After 16 reviews we know how to fix healthcare, experts say

After 16 reviews we know how to fix healthcare, experts say

Tom McIlroy  Feb 28, 2019

After 16 national reviews in 35 years, the road map for improving the healthcare system is well known and government should get to work implementing necessary structural reforms.

That’s the blunt message from think tank the Australian Health Policy Collaboration, which says experts keep agreeing with each other that the system is too complex and under stress but have avoided creating a body to lead long-term change at a national level.

The report by the group, part of Victoria University’s Mitchell Institute, says while the country spends more than $180 billion a year on healthcare, just 1.34 per cent goes to reducing health risks and preventing disease.

After Labor said this month it would create a permanent health reform commission if it wins the federal election, the report says decades of reviews have shown health service design, funding and operations are the major contributors to inefficiency.

It says chronic diseases account for 90 per cent of all deaths and urges federal and state governments to agree on a national steward to lead long-term planning and a restructure of financing based on simpler access and improved care.

Half of all Australians live with at least one chronic disease, and almost 25 per cent have at least two.

Between 2013 and 2017 there were 49,227 premature deaths, with more people in lower socio-economic groups dying from chronic disease before the age of 75.

People in the most disadvantaged areas were found to be 57 per cent more likely to be obese and 60 per cent more likely to be living with diabetes. They were also 2.5 times more likely to smoke.

All the reviews are ‘strikingly consistent’

More than 16 per cent of adults skip medical consultations due to cost while 7.3 per cent delay or go without necessary prescription medicines.

The report says while the original intentions of Medicare were widely valued, a series of amendments and workarounds have made the scheme difficult for consumers and providers, with a complex set of services and multiple payers.

“Breaking down the current inefficient arrangements between states, the Australian government, private health insurers and individuals would allow for new payment systems. Australia needs governments and health leaders to take the advice that is in place and get on with building a health system that is simpler, fairer and more affordable for all Australians,” it says.

Victoria University’s Rosemary Calder said reviews dating back to 1987 were “strikingly consistent” and provide a clear pathway to effective reform.

“Unless we make fundamental changes, the costs of chronic illness and resulting healthcare demand will continue to be a major issue for individuals and families and for governments” Professor Calder said.

“The health system is awkward and difficult to navigate for individuals who need care from general practitioners, one or more specialists and sometimes hospital care, often with geographical distance adding to the time and energy required to manage the health care they need.

“For too many, the costs of the care they need become prohibitive.”

Labor wants its new independent legislated body to have similar standing to the Productivity Commission, and be answerable to the federal, state and territory governments through the Council of Australian Governments.

Notre Dame University dean of medicine Christine Bennett, who led Kevin Rudd’s 2009 review, suggested combining elements of the Productivity Commission and the Reserve Bank for the best outcomes.