Now that the problems of public hospitals have been “fixed”*, can we please start talking and thinking about some of the country’s other, equally pressing health problems?

It is well past time that primary health care — the sort provided by GPs, dentists, community nurses and dietitians, for example — received the sort of attention and effort that our leaders have been devoting to hospitals. If this could be managed, we might start to do something that actually improves the country’s overall health, rather than simply addressing the political pain caused by headlines about hospital waiting lists and disasters.

In a presentation at the University of Sydney yesterday, health economist Professor Gavin Mooney offered an analysis of the state of primary care that was simultaneously depressing and encouraging.

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It was depressing because he’s spot on in describing the sector as “weak, badly organised and demoralised”. He also argued that it’s “currently driven largely by what GPs want and too little by what the community wants”.

But Mooney, of Curtin University of Technology in Perth, also had some interesting suggestions for the way forward. Firstly, efforts are needed to tackle the power imbalance which sees hospitals and medical specialists dominate debate and funding.

He suggests transforming divisions of general practice into much larger, more broadly based and powerful organisations funded to provide a range of services, including those from GPs, physiotherapists, dentists, psychologists and speech therapists.

They would be called “primary care centres for health” in recognition of their broad mandate to also act as public health advocates, working on the social determinants of health, such as negotiating with town planners.

Mooney also argues that involving the community more in decisions about health spending would help boost primary care. Not one of six citizens’ juries he has facilitated has argued for more money to be spent on hospitals. Instead, they have opted for increased spending on primary care because, believe it or not, most people value equity and fairness in health care. And boosting primary care is widely acknowledged as the best way to improve equity in health.

So, here’s a thought to end a week of political backslapping about the new healthy federalism. The Rudd Government has been successful in imposing tougher reporting on the states for public hospitals.

It’s time to turn the tables. Where is the push for the Feds to report on both our access to primary care, and the quality and safety of these services? For example, how many people with diabetes can see a dietitian when they need to? How many country people with mental health problems can see a psychologist when they need to? How many people can see a GP when they need help after hours?

(* Of course, the problems of public hospitals haven’t been fixed. It will take a lot more than extra money and better reporting to transform such notoriously inflexible and change resistant institutions. In fact, it’s entirely likely that the problems of hospitals will be around as long as hospitals themselves. )

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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