Scorecard on health policies

ADDENDUM: This piece was written prior to the weekend announcement by the ALP of its preventive health policy. The AHHA commends the policy, its strategy and its initiatives as a stand-out commitment, making preventive health the cornerstone of its approach to health — AV

HEALTH issues including the Medicare rebates freeze, public hospital funding and co-payments have hit the spotlight in the lead-up to the 2016 federal election, but other vital issues such as Indigenous health and preventive care have been underplayed, according to a review undertaken by the Australian Healthcare and Hospital Association (AHHA).

AHHA members, representing a broad range of stakeholders across the health sector, analysed the publicly announced policies of the national parties to develop the AHHA’s Australian election 2016 health policy scorecard.

Commitment to universal health care principles

Public health care is being severely tested by uncoordinated reforms, financial strain and increasing demand. Although Australians have had access to universal health care for over 30 years, our system is not immune to pressures such as an ageing population, rising rates of chronic disease and escalating health care costs.

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AHHA reviewers found that all parties recognised the disadvantaged and under-serviced groups with respect to health policy.
However, there is little policy detail as to how the discrepancies in health outcomes for these groups will be addressed.

The Coalition was singled out for the negative impact of its policies freezing payment indexation and raising the possibility of co-payments for health services – this increases the risk that access and equity, particularly for vulnerable groups, will be eroded.

All parties are supportive of Closing the Gap in Aboriginal and Torres Strait Islander health, with Labor considering broader systemic issues, such as a possible treaty and the central role of the National Aboriginal Community Controlled Health Organisation. However, announcements from all parties give minimal consideration to the major health challenges facing Aboriginal and Torres Strait Islander people.

Commitment to long-term sustainable funding

Reviewers scored the Greens highly on their pledge to legislate the Commonwealth’s share of health funding for the states and territories. Labor’s Australian Healthcare Reform Commission was praised as a potential positive force for system reform.

However, reviewers cautioned that independence in the pricing of hospital services must be maintained via the Independent Hospital Pricing Authority, which Labor would fold into the commission. Policies for innovative models of patient-centred, integrated care, such as the Coalition’s Health Care Homes and Labor’s Your Family Doctor, were welcomed but reviewers questioned the adequacy of the Coalition’s funding commitment to Health Care Homes.

Policies to support integration

A whole-of-system approach to reform is needed to ensure Australians with multiple care needs are able to access the services they require with minimal difficulty. As our population ages and the rates of chronic disease rise, more Australians will find themselves in need of multiple types of care. Greater integration is required to ensure better service delivery and health outcomes.

The Greens, the Coalition and Labor were all praised by our reviewers for supporting Primary Health Networks and including them in policy positions. Questions were raised over the patchy commitment towards addressing the increasing burden of mental health.
All parties were urged to target better health outcomes via quality outcomes-based funding.

Commitment to preventive care

Expenditure on preventive health measures is necessary if we are to reduce future demand on the health system and improve health outcomes for all Australians.

While all parties committed to specific programs, there was a lack of unequivocal funding support for a broader preventive care strategy. The Greens’ Active Transport policy to invest in cycling and walking came closest to true upstream prevention policies.

Longstanding multipartisan support for action on immunisation and tobacco has not been replicated in preventive health policy announcements in this election campaign, and there is an ongoing absence of broad cohesive strategy for preventive health.

Commitment to quality outcomes

Maintaining the status quo and tinkering around the edges of system reform, exemplified by current multiple review processes, will not provide a future-proofed health system. Traditional approaches of measuring outputs rather than outcomes do not capture elements of quality and safety, nor do they reflect patient experience.

Reviewers found that the Greens and the Coalition expressed support for reform focusing on quality outcomes, but only Labor had attempted to articulate how it might be achieved. Details of the announced policies remain unclear and will be key in determining the quality of outcomes achieved.

Policies to support innovation

Australia has a high quality, world-class health system, but for some groups health outcomes are poor. Innovative approaches to health services delivery, underpinned by a strong evidence base, are needed to respond to these challenges. 

Shared electronic health records remain a weakness in developing innovative models of care; all parties recognise the need for a workable electronic health record system, but there is no clear articulation of how the impediments will be addressed.

Our reviewers found that Labor’s pledge for an Australian Healthcare Reform Commission was positive, but warned against the potential to dilute the specific focuses of the agencies it will merge into the Commission. The Coalition’s establishment of the Medical Research Future Fund and their commitment to improving access to clinical trials was applauded, but it was noted that health systems research should be in scope for the Fund.

Commitment to working collaboratively with the states and territories

Governments and the health sector agree that current arrangements in health policy and funding between the Commonwealth and the states and territories are not working as well as they should and are limiting the ability to deliver effective, accessible, equitable and sustainable health care focused on quality outcomes.

Reviewers praised Labor for their frequently articulated commitment to working collaboratively with states and territories. While the Coalition has begun to re-establish relationships with states and territories, developing durable partnerships will take significant work.

Conclusion

The Coalition has made some amends for the damaging cuts in the 2014-15 Budget, but some policies continue to exacerbate issues of access, equity and sustainability. Labor’s support for universal care is welcome, but further development of the party’s reform proposals will be important. The Greens are strong supporters of universal care and have announced positive policy proposals, but gaps remain.

The AHHA urges all parties seeking election to commit to maintaining a healthy Australia, supported by the best possible health system.

Alison Verhoeven is the Chief Executive Officer of the Australian Healthcare and Hospitals Association, the independent peak membership body and advocate for the Australian health care system and a national voice for universally accessible, high quality health care in Australia.