Health care: good, better, but for goodness sake give up on ‘the best’!

When I came to Australia over a decade ago, one aspect of the debate around Australian health care I found rather amusing was the insistence that Australia had a “world class” health care system and even that its health care was the “best in the world”. Now I am not arguing it is poor But rather how would, how could, one make such judgments?

Certainly in 2000 the WHO sought to draw up a league table of health care systems. They assumed all countries had the same goals and attributed all of these goals with the same weights in each country. That was nonsense on stilts. Health care systems are social institutions and each country legitimately wants different things from them. So we are into apples and oranges.

Again, why would Australians in any way be interested to know if our health care system was better than the Austrians’ or the Norwegians’? Trying to compare systems which are inevitably different by virtue of being culturally based is not useful.

Now that sort of silliness maybe doesn’t matter too much, but the complacency and arrogance that go with it do. What we need in Australia, wherever we start from, is a better health care system.

It would matter, however, if we were comparing like-with-like in terms of say specific treatments and Australia came out badly. So it is worrying that, for example, our hip replacement failure rate is up to 25 per cent compared to the Swedes which is 7-8 per cent. That is a legitimate comparison and not a happy one.

Generally, how pervasive such high failure rates in our health care are, we do not know and I do not suggest we spend lots of time finding out. Rather, I want to argue that we spend less time saying how wonderful it all is and see how we can do better.

Without getting into relativities and comparisons, what we CAN say is we have an absolutely crazy funding and organisational set up. There is no logic in the states-Commonwealth split. None.

There are other absurdities in the system, for example, paying and judging hospitals by what they do by way of cases (usually “cost-weighted” cases) and not what they produce by way of health. This is some strange attempt to estimate the value of hospitals’ “output”. How can the cost of an operation be used as an indicator of benefit? “My operation was more expensive than yours so I get more benefit.” Is that the argument?

Likewise we pay GPs “fees for services”. This encourages them to do as many services as they can, to earn as much money as fast as they can, with almost no concern or incentives to make people healthy.

And so we move closer and closer to the US model, which may be fine according to the American people’s values - in terms, for example, of its inequities - but it does not fit with Australian values (see below).

We have pretty good health overall but there is little that tells us how much this good health has to do with health care. There is a new survey of health which suggests lifestyle issues are more important than anything an acute expensive tertiary cathedral can deal with.

We know that inequalities are bad for our health but then we exacerbate them through our tax policies. Social cohesion is good for our health, yet we worship more and more at the altar of individualism. We have continuing appalling Aboriginal health but clearly as a nation do not really care about that.