Lyn Allison (Victoria, Australian Democrats) Share this | Link to this | Hansard source

By international standards, Australia has a good healthcare system, but it is not good enough. We are there with the high health spenders internationally, but it is not smart spending. The Howard government blames the states and the states say that the federal government is welshing on the deal to pay 50 per cent of hospital costs. The government is not interested in long-term solutions, will not listen to persistent calls for reform and will not ask people who use the system. Swooping in like Dr Who to save the Mersey hospital, in Tasmania, in the lead-up to the election does not count as asking! In fact, that sad little exercise says it all: short term, ad hoc and politically opportunistic. For the sake of a handful of votes in Tasmania, the government has made itself a laughing stock to the rest of the country, and people are asking, ‘Is this the best you can do to solve our problems?’ Even the House of Representatives Standing Committee on Health and Ageing found inefficiencies, duplication, cost-shifting and buck-passing, not that any of this is new.

Ideology has driven the government to see the answers in private health, and the health system has paid dearly for this blinkered view of the world. Australians are very attached to universal access to health, but they are being herded into private health insurance by a government that will not take a hard look at the price—that is, the price to the system overall and the price to individuals who are sick. Our hospitals are full of people who should not be there, not because they are not sick but because better primary care and prevention could have kept them well. If people with mental illness received services when they were needed, if more than a pittance were spent on discouraging smoking and if the government were to insist on a proper system of labelling food the demand for hospital beds would be far less than it is today. If there were a decent public dental health program, people would not end up sick for want of a timely filling. The government takes baby steps, such as funding dental services for people with a small range of chronic illnesses but leaving 650,000 people lingering on waiting lists.

If simple measures like antibiotics for trachoma and treatment for scabies were taken up, these debilitating Third World diseases could be eliminated from our Indigenous communities. The abuse that comes from wilful neglect by governments is at least as serious as sexual assaults on defenceless Aboriginal children. We know there is a chronic shortage of medical staff, so communities go without or we poach them from countries that can ill afford to lose them. Turf wars between professions aggravate the problem. Our outdated MBS system is doctor oriented and rewards expensive diagnostic procedures and interventions over cheaper preventive activities. Rural Australians miss out and people on low to middle incomes are disadvantaged.

So how can we do it better? Good health policy is not just about throwing money around like a drunken sailor; it is about spending money wisely and engaging in long-term visionary solutions. It is time for structural change. Labor says it will establish a national health and hospitals reform commission, but there is no detail yet. The Democrats too want to see a Commonwealth-state health commission, made up of state and federal representatives, to guide reform and to determine priorities intelligently and independently, informed by both the evidence of what works and what people say they need.

It seems to us to be a good idea to pool Commonwealth and state funding to take away the buck-passing and absurd ad hoc decisions and to work with current providers and build into the system incentives linked to health outcomes rather numbers of procedures delivered. Efficiency should be measured not by how soon a patient can be turfed out of hospital but by how rates of preventable illness can be lowered so people stay out. The revolving hospital door of mental illness is a classic and awful example of the lack of alternative services.

Such a commission should identify and contract out the services that are most needed and see that they are properly funded. The Democrats would start with reform of the health workforce, whose structures and practices are, frankly, archaic. Roles and responsibilities should be reorganised, perhaps creating new professions and certainly opening up the MBS to health professionals currently shut out of the Medicare system and to those working more collaboratively in primary health care, outside private practice.

Victoria has a good network of community health centres that ought to be enhanced and replicated around the country. We have made some progress here with psychologists, but there is much that physiotherapists, podiatrists and others can do to keep people healthy and prevent conditions from putting people in hospital. The Productivity Commission says that a five per cent improvement in the productivity of health services would deliver resource savings of around $3 billion every year, which could fund a big shopping list of initiatives.

Many procedures carried out by doctors and specialists could be done by other health professionals. Only 10 per cent of normal pregnancies and births are managed by midwives in Australia. In the Netherlands the figure is 70 per cent and in the UK it is 50 per cent. In the US there are 65,000 nurse practitioners, who prescribe medications, initiate tests and X-rays, refer to specialists and admit and discharge patients. In Australia, we have just 100. We need role renewal, upskilling, multiskilling, broadbanding and teamwork. We need integration of education and employment. We have to make these decisions based on evidence and tackle the barriers put up by some health professions.

We learnt how dangerous our health system was 10 years ago, when the first hospital safety report showed that, each year, 10 per cent of Australian patients suffered an adverse event because of errors and that 18,000 people had died as a result. At least 50 per cent of those deaths were avoidable. A decade ago the estimated cost of this harm was $4.17 billion, and it is probably more like $6.5 billion today.

The Bundaberg hospital scandal showed how staff who notice mistakes are victimised. We need to change the culture to one that is open and transparent. We must have a mandatory, national open disclosure standard to help identify problems and ensure that responsibility is widely shared, including tackling systemic problems.

Private health insurance pushes up health costs and does not deliver better care. Taking into account the 30 per cent rebate, the one per cent tax penalty and other measures, public support for private health insurance costs around $6 billion a year. It should be phased out. Imagine having this kind of money to spend on Indigenous health, mental health and dental services. Alternatively, we could fund private hospital providers directly. They would be better off and the government would have some control over costs, something that the private health insurance rebate has failed to deliver.

The treatment that patients get for the same condition varies widely from doctor to doctor, hospital to hospital and town to town. Perverse financial incentives encourage under and over servicing. We need financial incentives for better care and to let go of our obsession with providing all forms of health care close to home. More local, integrated primary health care is vital, but cost-effective, quality specialised care needs patients to be mobile and we need to support them in their travel. We need state based centres of excellence for certain pressing conditions.

The IT revolution, which has driven productivity gain in other parts of the Australian sector, has passed by the Australian health sector. IT can support better clinical decisions; avoid waste in equipment, supplies and resources; and support continuity of care and self-management. We still do not have a minimal electronic patient record system, after nearly $1 billion has been spent on various projects. Privacy protected electronic patient records would cut out huge amounts of duplication, save time on collecting basic data, cut the need for repeat tests and improve medication adherence.

Choices have to be made in what services can be provided, but the only voices we hear at the present time are those of doctors, pharmaceutical companies and our health ministers. We want a national public dialogue on the health system. We want a national set of expectations that are based on a common set of values, principles and priorities for the health system. We also want a national preventative health task force, like those in the US and Canada, to initiate investment, for instance, in prevention and treatment research.

Australia can have an excellent health system. It is not that hard. It just takes political will, collaboration between levels of government and the Australian people and a much more intelligent, common-good approach to health.