Introduction: Health reform is usually highly contested and politicised, with the least powerful voices often relegated to the sidelines.
As National Cabinet meets today to consider health reform, the CEO of the Consumers Health Forum of Australia, Dr Elizabeth Deveny, offers 10 key recommendations. She also reflects on her experiences with the Strengthening Medicare Tasforce, whose report is expected to be released soon.
Elizabeth Deveny writes:
It’s 40 years since universal healthcare became part of our cultural fabric. Time has moved on, and so must Medicare.
Government budgets and health systems are stretched, the health workforce has lost much of its resilience, our population is ageing, and our health needs have become more complex.
So how do we modernise Medicare, invest in the right reforms and ensure all Australians can access affordable, timely and safe healthcare?
Along with 16 other representatives of various medical professional groups, this was the challenge posed to the Strengthening Medicare Taskforce, which I joined when I became CEO of Consumers Health Forum in September last year.
One representative for the nation’s 25 million health ‘consumers’ (the term we coin for patients, carers and family members). The other 15 Taskforce members comprised eight representatives of various medical professional bodies and seven other sector leaders.
While there was much stimulating and collegiate discussion around the table, nearly all the lobbying (and subsequent media coverage) has focused on an increase in the Medicare rebate paid to doctors.
Yes, an increase is long overdue, but this is not the panacea to all our health system ills.
So, what do health consumers want? We know because we regularly ask thousands of them for their opinions. In regard to the desired Taskforce outcomes, we got hundreds of responses to our December survey with scores of different patient groups and community groups represented.
Our combined response to what consumers want from ‘the new Medicare’ is independent of any vested interest. We only want what is best for all Australians – especially those who can least afford or access healthcare.
So here is CHF’s 10-point action plan.
1. Put consumers at the centre of any reform
Whatever reforms the Government decides to introduce, it is essential that health consumers are involved in the design and implementation of any new policy or service. We must address, test and judge the reforms on how they work in the ‘real world’.
The lived experience of those who use our health services contains much-distilled wisdom. All of us must better respect this expertise and use it to improve Australia’s healthcare system. We must also ensure that health consumers are supported to actively contribute their expertise and lived experience to any committee or policy forum, providing education or training as needed.
We must also lift the standard of health literacy of all community members, remembering to use plain language and work with community leaders to explain any changes.
CHF has actively promoted the creation and funding of a Health Consumer Leadership Academy to achieve these aims and we are hopeful for a positive response from Minister Butler in the 2023 Federal Budget.
Health Minister Mark Butler said last August that ‘“I’ve always had a very strong philosophical commitment, and very practical commitment, to the consumer voice…Nothing about us, without us. It’s not just the right thing to do, it’s the clever thing to do.”
2. Increase access to more bulk-billing GPs
Not surprisingly, when we polled our members in December, access to more bulk-billing GPs and a general reduction in healthcare costs was their number one priority. CHF supports increasing the Medicare Rebate as part of a new funding mix. We also support incentives for general practices to encourage them to adopt new technology and upskill practice staff.
3. Provide wraparound care for those who need it most
We also support general practices to be reimbursed via ‘bundled care’ payments to better manage consumers with chronic diseases or complex needs. This has been tried in various pilot programs, such as HealthCare Homes, so there are many lessons already learnt here and overseas to guide this work.
Most importantly patient registration in these schemes must be voluntary and consumers need to be fully informed about any new scheme.
4. Address rural and remote inequities
CHF is looking for a multi-pronged approach to increasing access to health services for Australians who live in rural or remote communities.
Solutions could include additional incentives for rural service providers and shared care models where local hospitals and other providers determine the most appropriate place-based solutions for their communities.
5. Integrate care to treat the whole person
It feels like stating the ‘bleeding obvious’ but consumers want health professionals to treat the whole person – that means having their physical, mental and emotional health addressed in an integrated approach. Our minds and bodies don’t operate as separate systems so why is our health system is split along these lines?
Greater access to mental health services was also high on our members’ wish list.
6. Stop the funding fights
Consumers don’t care about who pays for what so why do we keep arguing about the funding split of health costs across both national and state governments?
CHF will be looking for greater cooperation between various levels of government in service design and delivery. We saw this happen during the COVID-19 pandemic and we want to see best-practice approaches adopted in the future.
For example, Primary Health Networks (which distribute primary health funds on behalf of the Australian government) and state-funded hospital networks could work much closer together.
7. Let health professionals operate within full scope
CHF would like to see the full skills of health professionals utilised, including those of pharmacists, nurses and allied health practitioners. We’d hate to see this depicted as a ‘turf war’ between various professional groups.
Consumers want a multi-disciplinary approach taken, with professionals collaborating and consumers’ needs being put front and centre.
8. Help consumers navigate the health system
Everyone talks about patient-centred care but, it is really hard to navigate our health system. Coordinated care was high on our consumers’ wish list. In the short term, CHF would really like to see the government fund ‘navigators’ to support consumers in their health journey and be a central point of coordination for all their needs. World class redesign of our system would see the need for such support decline.
9. Build health literacy into preventative health initiatives
As supported by the government, CHF supports allocating 5% of health budgets towards preventative health. We believe that at least one-fifth of this, or 1% of the health budget, should go towards building consumer capacity and initiatives to encourage self-care. There is so much opportunity in this area – everything from social prescribing to planning for the next pandemic.
10. Promote digital health
Last but not least, CHF would like to see greater investment in, and consumer education around, digital health.
Let’s modernise My Health Record to make it easier to use and better connect health data across all parts of the system. Consumers should be able to access and share their health information as they choose. This would lead to more efficient and effective health care by both professionals and consumers.
See Croakey’s archive of articles on the Strengthening Medicare Taskforce report
