Improving Australia’s health system beyond the election

By Professor Maarten J. IJzerman; Dr Kim Dalziel
VCCC Chair of Cancer Health Services Research, University of Melbourne; A/Professor, Health Economics Unit, University of Melbourne

Australia has one of the best performing health systems in the world.

International evidence from the CONCORD-3 study, which records the world-wide surveillance of cancer survival rates, repeatedly confirms that cancer survival in Australia outperforms many other countries as does general life expectancy at birth and at age of 65 (OECD, 2017).

And with estimated spending of about 10 per cent of Gross Domestic Product or about $A5200 per capital per year, Australia also performs above average according to the annual health indicators report of the Organisation for Economic Development (OECD).

However, a more detailed analysis of Australia’s healthcare sector doesn’t justify complacency with the status quo. And the country’s three major political parties in the upcoming federal election provide interesting perspectives.

Firstly, while all three parties have different plans to further invest in healthcare, there’s little emphasis on improving the performance of the health system as a whole.

Second, all parties promote universal health coverage (UHC) but this requires more thought than simply who is paying the bill. UHC typically is about three questions: Who is covered? What is covered? And what share of the costs are covered by state and federal governments?

Finally, there are global concerns about the sustainability of healthcare systems that are not addressed by any of the three parties.

Specifally, the emergence of new technologies such as genomic testing and new expensive cancer drugs place increasing financial pressure on health systems globally. These pressures have been referred to as a climate of financial toxicity and it is widely recognised that different approaches to health service financing and delivery will be required to achieve further and sustainable improvements in health outcomes.

Along with concerns about the growing cost of health care are public concerns about equitable access to health services and an equal opportunity to achieve health. One of the greatest disparity concerns is experienced by Australians living in regional and remote areas.

So, what do the major parties have to say on these issues?

The Liberal Party

The current Coalition government provided significant investments in biomedical research fostering better treatments and stating that innovative healthcare should be accessible for all. They also claim increases in public hospital funding and announced several new expensive drugs to be listed on the PBS, reducing out of pocket pays to dollars instead of thousands of dollars. The new drug approvals however follow existing bipartisan protocols.

The Liberals promote reform of the private health system, strengthening primary care, improving access to health services in remote areas and reducing disparities in minority populations.

Unfortunately, with these priorities identified, the liberals fail to provide an overarching view on how to achieve this and how they will support a more equitable and accessible health system.

The Liberals have also not explicitly raised long-term sustainability of the health system as an issue. They neither refer to financial toxicity – that is not being able to pay for expensive cancer drugs –  or acknowledge the increase in expensive cancer drugs, as a policy issue.

Financial toxicity is expected to become one of the most important problems in cancer policy and a recurring issue in regard to the sustainability of health systems.

The Australian Labor Party

Labor has a more comprehensive view of an equitable and accessible health system and have proposed several policies to implement UHC that ensure a transparent and affordable health system.

Labor also proposes governance arrangements to support integration and coordination of services at a regional level (including primary, community, acute, sub- acute, aged and disability).

To do so, Labor says it will invest in research that addresses health systems efficiencies and promotes public reporting of hospital performance, sometimes referred to as value-based healthcare.

Interestingly, the recent public debate related to Labor was around the $A2,3 billion package to improve cancer services, including additional public hospital outpatient funding to reduce waiting times, a new bulk-billing item for consultations and more funding for MRI machines for cancer diagnosis.

But the proposed investments cause some concern.

Firstly, what is the rationale of investing in a single disease when there are more pressing public health concerns? And why do we need an additional investment in MRI screens? This seems a rather isolated investment for which the public benefits are not clear if one is concerned with integrated cancer services. For instance, there is quite a bit of evidence that more (and free) imaging also increases false-positive rates at an overall increased cost.

As part of its election promise, Labor also proposes new cancer drugs are listed on the Pharmaceutical Benefits Scheme (PBS) once approved by experts.

As per the coalition the listing pharmaceuticals is bipartisan, ongoing and subject to protocols unlikely to be changed by an election cycle. However, global experts expect cancer drugs, such as immunotherapy, will be unaffordable and other policies will be needed to control rising costs so promising new treatments also remain available in the future.

The policy to list cancer drugs perhaps is more of a signal of their general support for the PBS going forward.

The Australian Greens

Many policies of the Greens are similar to Labor, but the Greens are keen on further investments in health prevention.

They also have more pronounced ideas about UHC as well as investments in mental health programs and dental care. The Greens also promote incentives and policies for team-coordination in the management of chronic diseases, although those details are thin.

But unlike Labor, the Greens do not specifically implement policies for cancer patients.

Conclusions

All three political parties have a shared vision related to their view of how a health system should be designed. UHC, and the reform for a more transparent health system, is a priority for all parties.

This is essential and a priority as ageing population, a growing burden of chronic disease and an increasing life expectancy put pressure on our health system, alongside escalating healthcare costs associated with new treatments.

But improving health care is not simply a matter of investing more dollars. It is also a matter of investing wisely and ensuring our health system is improving health outcomes in the best possible and most efficient way. A further discussion about how Australia can move toward more transparent outcomes measurement promoting value-based healthcare should be encouraged.

All three parties are also committed to Universal Health Coverage, but the Greens and Labor tick most of the boxes; they both propose investments in dental care and make explicit statements about transparency regarding outcomes, access for everyone, affordable and transparent out-of-pocket costs, availability of mental health programs and reform of the private health care.

Labor’s proposed investments in cancer services is good news for cancer patients but perhaps need to be thought of better in terms of justifying policies that improve integrated cancer services instead of single interventions and the singling out of a single condition.

And, while access to health care is a key-priority, long-term sustainability is not an issue that’s currently being addressed as part of the election.

None of the parties have clear views about how to pay for additional investments which will be the greatest issue for all health systems in the near future. For instance, policies to implement new treatment and technologies (like dental care and new drugs on the PBS) should be followed by a discussion on how to disinvest in low-value health services.

De-implementation of low-value services is part of a global debate and can potentially provide a much more efficient health system. However, dis-investment whilst sensible has never been seen as a vote winning strategy.

Coalition - Primary Policy Documents

Health system | Health care

Labor - Primary Policy Documents

Cancer plan | Hospitals fund

The Greens - Primary Policy Documents

Health

Image credit: Getty Images

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