The interim report of the National Health and Hospitals Reform Commission is due to be released on Monday. NHHRC Chair, Dr Christine Bennett, will address the National Press Club in Canberra from 12.30pm.
Who says what about the report will be interesting – if only for the insights these comments will yield about the health system and whose interests it serves. The observation that the public’s interests are often the poor cousin to other interests in the health industry is an old one but, unfortunately, still apt.
We in the media often reinforce this power imbalance by giving disproportionate space and weight to those representing professional, commercial and institutional interests. It’s likely that the AMA, ANF, and hospital lobby (both public and private) will win a prominent run next week.
Whose responses should we be seeking to represent the public interest in the debate? Especially those sections of the community who get a particularly raw deal from our current health system, like Indigenous, and rural and remote Australians, and others who generally don’t wield much clout in society?
More importantly, whose voices should the Government be listening to as they develop their response to the report?
In a stroke of serendipitous timing, the Canadian Health Services Research Foundation has just released two relevant articles with self explanatory titles:
• PUBLIC ENGAGEMENT (PART I) – ENGAGING THE PUBLIC IN HEALTHCARE POLICY: WHY DO IT? AND WHAT ARE THE CHALLENGES?
• PUBLIC ENGAGEMENT (PART II) – HOW DO DELIBERATIVE PROCESSES ACHIEVE MEANINGFUL PUBLIC ENGAGEMENT?
Some timely reading for both journalists and policy makers who are likely to be swamped by the powerful voices of vested health industry interests in coming weeks.
Glenn Salkeld (School of Public Health, University of Sydney) sent in this comment: “You are bang on the mark with this Croakey post. Our political system makes it difficult for the unorganised and unfunded to have
a voice that penetrates. But social networks and the connectivity
provided by the net can make a real difference in sending the message
to those who need to listen. But a helping hand is needed. Those who are
well educated and know how to express our desires need to help those who may not have the capability to desire or to express that desire.”
Ian McAuley (Centre for Policy Development and University of Canberra) sent in this comment:
“My main concern is whether the Health and Hospitals Reform Commission will propose any reforms which will bring the various elements of health care together as an integrated system, or will they take the present fragmentation as a given condition? If they have a system view, how will they reconcile the different values and principles built into the present elements – values and principles which reflect economic concerns and political fashions and prejudices of the different times these programs were designed.
And that leads to the question of whether they can bring together the best of centralised financing and the best of market forces. At present our financing of health care disingenuously combines many of the worst features of both. Among these distortions are private insurance, which has all the moral hazard of public insurance but without its capacity for cost and utilization control, protection of many providers (particularly pharmacists) from the full forces of price competition, and a mix of pricing ranging from free through to prohibitively expensive services, which distort both consumer and provider choice.”
The Bennett Interim Report will no doubt generate debate from the vested interests in the health system but it has to be remembered that behind those vested interests are often very valid concerns about quality and safety that should not be easily ignored. It is not always just about self interest. The AMA and the ANF do represent vested interests in the health care system but there is a power imbalance between these organisations which the current Federal Government is trying to address. It is reasonable that the organisations representing thousands of professionals and workers in the health system are consulted and their voices are heard along with the representatives of organisations that foreshadow initiatives and new directions in the health system.