The 7 wonders of health funding

I recently had the privilege of participating in the Consumers Health Forum’s ‘Health in a time of change’ national workshop in Melbourne.

The Workshop brought together a large number of consumers and other health stakeholders to debate current issues in health policy and advocacy.

Copies of many of the presentations are available here, including an overview article from CHF’s Mark Metherell.  All of the presentations are worth a look but those with an interest in the use of social media for health advocacy should check out the presentations from Croakey’s own Melissa Sweet and consumer advocate Melissa Cadzow. 

I presented in a session with Professors Stephen Duckett and Andrew Podger and Assoc. Professor Adam Elshaug.  CHF’s media manager Mark Metherell challenged us with the topic ‘7 options better than $7’ and I used the theme of the Seven Wonders of the Ancient World for my talk.

I thought this theme was particularly apt for two reasons. Firstly, I felt that just as each of the Seven Wonders have become symbols of their respective cultures representing something important about the society that created them, so too does Medicare reflect something significant about our community and our values. Secondly, I felt that the fate of the Seven Wonders (all but one having been destroyed) highlighted the fact that we cannot take institutions such as Medicare for granted but need to continually preserve, update and maintain their relevance (although at only 30 years old Medicare has a long way to go to compete with the 4,500 year old Great Pyramid!)

For those whose memories need refreshing, the Seven Wonders are: the Great Pyramid of Giza, Hanging Gardens of Babylon, Temple of Artemis at Ephesus, Statue of Zeus at Olympia, Mausoleum at Halicarnassus, Colossus of Rhodes and the Lighthouse of Alexandria.

My seven wonders of health funding (in brief) were as follows:

The Colossal Health Funding Myth

As argued extensively by many economists and experts, we do not have a health funding crisis.  While we are spending more on health care, this level of expenditure is affordable, given our increasing wealth, and in line with global trends. Furthermore, there is good evidence that our expenditure is – in general – delivering us good value.  We need to ensure that we continue to receive good value from our health spending but do not need to make sudden or radical cuts to funding to meet short-term Budget pressures.

The Low Hanging Fruit

If we want to find savings within the health system, it makes sense to look first to areas of waste rather than to increasing costs to consumers.  A number of recent studies have identified areas within our health system which could save significant amounts of money, for example, work by the Grattan Institute has found that we could save over a billion dollars a year through changing the ways in which we fund public hospitals.  Adam Elshaug has identified 150 low value services routinely provided in our health system.  These options should be the first put on the table by Governments concerned about increasing health care costs, not inefficient and inequitable co-payments from consumers.

The Lighthouse of Data

We are living in an era when an unprecedented amount of data is being collected which can be used to inform our health policy and funding decisions to increase their value and reduce waste.  However, often this data is not used to its fullest extent, in part because access to this data is often restricted to those with a vested interest in the issue.   For example, private health funds cannot use the data they have on poorly performing hospitals and doctors to advise consumers on their treatment choices.

The Great Pyramid of Primary Health Care

Worldwide evidence shows that the best performing health systems are those with a universally accessible, comprehensive primary health care sector.  A health system that is based on a solid foundation of primary health care delivers better health outcomes and greater equity than those focussed more on hospital and specialist services.  To increase the value of our health dollars we need to be breaking down current barriers to access, not increasing them through imposing additional costs.  

The Mausoleum of Archaic Workforce Practices

Current health and medical workforce practices in Australia have not changed significantly in a generation, despite good evidence that there is potential for greater substitution of nurses and other professionals for tasks currently performed by doctors.  This is not about undermining the role of doctors, rather it is about valuing their unique role and contribution to the health care team. Our medical workforce is one of our most valuable and limited resources and it should be used judiciously. In cases where non-doctor professionals can perform tasks as well or better than doctors, there should be concerted efforts made to support these workforce changes and leave doctors to undertake the important tasks that only they can perform.  

The Temple of the AMA

However, changing even minor aspects of medical workforce policy requires taking on the quasi-religious beliefs of the AMA about the inviolability of the doctor’s role in our health system.  While medical professionals are as entitled as members of any other profession to union representation, they should be savagely critical of the role the AMA has played in entrenching outdated and inefficient workforce practices within our health system.  Had the AMA been around in 1745 when the surgeons formally split as a profession from the barbers, we would no doubt still be requiring GPs to perform a cut-and-blow-dry with each Level B consultation.

The Statue of You (the Consumer!)

Finally, it’s vital to remember that the most important aspect of any health system is the community and consumers that it serves.  It’s easy to focus on one aspect of the health system and become evangelistic about the benefits of primary health care, prevention, care coordination or any of the other worthy areas of our heath system.  However, it’s worth remembering that these are only beneficial to the extent that they reflect the values and priorities of the community.  Similarly, reducing waste through eliminating low value services or changes workforce practices are only useful strategies if they are implemented in conjunction with consumers, in particular those from disadvantaged and vulnerable communities.  Keeping consumers at the centre of the health funding debate (which means involving them directly in decision making processes at all levels) will ensure that the necessary evolution of Medicare will reflect their values and priorities, rather than those of the medical profession, pharmaceutical companies, politicians, economists or any other ‘experts’.

Thanks to CHF for inviting me to this workshop, as always with CHF events I came away very impressed with the work of this organisation and its many passionate, committed and highly skilled staff and consumer members.   Special mention should be made of the excellent dinner entertainment from, Luke Escombe, possibly the only musician in the world to release a single on the topic of public toilet access for people with Crohn’s disease (Master Key), who had us all in stiches.  Also a hit was this Happy video from Choosing Wisely Canada.

Disclaimer: Jennifer Doggett has previously provided consultancy services to the Consumers Health Forum.