At a health communications conference in Sydney yesterday, the former Health Minister, Dr Michael Wooldridge, said he’d had to switch off the Rudd Vs Abbott health debate after five minutes because its focus on health financing rather than health was so depressing.
It’s a widely shared view. In case you missed it, Adam Cresswell had a good analysis in The Australian yesterday, a shorter version of which you can read here. I raised similar issues in a Crikey piece yesterday, “The questions the journos forgot to ask at the Press Club”, which was written, I must admit, in a late-night vent of frustration.
Meanwhile, the Medical Journal of Australia has just published two new articles online casting raising further questions about Rudd’s hospital reform plans:
• Professor Jeff Richardson, Foundation Director of the Centre for Health Economics, Monash University, says the plans have superficial appeal but from a longer term perspective, are a “poisoned chalice”, and will not end blame-shifting.
He also suggests the National Health and Hospitals Reform Commission’s final report could have done more to acknowledge the international evidence around various health policy options: “The balance shown in the NHHRC’s judgements may also be questioned,” he wrote. “In one of its few references to adverse events, it notes that “admission to hospital is not without risk”. It is also true that the Sahara Desert has dry bits.” Ouch!
• Professor Kathy Eagar, Professor of Health Services Research and Director, Centre for Health Service Development, University of Wollongong, also raises several questions about the Rudd plan, including the lack of attention to equity concerns, and the lack of detail, and also doubts that it will end blame shifting.
Meanwhile, Professor Mike Daube, Professor of Health Policy, Curtin University and President of the Public Health Association of Australia, and Dr Sue Page, Director of Education, Northern Rivers University Department of Rural Health, give their respective takes below on the not-so-great debate….
Mike Daube writes:
“So what happened to prevention in the Great Debate?
The discussion was about hospitals, health systems and past records. An hour went by with virtually nothing on prevention, let alone mental health, chronic disease, ageing and remedying inequities.
In response to a question, the Prime Minister touched on prevention where, to be fair, this Government has committed more funding than any of its predecessors and is committed to establishing a new National Preventive Health Agency (although that is still stuck in the Senate), but the discussion and debate missed out on crucial areas where we know that the health of the community can be improved.
Of course we need good treatment and care, but public health is too important to ignore.
The report of the Preventative Health Taskforce showed that we can prevent the premature deaths of hundreds of thousand of Australians now alive. A doctor who treats a single patient inappropriately – or fails to treat, so that the patient dies – is likely to be disciplined. Yet when politicians fail to take evidence-based action, hundreds of thousands of people die needlessly.
We need to know from both sides of politics what they will now do to reduce the avoidable toll of death, disease and social problems from tobacco, obesity and alcohol, and how they will deal with overarching issues such as health inequities.”
Dr Sue Page writes:
“Watching the health debate made me long for Rudd’s next overseas jaunt so that Julia Gillard could take his place as PM – she used to make a far more interesting opponent for Abbott, even pulling on boxing gloves for one stoush!
Rudd was debating from a position of power, the leader of a government promising health reform on a day when Obama’s healthcare bill had finally passed. Anyone who expected him to do more than spout fuzzy feel-good platitudes like family, doctors, nurses, partnership blah blah blah was naïve, but personally I found it a bit irritating. He drew on personal stories of his childhood, andI’m pretty sure I heard a reference to working families at one point! Really, all he had to do was keep his face pointed toward the camera – which he did, studiously avoiding all eye contact with his opponent in a fashion so reminiscent of his interview with Keneally that it had us falling about laughing!
In all the talk of local governance, both sides talk of direct national funding but there appears to be no detail from either side on how decisions will be made. Rudd asserts local networks of between 1 and 4 hospital size although nobody I have spoke to thinks these regions are large enough for economies of scale.
He says these will need to meet national targets which may be meaningless locally: for instance, what is this obsession politicians have with surgical waiting lists? Other than being amongst the easiest data to collect, they trap funding in the hospital sector and may result in anomalous decisions such as cardiac surgery being bumped in preference for orthopaedic targets, already fatal for at least one of my patients.
And yet these locals will be “responsible” for health! Shades of Pete Garrett treatment I think – where locals with high credibility will attempt to mitigate the disasters of distantly imposed policy while all the glory of good outcomes heads off to Canberra. Perhaps I am being too cynical.
Someone will have to do the central data collation, so ANU looks to have a bumper research year again next year, having already gained $200+ million in additional public sector funding last year according to the Go8 presentation I saw recently. Shame some of that money couldn’t go toward reducing health inequality.
More importantly, someone will have to do the local data collection. Never mind about the increase in medical training positions, which won’t produce doctors for another 10-14 years and even then give no guarantee the doctors want to work where they are most needed: we are going to need a whole new generation of health information and casemix funding coding personnel, particularly in rural areas. Not to mention the compliance costs! The one ray of sunshine I heard amongst the rhetoric was that separate arrangements might have to be made for rural hospitals – for whom casemix funding was an economic disaster in Victoria.
Personally I am happy with an ongoing system of private-public partnership, after all our private hospitals currently perform 53% of breast cancer surgery, but both sides seemed to dodge discussion on how the different sectors will work together under their new structures. Both sides commit to no hospital closures, but since the buildings and the staff are either private sector or state assets the Federal government can’t control the outcome.
Even under a new local network structure for public hospitals, for local control to be meaningful it would still remain that service delivery in both quantum and location is not a federal role. Why promise something you can’t hope to deliver?
How does a 60-40 split stop the blame game when overall funding is not guaranteed and when efficient cost are not even defined? How will primary care be different? Superclinics currently offer greater clustering of services but in few locations, and we know lack of transport has a significant impact on access.
If the Commonwealth takes over 100% of primary care, does this mean all our community health staff must be re-contracted to move from their state awards, or will the Commonwealth fund staff it is unable to direct? Where is the progress in e-health? More importantly, where was the grand plan for disease prevention?
Predicting the general pattern of rhetoric – after all Rudd is ever the man with public vision but no detail – Abbott wisely chose not to give any new direction about Coalition policy. However, this meant the time spent watching our two most influential health politicians would have been better spent as Abbott often does, walking or running for our own fitness rather than relying on a failing hospital sector.
This wasn’t a debate about health, it was a debate about politics. Meanwhile people are dying.”