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We need to ensure the extra investment in health is put to the best use

The health budget contains plenty of new initiatives that warrant careful implementation and evaluation.

But there is still a “troubling sense that initiatives are being hastily stitched together to meet electoral rather than health priorities”, cautions Professor Philip Davies, a former senior executive of the Department of Health and Ageing, and now Professor of Health Systems and Policy at the University of Queensland.

He writes:

“With so much money already committed to oiling the wheels of the recent COAG Agreement on hospitals, the health sector did pretty well to gain yet more funding in yesterday’s Federal Budget.

Three initiatives are particularly noteworthy.

The move to fund nurses in GP practices, and to do so without recourse to Medicare rebates, should do a lot to relieve pressure on many busy GPs.  It should also make services more accessible and affordable for their patients.  A flat $25,000 payment per GP might not be the most cost-effective approach and the money could arguably have been better targeted.  As it is, there’s a risk areas that are already well-supplied with GPs will simply become equally well-supplied with practice nurses, but overall it’s a smart and welcome move.

The establishment of ‘Medicare Locals’ is second cornerstone health initiative.  While the details are still sketchy it seems these new organisations will fulfil the roles of the promised Primary Health Care Organisations with an added obligation to facilitate access to after-hours GP services.  The name itself seems a tad clumsy and out of line with Medicare’s main role as a payment function but, according to one well-informed insider, it “tested well” with the public.  Perhaps some Canberra folks have seen too many of those irksome bottle store ads on TV that implore us to “shoot down to the local”?

Much of what Medicare Locals will be expected to do is already core business for the better-performing Divisions of General Practice but some important questions remain about the ownership and governance of the new organisations.  Divisions would certainly have to evolve quickly if they were to become Medicare Locals.

More fundamentally, the interfaces between the established National Health Call Centre, the new network of Medicare Locals and the individual practices and GPs who’ll be called upon to deliver services at night and weekends will take some working out.  Coupled with the fact that there are already well-established and well-functioning after hours arrangements in many parts of the country it would seem aspects this measure may be more spin than substance.

The announcement of funding for e-health is also sure to grab the headlines.  The case for investing in e-health and developing a coherent system of electronic health records is compelling, but experience overseas has shown it to be a massive, complex and risky business.

The Budget papers make it clear that the commitment of $467 over two years is just an initial down-payment and that further funding may follow.  The National E-health Strategy, prepared by Deloitte, estimated that developing a national system would cost around $1.5 billion over five years (and $2.6 billion over 10 years).  With those figures in mind the reality of what this first tranche of funding can deliver might be somewhat constrained.

It’s to be hoped the Government hasn’t fallen into the trap of over-promising and under-delivering which besets so many major IT initiatives.  Public expectations will need to be carefully managed to ensure that this is seen as a long-term programme, otherwise the credibility of e-health itself could be called into question.

Set alongside previously announced commitments on hospital funding and with the inclusion of other measures to bolster prevention, mental health services, chronic disease management and aged care the Budget gives a clear sign that health is shaping up to be a crucial election issue.

Some of those earlier announcements were criticised for lacking detail and the same could be said of what we heard yesterday.  There’s still a troubling sense that initiatives are being hastily stitched together to meet electoral rather than health priorities.

On the other hand, $7.3 billion of new money has to be good news by anyone’s standards.  We just need to be sure it’s put to the best possible use.”

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