A focus on national health and wellbeing as well as on healthcare services is an investment in equity, productivity and prosperity, argues our social policy whisperer Dr Lesley Russell (University of Sydney). Healthcare policies need to go well beyond the current over-medicalised focus on hospitals, doctors and prescriptions – how do the major parties measure up?
Healthcare issues are always at the top of voters’ minds during election campaigns, and never more so than when there is a perceived threat to Medicare. In the lead-up to this year’s federal election, the actions of the Abbott /Turnbull Government once again indicated a lack of conservative commitment to the universality of Medicare. This was most obviously expressed in budget measures that would increase the already substantial out-of-pocket costs for patientsand cut public hospital funding. Less obviously, via Cabinet documents, the work of the National Commission of Audit, the Harper Competition Review, and the Productivity Commission review of public services, there was a push to privatise the operations of Medicare and the PBS, expand roles for private health insurance, and increase competition and contestability (code for privatisation) in the delivery of a range of public healthcare services.
Reforms to the healthcare system are essential to address coordination of care, increasing pressures from non-communicable diseases and an ageing population, and financial strains. But the inability of the Coalition to present a strategic vision and cogently argue their case for change beyond the usual mantras (budgetary restraint, the supposed moral hazard of supposedly free services) has left the Australian public sceptical about their agenda. A recent poll shows that the majority of voters are concerned about the privatisation of Medicare as well as the possible end of the federal health insurance program in its current form.
This Coalition Government has shown a great reluctance to undertake the hard work of evidence-based policy development. Needed reforms in critical areas like primary care, mental health and Indigenous health have to date involved little more than disruption (of the non-innovative kind), budget cuts, short-term funding, and transfers of responsibility. Most egregiously, this has led to the axing of primary health care research, development and evaluation with the loss of the PHCRED Strategy and BEACH; mental health reforms floundering between PHNs and the NDIS; and efforts to Close the Gap on Indigenous disadvantage making little progress due to significant budget cuts and program delivery increasingly removed from Indigenous organisations.
After three years in office, the positive achievements of this government are few: a review of MBS items that is yet to deliver real changes but offers potential and agreement by most stakeholders to begin the implementation of a ‘medical home’ approach to delivering community-based healthcare for those with chronic and complex conditions. The Government’s biggest success may be that it has united constituencies as diverse as the AMA, the CHF, the AHHA and NACCHO in opposition to its policies.
In Opposition, Labor has worked hard to develop a suite of policies that runs the gamut from prevention to boosted primary care, mental health reforms, suicide prevention and increased hospital funding. These have highlighted the paucity of the Government’s policy portfolio and for the most part have been well received, albeit with valid criticisms about lack of details and funding limitations. Importantly, they have served to push the Government into policy flip-flops and deals on a range of issues, including bulk billing incentives for pathology and diagnostic imaging and (apparently) continued support for headspace and early psychosis programs.
Labor’s most important policy contribution may well turn out to be the recommendation for the establishment of a permanent Australian Healthcare Reform Commission, reporting to COAG, which would include a new Centre for Medicare and Healthcare System Innovation. Such a proposal holds the possibility of making real system reforms possible by isolating them from the electoral cycle and involving all levels of government.
This election seems certain to elevate the roles of the Greens and Independents in the parliament. The Greens deserve credit for a continuing focus on the importance of dental health. Hopefully in the next parliament they will also be a voice for the need to address the health impacts of climate change.
At their best, election platforms and policies are aspirational - their translation from fine words on paper to development, funding and implementation is a long journey that requires leadership and commitment. At their worst, they focus on high profile issues like medical research, and electoral pork-barreling like hospital handouts. This election is a tipping point. Will the next government perpetuate the further erosion of public healthcare services and the retention of a very medicalised focus on hospitals, doctors and prescriptions? Will we get tinkering at the margins of reform? Will a change in government bring more upheavals in the health sector?
What is needed is a focus on national health and wellbeing as well as on healthcare services, and a government brave enough to see this as an investment in equity, productivity and prosperity.
Dr Lesley Russell is an Adjunct Associate Professor at the Menzies Centre for Health Policy at the University of Sydney.