THIS year will be a critical time for federally funded health care in Australia and many of us are wondering which direction we will take.
Will we see the dismantling of Medicare and health care services as we know them, or the rebuilding and restructuring of both the system of care and the way we finance it, to better meet the needs of all Australians?
In its first year, the Abbott government has torn down and cast aside policies and programs of the previous government and commitments it made in election mode. Central to these is the undermining of the financial base for acute care services, by the clawback of an estimated $50 billion over the next decade from the National Health Reform payments to the states and territories and the abandonment of activity-based hospital funding.
Primary care is central to a sustainable health care system but the government clumsily undermines this, initially by attempting to add patient copayments to medical consultations and increase copayments for prescription medicines. The resulting public backlash saw a change of direction at the end of last year, with the government announcing the Medicare copayments would be replaced by a $5-cut to the rebate for general practice consultations, together with changes to time requirements for level B consultations and a six year pause in fee indexation. In the face of continued vehement opposition, the government has now said it will go back to the drawing board in a more consultative mode.
The reasons given in support of changes to Medicare are confusing and incompatible: price signals, contributions to meeting unsustainable costs and financing medical research.
The highly regressive nature of these changes and other non-health Budget measures will hit the poor hardest. Social inequalities in health will rise and health status will fall.
The conversion of Medicare Locals to Primary Care Networks, estimated to cost $112 million, was not supported by a compelling policy argument. The abolition of the Australian National Preventive Health Agency, Health Workforce Australia and General Practice Education and Training will be keenly felt.
Most egregiously, net savings of $534 million have been taken from Indigenous programs, and the transfer of Indigenous affairs to the Department of Prime Minister and Cabinet in the name of “rationalisation” has seen a real loss of momentum that further diminishes chances of meeting Closing the Gap targets.
Australia must make 2015 the year to move back to a more measured approach to health care, doing the hard yards of policy development, consultation and careful implementation.
The federal government needs to rebuild its approach to health and health care based on strong partnerships with the Council of Australian Governments, health professionals, communities and the public. Its agenda must put consumers at the centre of the health care system, and it must demonstrate a willingness to make long-term, evidence-based investments that will deliver better health outcomes, greater productivity and sustainable health care costs.
There is no shortage of collated evidence and expert advice available to the government to use in developing policy. Conversations with political insiders or those whose self-interests dominate are no substitutes for thinking, debating and developing policy.
The work of the National Health and Hospitals Reform Council, the National Primary Health Care Reference Group and the National Preventative Health Task Force is also there to be critiqued and used, not cast side.
There is a strong case for health policy reform in Australia. Our high international ranking for life expectancy hides a multitude of problems, including years lost needlessly to disability, growing health disparities in some population groups, a health workforce that does not reflect current and future needs in its make-up and distribution, outdated reimbursement methods, and a failure to direct spending to where it is most needed and can achieve the best value.
Savings in health expenditure are possible, but knowledge and hard work are required to find and realise them.
Health care systems, while complex, must be flexible, innovative, responsive to evaluation and benchmarking and efficient.
Australia has many internationally recognised experts in key health policy disciplines just waiting for a call from the Minister for Health to contribute their expertise to rebuilding, reforming and delivering better health for all Australians.
Professor Lesley Russell is an adjunct associate professor at the Menzies Centre for Health Policy at the University of Sydney.
Professor Stephen Leeder is the editor-in-chief of the MJA and emeritus professor of public health and community medicine at the University of Sydney.
Thanks to Professor Bruce Armstrong for his comments and insights.
Jane McCredie is on leave.