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How to reform the health system so it makes life better for consumers

By Vern Hughes - posted Thursday, 4 September 2003


As one of 265 invited participants in last week's Health Care Summit in Canberra, I was hoping for some long overdue debate about health reform free from partisan political point-scoring.

I was disappointed. Political partisanship reigned supreme. The familiar ideological barrows on the left side of politics were out in force. In a bizarre twist, the Summit concluded with a commitment to join North Korea, Cuba, and Canada as the only societies to outlaw private insurance. The Summit then parted company even with Canada in outlawing consumer choice. East Germany 1960, here we come.

Health reform is arguably the most difficult area of policy and institutional reform. Vested interests amongst providers and professional groups loom everywhere to thwart the reformer, jurisdictional demarcations run through every program and discussion, and there is no effective consumer voice in the debate.

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Having embraced market-oriented economic reform in the 1980s, Labor has lurched back into the Soviet bloc when it comes to health care. The Commonwealth finds reform too difficult, and the states just want more money tipped into their public hospitals.

Why do we find this too hard? After all, Australians were once innovators in health care. In the 19th century, most of our medical care was organised through consumer-governed associations. Friendly societies contracted with medical providers for capitation-based payments for medical services and ran dispensaries employing salaried pharmacists. Around the country we established and financed bush and community hospitals by voluntary public subscription.

Can we become innovators again? To be sure, the complexity of health financing and delivery works against informed public discussion - it is much easier for politicians, the press gallery and voters to focus on a simple catchcry like "bulk-billing" rather than focussing on the systemic nature of the crisis.

Yet systemic reform is critical. The population over 65 years consumes the bulk of our health resources, and as this segment of the population increases, the cost of care will rise dramatically over the next 20 years. Without structural reform our current 8.9 per cent of GDP will hit 15 per cent.

Cost management is one driver, but the key reason we need reform is to enhance and empower the consumer, that long neglected stakeholder in the health system. In short, we need a health system that works for the consumer and her or his good health, rather than for the benefit of the various industry players.

In a nutshell:

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1. The system is highly fragmented, with little continuity of care across program, service and practitioner types, and with few incentives for the industry to become consumer-focussed.

2. There is little or no financial incentive for practitioners and providers to keep people healthy and out of surgeries or hospitals. On the contrary, most of the financial incentives favour repeat business.

3. Consumers have little market-based power in the organisation and pricing of services. There are insufficient means for consumers to substitute one care regime for another better and more price-effective regime.

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Article edited by Margaret-Ann Williams.
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About the Author

Vern Hughes is Secretary of the National Federation of Parents Families and Carers and Director of the Centre for Civil Society and has been Australia's leading advocate for civil society over a 20-year period. He has been a writer, practitioner and networker in social enterprise, church, community, disability and co-operative movements. He is a former Executive Officer of South Kingsville Health Services Co-operative (Australia's only community-owned primary health care centre), a former Director of Hotham Mission in the Uniting Church, the founder of the Social Entrepreneurs Network, and a former Director of the Co-operative Federation of Victoria. He is also a writer and columnist on civil society, social policy and political reform issues.

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