Impromptu Speech Given 13th November 2009.
What should be done to solve the problems of our already stretched health system?
How do we answer this question within the framework of Green’s principles? Progress in health over recent decades has been deeply unequal so clearly this is a social equity issue.
Many of you will have heard about the National Health and Hospital Reform Commission and their recommendations. The most widely publicised recommendation is to shift responsibility for key health and aged care services from the states to the commonwealth. The report also said that Australia could save $1BN in health costs by preventing half of the mistakes that currently occur….mistakes that occur because staffs are being forced to work longer hours, with less.
One of the biggest money wasters has to be subsidising private health insurance; even Treasury says this is poor policy. It should be abolished; the equitable and efficient way to fund health care is through a universal health system funded via taxation. In this way we all provide health insurance for each other.
Let us look at social equity issues. People with the most means – whose needs for health care are often less – consume the most care whereas those with the least means and greatest health problems consume the least. Public spending on health services most often benefits the rich more than the poor. Health services for poor and marginalised groups are often highly fragmented and severely under-resourced.
NSW suffers greatly, in my opinion, from misdirected care, that is poor resource allocation that focuses on very high cost healing services, allocation that neglects the potential of preventative health. At the same time, the health sector lacks the expertise to mitigate the adverse effects on health from other sectors and to make the most of what these other sectors can contribute to health. This is another case of looking at health as though it was an island. The health sector does not operate in a vacuum. One of the many solutions that can be looked as is how the Transport Sector, for example, can contribute to better health outcomes, or how the Tourism Industry can do the same thing. A complex web of interrelated factors is at work, involving population and social tensions, all with definite, but largely unpredictable, implications for health in the years ahead.
Of course resource allocation is merely a symptom of poor management and institutional structures. Once upon at time there were hospital boards with doctors, nurses and other front line staff. Now we have Centralised Area Health Services run by people with business degrees. Unlike the finance sector, decisions that affect health need to be made at the coal face, not in an office with a lovely view. Having bureaucrats determine financial allocations and hospital goals is a mistake that needs to be addressed. Until hospital performance is measured by how healthy the population is instead of by waiting times, bed numbers and patient turnover we will forever be in this cycle of poor resource allocation.
As well as a monumental push towards preventative health there is a desperate need for better care in the community, especially through general practise and community health centres. When I have spoken to my doctor friends they consistently tell me that they wouldn’t work in remote of country areas because there is no support. In this day and age of technology surely support for rural doctors could be substantially impacted by use of medical informatics. Luckily there are pilot programs where this is beginning to happen around the country.
Preventative health, general practise and systems thinking are the keys to improving health.