For years I have repeated: 'There is
no Australian healthcare crisis. Australia
enjoys very good health by international
standards. Australia has a very good health
system. Australians like Medicare. Medicare
has some problems and they need fixing.
But ... THERE IS NO CRISIS!'
Recently though, I have thought again.
There is a crisis looming. But it isn't
dollars or waiting lists or nurses or
EDs or hospital beds or GPs, or any other
recurrent headline-grabber. It isn't even
medical indemnity, although I concede
that, unlike the others, this is a new
problem. And it isn't the continuing appalling
state of indigenous health (how can it
be 'a crisis'? it's been bad for decades
and is improving slowly) or the growing
epidemic of obesity -- or any of the other
health, rather than healthcare, problems
that beset Australians.
No, the real crisis is the totally inadequate
attention being given to the development
of long-term goals and coordinated strategies
for Australia's health system.
The division of powers between the Commonwealth
and State governments has created problems
since Federation, not only in healthcare.
But it seems that we are moving into a
new phase where cooperation, willing or
unwilling, between the jurisdictions is
being replaced with health ministers preferring
to blame each other publicly for the symptoms
of poor planning and coordination: ('he
can't run his state's hospitals efficiently';
'she won't improve bulk-billing rates'),
rather than work together to create a
sustainable system. The result is an increasingly
dysfunctional health system that will
eventually fail to deliver good health
and good healthcare for all Australians.
So why is this so and how might we proceed?
Having nine jurisdictions with different
parties in power and different electoral
cycles is a major impediment to good planning
and coordinated service delivery. This
will not change, however, so we must continue
to live with it.
The split responsibilities, grounded
in the Constitution, are another hurdle.
It has long been mooted, and it will involve
major upheavals, but we must move to a
simpler healthcare system. The Commonwealth
controls the money, so maybe they should
be responsible for all the services.
The current Commonwealth Government
is deliberately dismantling Medicare piece
by piece, no matter what its rhetoric.
It is misrepresenting the aims and principles
of Medicare. It is shamelessly wasting
over $2 billion a year on the totally
ineffective private health insurance rebate.
It is redefining bulk-billing to destroy
its purpose. It is entering into trade
agreements with the USA and other countries
(through GATS) that seriously threaten
the integrity, efficiency and excellent
cost-control record of Australia's healthcare
system. Why a government would want to
destroy a highly productive, cost-effective,
well-liked, internationally admired system
to create a more fragmented, more costly
one (for individuals and for Australia)
is totally beyond me. Anyone who cares
about health, equity, universality, and
service availability on the basis of need
not ability to pay must oppose this underhand
deconstruction of Australia's healthcare
Forces whose primary interest is neither
improved health nor improved healthcare
are driving many of the current developments
in Australia's healthcare system: reduced
direct taxation, international trade agreements,
doctors' salaries, corporate profits,
cost-shifting, political points scoring,
professional rivalries, to name a few.
This is compounded by an all-too-frequent
focus in parliaments, policy and the press
on inputs ('we're spending more on health
than the previous government'; 'we need
more hospital beds'), and outputs (number
of bed days per year, length of waiting
lists), rather than service quality, value
for money and health outcomes.
Health departments across Australia
have plans for every conceivable service,
population group, illness and risk factor.
We also have the Australian Healthcare
Agreement between the Commonwealth and
State Governments. But these are like
railway carriages with no engine and no
track. We need a national plan, agreed
by all jurisdictions, that clearly specifies
the overall goals of the health system,
its underlying values, and the broad strategies
to achieve it.
As President of the Public Health Association,
I must emphasise that such a plan should
include more emphasis and more funding
for health promotion. This is evidence-based
and cost-saving; a wise investment. Also,
the national plan must be developed in
consultation with an informed community
(who know what they need and what they
are prepared to pay), and service providers
(who know what's practical and what will
Such a plan will not be developed overnight
and it will involve many compromises.
But the real crisis is looming, and those
who should be taking it seriously are
ignoring it. The alternative, continuing
to undermine a good but not perfect system,
will have disastrous consequences for