The foundations of the nation’s health system are being undermined by a dangerous period of policy drift characterised by piecemeal approaches to major challenges, AMA President Professor Brian Owler has warned.

In a major televised speech, Professor Owler bemoaned a lack of vision and resolve among the nation’s political leaders on health, and called for the formulation of an overarching National Health Strategy.

He said that too often, the slogan that health care should be about the ‘right care, right place, by the right person’, had become little more than code for cost shifting and responsibility ducking.

“A long-term, bipartisan National Health Strategy may be difficult to achieve, but allowing our health care system to meander risks its future, and allows its foundations to be undermined piece by piece,” the AMA President said. “A National Health Strategy should guide our health policy, our decisions, and any future reform of the health care system.”

Professor Owler’s call received strong backing from the Australian Health Care Reform Alliance, a coalition of peak health groups, which said the AMA President’s speech was “a wake-up call” on the need for national health strategy and greater focus on preventive and primary care.

“Apart from a focus on funding cuts with little evidence of their value and long-term impacts, the Government has not articulated its values and intentions to tackle the variety of urgent issues reducing the effectiveness and fairness of our health systems,” AHCRA Chair Tony McBride said. “Saving money by randomly cutting services, such as funds for…public hospitals and…for NGOs appears to be the extent of the Government’s vision for health.”

The outlook for health has for years been clouded by unresolved Commonwealth-State tensions and disagreements over funding and lines of responsibility.

Professor Owler said a national leaders’ retreat held last month to consider the division of health responsibilities and funding as part of reform of the Federation was a welcome first step, but talks limited to rearranging tasks or raising a little more revenue by themselves were not enough.

He called for a thoroughgoing reassessment and change in the way health is considered by governments.

“Health should not be an annoyance – a concerning budget line to be dealt with,” he said. “Health is an essential ingredient to any economy.

“We need to see health care expenditure not as a waste, but as an investment.”

The AMA President held up the Federal Government’s approach to Indigenous wellbeing as an example of the muddled and ineffective policymaking that can arise in the absence of an overarching strategy.

The Commonwealth has instituted a crackdown on truancy among Aboriginal children and carrot-and-stick measures to boost Indigenous employment.

But Professor Owler said that, by neglecting health, the Government’s strategy would achieve only limited success in closing the gap.

“The lack of focus on health is one of the reasons why I struggle to understand the Government’s Indigenous advancement strategy,” he said. “Making kids go to school, encouraging young people to get a job, and making a safer society are all noble objectives. But health must underpin these strategies, particularly when it comes to Closing the Gap.”

The AMA President said a more honest and incisive assessment of the health system was needed to identify and take advantage of opportunities to achieve better and more cost-efficient care.

He said that, contrary to the claim of politicians, health spending was not out of control, though he acknowledged that scarce health dollars could be used to greater effect.

Rather than trying to hold down health spending by rationing access to care and other punitive measures, Professor Owler said a smarter approach was to drive dollars further by improving health system integration, particularly through the use of information technologies.

In addition, he said, governments should invest in general practice to help care for patients with complex and chronic conditions and to upgrade preventive health initiatives.

“Investment in general practice is essential if we are going to keep people well and in the community,” the AMA President said.

“Seven per cent of hospital admissions may be avoidable with timely and effective provision of non-hospital or primary health care.

“Our family doctors are the cornerstone of chronic disease management. They need to be supported to do this work with investment, funding, and resources.”

Mr McBride said that the Government should search for efficiencies before resorting to rhetoric and fearmongering about “unsustainable” health expenditure: “This means being smarter about what services we fund, not just cutting them.”

Adrian Rollins