Who gets the most health funding? Toorak or Tennant Creek?

Do Australians really think we should spend more on the health care of a Toorak resident than an Aboriginal child from Tennant Creek?

That’s one of the questions raised in the piece below by Dr Richard Di Natale, a public health physician with a special interest in the drug and alcohol sector, and Lead Senate Candidate, Australian Greens (Vic).

From where Croakey sits, the lack of attention to equity issues in the health reform debate has been both astounding and dismaying. In an ideal world, those proposing policies of any sort would consider their impact not only on health but on health equity.

Meanwhile, Dr Di Natale writes:

“Australia’s health system is one of the best in the world. Most people, regardless of income, get access to high quality care when they need it. We do it efficiently, spending less on health care thanmany other industrialised countries yet we still achieve good health outcomes by global standards.

Granted, there are significant problems, but Australia has the resources and the expertise to confidently meet the health care needs of its population.

That is, of course, if the right choices are made.

While the PM’s Health Reform package announced last month is a start, it is not genuine health reform.

Most of it is simply a change to the way hospitals are funded. The only reason Mr Rudd can boast about it being the biggest reform since Medicare is because there hasn’t been reform since Medicare.

Hospital financing reform is welcome but the real challenge for government is to place prevention and primary care at the centre of health care policy. Currently, the majority of health funding goes to hospitals, acute care and medicines while less than 5% is spent on illness prevention.

The changes announced so far in the area of primary care are problematic.  They focus almost exclusively on general practice and will do little to improve community care. The $436 million dollar announcement for GPs to develop care plans for diabetics demonstrates the folly of a doctor-centric approach. GPs are already overworked, they don’t practice where disease is highest and they are fiercely independent, often working in isolation from other practitioners within the primary care sector.

This was a missed opportunity to expand the role of nurse practitioners and diabetic educators in an area of growing need.

Similarly, maternity services are also skewed towards high cost, high-tech medical intervention with little evidence of better health outcomes. In most other developed countries, midwifery plays a much larger role and has been shown to produce benefits for mothers, babies and the health dollar. The current review of midwifery services being conducted by the government suggests little will change.

Fee for service in general practice is an impediment to delivering good preventative care. It creates a perverse incentive to generate services and concentrates services in areas that are already over supplied. As a result we spend more on treating a Toorak resident than we do on an Aboriginal child in Tennant Creek. The government’s health package indicates little appetite to challenge this financing dilemma.

A blended payments model would a positive move.  Fee for service should be retained but we should also pool some Medicare and other public health funding to be reserved for local health networks, as the hospital reforms propose to do. Local boards, who are more connected to problems on the ground, could then distribute this funding to a range of primary care practitioners on the basis of health need, not just to those who are lucky enough to be able to access services.

Under any model of genuine reform, the private health insurance subsidy must also be addressed. Health economists have repeatedly demonstrated that the private health insurance subsidy is expensive, inefficient and highly inequitable. Low income earners should not be paying for other people’s gym membership and bike shorts. Genuine reform would pass on the rebate to preventative models of care.

The proposed health reforms announced so far by the government seem to indicate that they don’t understand that a major function of any health system is to keep us healthy. If the PM wants to get serious about health, he needs to prioritise prevention and primary care in the community over expensive end-of-the-road treatment.”

• Richard Di Natale worked for a number of years as a GP in a variety of health settings, including a two year stint for an Aboriginal community controlled health organisation in the Northern Territory. He is a fellow of the Australasian Faculty of Public Health Medicine and recently completed several years with the Nossal Institute for Global Health, where the focus of his work was HIV prevention among injecting drug users in India. He currently works as a drug and alcohol clinician within Victoria’s public health system.