As reported in this morning’s Australian, the Bennett Report recommends a federal-takeover of all aspects of primary health care because there is “compelling international evidence that demonstrates the benefits of strong primary healthcare services in improving health outcomes for people.” To this end, the report apparently advises the federal government to transform its planned network of GP Super Clinics into ‘Mega-Clinics’, offering an even larger range of Medicare-funded, community-based services.
Let’s remember where all this began. When the Howard Government was in its death-throes, then Opposition leader Kevin Rudd pushed himself over the top with the electorate by promising to “end the blame game” over public hospitals. The Prime Minister and Health Minister Nicola Roxon appeared to deliver on Labor’s commitment to evidence-based policy by appointing the hand-picked National Health and Hospital Reform Commission to draw up a ‘blueprint’ for root-and-branch health reform.
It now seems that we have a report which echoes the federal government’s well-established policy line, which is that the best strategy to solve the hospital crisis is to “invest” in primary care to “keep people well and out of hospital”.
Let’s also remember that endlessly seeking to avoid the need for hospitalisation is a Sissphyean labour. The better prevention we have, the longer people will live, until older and sicker patients inevitably require admission to hospital. Emergency departments are struggling around the country because public hospitals don’t have enough beds into which to admit rising numbers of acutely-ill elderly patients who cannot be treated elsewhere in the health system.
Unfortunately, the approach the Bennett Report endorses — which is beloved of funding-seeking primary care, community health and public health lobby groups — fails even the first test of evidence-based policy.
The claim, familiar to those who follow the health policy debate, is that countries with health systems oriented towards ‘preventive’ primary care achieve better health outcomes at a lower cost, especially in areas like chronic disease, than do health systems oriented towards more expensive hospital-based care.
However, the so-called international evidence is not as authoritative as claimed. Some studies, mainly from the United States, have linked higher provision of primary care to lower mortality. Yet even these studies admit they contain no evidence that receipt of primary care actually had a preventive effective and reduced risk factors like obesity or actually lowered the incidence of chronic disease.
Moreover, it may well be that higher provision of primary care improves health outcomes because more patients receive timely diagnoses and referral to necessary hospital care. Hence these studies also admit that improved health outcomes depend on an ‘appropriate balance’ between primary and secondary care, and that “international comparisons and studies within the United States point to this conclusion.”
For example, a 2002 cross-country analysis of 13 OECD members showed that countries with comparatively “weaker” primary care systems — including Australia — that spent more on hospital care achieved better health outcomes than those with a stronger orientation to primary care. In other words, the international evidence suggests that access to higher costing hospital care, rather than strong primary care alone, produces better health outcomes.
The point is that greater government spending on primary care is no silver bullet for the ailing hospital system as the champions of this approach would have us believe. Rather than evidence-based policy, this is a policy looking for an evidence-base.
At best, the recommendations of the Bennett Report will probably amount to wishful thinking. At worst, it will mislead policy-makers and outline a ‘reform’ strategy that gives governments an excuse to avoid addressing with the real issue: the dysfunctional funding and governance arrangements that allow inefficient State-run public hospital systems to churn through billions of taxpayer’s dollars while failing to deliver a safe and adequate standard of basic emergency and hospital care.