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This ain’t health reform, not really….

(Part 7 of a Croakey series on health reform)

At last there are some suggestions of health reforms directed towards primary care and chronic disease management. At least, according to this report from The Daily Telegraph.

While we wait to learn what is really in the Budget for health, here are some reflections from two close observers of health reform:  Dr Patrick Bolton, a senior health services manager (who is not convinced that what is underway should be called “reform” at all), and Carol Bennett, executive director of the Consumers’ Health Forum (who has some critical questions for the Government and the Opposition).

Patrick Bolton writes:

“The more I think about this the less I think it is reform.

Real reform would involve thinking about what we want out of our healthcare system and then thinking about how those needs might best be met.

This would offer the opportunity to move healthcare beyond incremental change based on established service models and interests to something that was based on evidence, adaptive and responsible for delivering outcomes. The funding and governance of the new models would need to be thought about once the models had been developed and designed to support them.

The kind of reform that has been spoken about in Australia has mostly been about change in governance and funding. I am not sure that that is reform but it didn’t happen either. There are still two funders. The proportion has changed, but it is not clear what has happened to thetotal quantum. This is for two reasons. First, no one has actually said how much the “efficient price is”. The Commonwealth contribution of 60% of the efficient price might be less than its previous contribution of 50% of whatever hospitals cost.

Second, it is not clear to me whether all the apparent extras that Rudd threw in as sweeteners are part of the 60% or additional to it. Theagreement does talk about $15.6bn top up funding above and beyond the 60% for the five years from 2014-15. That will be an annual addition of around 2% to total national health spend. Not unwelcome but not extraordinary either.

The states still remain firmly entrenched running things. This is not necessarily a bad thing, but reform it ain’t. I believe that John Brumbycoming out of COAG described the new role of the Commonwealth in respect of hospitals as no more than “moral suasion”. Given how easily all players in the negotiation gave up their principles in favour of money one can’t hope that morality will be a strong influence.

Taken on their own, the Rudd proposals are a bunch of ideas based on limited evidence and thinking which were prepared without any consideration of the purpose of the system or how it would integrate. I don’t concede that a convincing case was made that improvements were required to the old system. I think the system could be better, but not enough thought was given to the diagnosis to be sure. One has to be grateful that Rudd isn’t really reforming because the shallowness of his approach means that real damage might be done if he was.”

***

Carol Bennett writes:

“CHF welcomed the COAG outcomes as a step towards achieving a better health system for all Australians.

But after the storm comes the calm, the confusion and the questions.  It was something of a shock to pick up the newspapers in the week after COAG, and see that other hot button political issue, climate change, back on the front page and health relegated to the occasional story inside.

Health consumers are now drawing breath after a hectic few months of political wheeling and dealing and a swathe of announcements and are asking three questions:  “What does it all mean” “what’s missing” and “what comes next”.

We would like to know:

  • Will much needed reform in areas like dental health, mental health and e-health be given the funding and priority they deserve?
  • How will the regional hospital networks work?
  • How the new Primary Health Care Organisations be structured and how they will operate?
  • Will there be meaningful consultation on all these issues with consumers?

As the country moves towards an election in the coming months, consumers would expect these questions to be answered and would want the Federal Opposition to put a comprehensive health policy on the table for debate.

As a final comment, most consumers don’t really care who controls health funding; they just want a system that works better at all levels, that is not the source of constant political finger-pointing and that actually takes the pressure off our overburdened hospital system by providing better health services where they are most needed.”

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