Health

Policy analysis by Professor Jane Gunn, University of Melbourne

Operating theatre

Key points

  • Australia’s health care expenditure keeps on increasing and governments have been unable to reverse this trend
  • All the policy detail to date is tinkering around the edges.  No Party seems to have a bold vision for getting better value from the health care dollar

The Coalition plans to:

  • Continue the indexation freeze for all Medicare Schedule fees until 2020, with an estimated saving of $925 million
  • Rate private health insurance policies as ‘gold, silver or bronze’ to make it easier for consumers to see if they are getting value for money

Labor plans to:

  • Lift the freeze on Medicare Schedule fees will cost $2.4 billion over the forward estimates to 2019-20
  • Increase hospital funding by $2 billion more than the Coalition

The Greens:

  • Opposed the Coalition’s Medicare indexation freeze
  • Want to legislate for an agreed funding formula for hospitals and increasing hospital funding by removing the rebate for private health insurance

Affordable access to healthcare

A major point of difference between the major parties is their policy direction on Medicare rebates for GPs.  

The Coalition has announced it plans to freeze the GP rebate, which unleashed opposition from the Royal Australian College of General Practitioners and the Australian Medical Association.  

Labor has announced it would lift the rebate freeze providing a point of difference between the parties. Its plan is likely to lead to an increase in the deficit.

Central to a healthy Australia is ensuring universal access to health care. Labor has committed to maintaining Medicare, but have not laid out a plan for how they will do this in a way that leads to better value or slow the rising costs of healthcare.

The chair of the Quality Committee for the RACGP, Evan Ackerman, makes the important point that rather than bulk billing service rates being the focus of the election debate, we should be hearing about the out of pocket costs.  This measure could be the focus across public, private primary, pharmaceuticals and acute care. These are the true costs of health care.

When it comes to hospital care, the Greens propose the most fundamental change of legislating for an agreed funding formula for hospitals and increasing hospital funding by removing the rebate for private health insurance.

The health care system needs to be underpinned by funding models that improve accessibility to health care and provide appropriate reward for practitioners.  

Such models must take into account the different risk profiles and complexities of the patient population.  

Whilst the current Medicare Benefits Schedule Review of around 5,700 items is welcomed and may result in some efficiency gains, the fundamental core of system improvement requires a move away from fee-for-service funding models for chronic and complex conditions.  

Reforming the way the health care system responds to chronic illness

There are signs that the major parties recognise the importance of primary health care to the reform of chronic illness care, but the detailed policies outlining how this would occur are thin on the ground.  

Let’s take chronic illness as an example. Just over a third of all Australians experience a common chronic condition, making chronic illnesses a major national health priority. To date, there is a paucity of policy aimed at improving chronic illness care.  

The Liberal Party has embraced the concept of the Healthcare home which advocates for better co-ordination of chronic disease management. Whilst this policy direction is in line with current evidence, the planned trials will take place in fewer than 4% of general practices across the country and there remains the risk that a national roll-out will never materialise.

Ensuring data drives health care delivery and reform

Ensuring a national policy for health data is an area for urgent action.  Achieving effective and efficient health care requires secure sharing of health care information between health care providers.

Despite Australia being an early adopter of electronic medical record systems especially in primary care, it still operates in an environment where data does not automatically flow between providers. Patients are required to provide the same information to multiple providers over and over, and to frequently repeat their tests - wasting valuable time and money for all concerned.

There are data sharing solutions that can address this issue. The recent announcement regarding cancer registries and the planned roll-out of MyHealthRecord should generate debate about the most appropriate mechanisms for large scale health data sharing.  

Whilst these examples offer the promise of better data management they also raise concerns about appropriate safeguards for sensitive health information.  We urgently require national leadership and debate to ensure that the public interests are upheld in the way that health data is stored, shared, analysed and used to inform individual patient care and system improvement.

Integrating mental and physical health care

The mental healthcare system has been subject to major review and the report of the Mental Health Commission concluded that the current mental healthcare system is poorly planned and badly integrated making system reform an issue of national importance.

One of the most alarming statistics is the gap in life expectancy of between 14-23 years for those with severe mental illness compared to the general population.  

These premature deaths are caused by cardiovascular and metabolic disease rather than by the mental health condition. This example highlights the urgent need for better integration of mental and physical healthcare.

To date, no major party has addressed this issue.

Managing medicines

We have access to a large range of subsidised medicines. A recent Grattan Institute report highlighted the high price paid for pharmaceuticals and suggested wide ranging reforms to purchasing pharmaceuticals.

Ensuring access to the latest medicines is important to Australians, but we also have to look at the problem areas of use.  

The increase in long-term use of antidepressants; the rising inappropriate opioid use; and overuse of antibiotics are just three problem areas warranting attention. Setting a policy direction for better use of medicines must include strategies not only about when to start medicines, but about when and how to stop their use.  

Despite overwhelming evidence that health care systems built on strong primary care deliver better health care at lower cost, the policy directions of the major parties do not demonstrate a clear pathway towards this vision.

There is little detail about how they will ensure affordable access to health services and medicines, integrate physical and mental health and reorient chronic illness management.  A central policy gap is the way that clinical information and data should be used to drive system improvement.  

It’s clear that the major parties are aware of Australia’s health care challenges, but have not yet provided clear and detailed policy direction on how to overcome them.

Professor Gunn is a general practitioner and Director on the Board of EMPHN

Image credit: Andy G/Flickr