Government’s provider-centric, medically-overweight committee I would like to suggest an alternative, consumer-focussed alternative ‘expert’ committee (see below), which would include representatives of a range of different consumer groups.
The Government’s Committee
- Consumers Health Forum
- Australian Medical Association
- Royal Australasian College of Surgeons
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists
- Royal Australian and New Zealand College of Ophthalmologists
- Australian College of Anaesthetists
- Australian Orthopaedic Association
- Urological Society of Australia and New Zealand
- Catholic Health Australia, and
- Private health insurance industry
My Alternative Committee
- Consumers Health Forum
- A middle income family where multiple members have a chronic illness
- A low income couple with high ongoing health care needs and an income just above the pension threshold
- A person with an illness or disability which requires ongoing treatment with non-subsidised therapies (OTC medicines, dietary supplements, medical aids etc)
- A couple where one person has had to reduce or leave employment to act as a carer to the other person.
- A person with complex mental health and physical health problems
- A family in a rural area which needs to travel to access most health services
- A family living on social security benefits
- Catholic Health Australia, and
- Australian Medical Association (because if one organisation can represent all the consumers in Australia then surely one group can represent all the doctors)
A better approach
My alternative committee includes the real experts on out of pocket health care costs – the people who understand the day to day struggle of trying to afford essential health care while managing kids, jobs and other living expenses.
This committee could explain to the Minister how a family decides whether to fill a prescription for antibiotics for a sick child or pay for a psychologist appointment for a parent with crippling anxiety and depression.
This committee could detail the costs involved in leaving a family farm or business, packing the kids into the car and driving 800 km to the nearest specialist for two days of essential medical tests.
This committee could outline the stress caused by waiting for the medical bills to come in after unexpected surgery, not knowing how much they will be or how to afford them.
This committee would not waste time complaining that basic, sensible changes, such as giving consumers a single bill for a single episode of medical care, are ‘a step too far’.
I can guarantee that, instead of spending months arguing about professional fiefdoms and outdated entitlements, this committee could find a way to make single billing work at its first meeting. Probably before lunch.
The medical profession has had decades to try to solve the problem of out of pocket expenses and has done nothing. If the Minister is serious about addressing this issue, he needs move the doctors aside and give the real experts a chance.
I just got my water bill and learned how the company (Yarra Valley Water) had run a diverse background citizens’ jury – 5 days over 3 months – for discussions including on finding a balance between service and prices….
This sounds a much better option than bringing together a group of experts to solve the problem of out of pocket expenses – which as rightly said ‘they’ helped to create in the first place; and without or unlikely to have any real experiential knowledge of the hardships these can cause and the circumstances that create them
Thankyou Jennifer for this insightful piece. “If one organisation can represent all the consumers in Australia then surely one group can represent all the doctors” – I did enjoy this line!
Unfortunately I think your proposed committee is also somewhat unbalanced and heavily weighted towards consumer representation. The problem as I see it requires a threefold perspective; consumers, providers and funders.
I would propose that perhaps the representation consist of 3 consumer reps, 3 provider reps and 3 funder reps (from govt, private and the not-for-profit sector). With the greatest respect to Prof Brendan Murphy, the Committee should be chaired by a senior health economist to ensure a balanced oversight while providing advice on the broader economic impacts of proposed changes.
A nice article. In my experience, the views of one or two consumers are often ignored in a committee dominated by medical &/or industry vested interests. However, I suggested adding an experienced policy officer from Choice (Australian Consumers’ Association) as well as CHF. Although individual consumers can input relevant experience and good ideas than can be bamboozled &/or steamrolled by a government appointed Chair and an experienced medical association delegate.
The list on the committee includes representatives of all the main gougers – surgeons, anaesthetists, Obstetricians, Ophthalmologists ( particularly egregious ), Private Health Funds and Catholic Health.
There is no representative for Rural/Regional GP’s, who would give a very balanced overview, particularly of the maldistribution of medical resources ( and the consequent constraints on choice )
There is a lot to be said for your list, but it needs a few bureaucratic and economic heavy hitters, who have seen through the racket of private medicine and privatisation and who know the evidence on health economics. Think people like Stephen Duckett.
Catholic Health run some of the largest , most expensive and most profitable private hospitals in the country, in which some of the most expensive specialists work and charge as they will. In many rural towns they have a monopoly on private hospital provision. They are very conflicted in any such enquiry.
This is the sort of enquiry one would expect from this government and minister, who have a long track record of being beholden to powerful vested interests and a remarkably poor record on social justice and care for the disadvantaged.
We need also to remember that the particular Minister’s key skill is the ability to smile unctuously and profess deep concern for something, while presiding over its destruction. One only needs to look at his record in Environment to be very afraid