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You may as well kiss goodbye to real health reform, whoever wins

Welcome to part 9 of Croakey’s election series.

This is what one senior health policy expert said when asked to contribute to the series: “I prefer to focus on whoever is in government after the election to see if we can get them to moderate their  policies then. I doubt they will think seriously now other than defend their existing positions against whatever criticisms are made, and they may then be unwilling to engage afterwards.”

It’s an interesting point. But one downside to this approach (which some others are also taking) is that their valuable expertise and judgment is then not available to help inform the public and public debate.  To achieve change, we need both the front-of-house and back room operators.

Meanwhile, the following articles are from Professor Stephen Leeder, director of the Menzies Centre for Health Policy at the University of Sydney, and from “Hannah Swarts”, a health policy analyst who must remain anonymous because of a job that does not allow public commentary.

Professor Stephen Leeder writes:

We are about to enter a period of conservative federal politics, whoever wins.  The margin of the winning side is likely to be small and the Greens may hold the balance of power in the Senate. Egg shells are safe: politicians will be walking circumspectly in carpet slippers.

Accordingly, I predict that nothing much will happen that will change health. The state bureaucracies will be little diminished in power or authority whether they are managing a system of corporatized public hospitals, each with its board and white picket fence, or local hospital networks.  (I do not imagine that patients will find much difference between the services provided by hospitals in the networks or hospitals behind picket fences.)  I expect hospitals will carry on their clinical services as previously.

I do not know how, under the Guillyrudd or Abbott reforms costs will be contained if hospital funding is intended to match activity with no cap on it.  Hospitals in poorer areas may be better off under a Guillyrudd network arrangement than an Abbott reform because there would be a mechanism in the former for investing in equity, whereas in the latter the big rich hospitals will get bigger and richer and the poorer ones will have only plastic palings on their picket fences.

The main medical and health care labourforce groups will continue to exert immense power over what is done and how it is done, whether they have lots of boards or few.

In other words, given a conservative government – Labor or Liberal – the time may have passed when we could look forward to true integration of community and hospital services in the care of the (many, many) people with chronic problems. And that, ladies and gentlemen, is why we started the conversation three years ago about health system reform.

It is fortunate that the current system is as good as it is because I anticipate only tinkering and tampering over the next three years.

The Shuttle will have more ceramic tiles glued to its nose and will fly again!  Could be a whole lot worse – but the opportunity for real reform has probably passed for the moment.”

***

Wither health reform….?

“Hannah Swarts” writes:

If the National Health and Hospital Reform Commission (NHHRC) process proved one thing, it is that there is no shortage of ideas and potential solutions for the challenges of health policy in Australia. It also clearly defined the challenges facing the Australian health care system such as the inequities faced by Indigenous Australians and areas of socio-economic disadvantage as well as poor coordination and access to primary care to name a few.

Why then, has this election campaign been devoid of new ideas to address some of these challenges? There has been very little on the social determinants of health or the health Indigenous Australians. There has been even less on improved integration of the health care system, access to primary care and systemic approaches to prevention (although the Greens policy included proposals for prevention and health promotion), arguably some of the most important challenges confronting the health care system.

All parties have put forward their health policies and, with the exception of the Greens, it has largely been more of the same, more beds and more doctors. While it could be argued that some parts of Australia suffer from workforce shortage and could do with more hospital beds, the campaign has not featured an underlying narrative or proposal for structural reform for Australia’s health care system. Many of the proposals have failed to articulate the problem they are trying to solve, although there are some exceptions to this.

Where are the brave politicians or the brave political parties putting forward a bold reform proposal, even as a pilot? Why is it that this election campaign has been about handing out more money, rather than the contest of ideas? Mental health has certainly been a (worthy) winner from this election campaign and while the Coalition is offering more money it has failed to put forward a comprehensive framework for mental health policy, treatment and prevention across the entire lifespan. The ALP has also failed on this account.

Or is it simply that interest in ‘health reform’ is beginning to wane? That the cost and complexity of reform are too much to contemplate, even for the most ardent of reformers? That it is much easier to build more hospitals, fund more beds and increase rebates than to battle with vested interests to change the status quo.

Reform is not an overnight process and sometimes failure is required on the road to success (consider the introduction and dismantling of Medibank and then introduction of Medicare in 1984). But reform requires vision, leadership and clear sense of direction, something which has been lacking from this election campaign and the current government.

To see the previous posts in the election series:

http://blogs.crikey.com.au/croakey/2010/08/13/beyond-the-election-horse-race-kicking-off-a-health-policy-series/

http://blogs.crikey.com.au/croakey/2010/08/13/a-comprehensive-analysis-of-election-health-policies/

http://blogs.crikey.com.au/croakey/2010/08/13/kellie-bissets-insightful-analysis-of-election-health-policies-dont-miss-this-piece/

http://blogs.crikey.com.au/croakey/2010/08/15/where-is-the-vision-in-health-policy/

http://blogs.crikey.com.au/croakey/2010/08/15/how-do-the-major-parties-stack-up-on-general-practice-policy/

http://blogs.crikey.com.au/croakey/2010/08/16/the-govt-opposition-get-a-big-fat-f-when-it-comes-to-obesity-control/

http://blogs.crikey.com.au/croakey/2010/08/16/what-we-need-in-the-last-week-of-the-campaign/

http://blogs.crikey.com.au/croakey/2010/08/17/how-should-we-judge-election-health-policies/

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