Will today mark a change towards a fairer health system?
Here in Australia we talk a lot about fairness. But the "fairness" we talk about is not being realised in our current health system, where health care is not available to all, writes Fiona Armstrong.
The National Health and Hospitals Reform Commission (NHHRC) report to be released today will have a large audience; this paper is long awaited by health reform advocates and those with an eye to the sustainability of health care. We are at a critical point in our history in terms of building for the future, with the global economic crisis having profound implications for the way we fund and deliver health services over the next ten, 20 or 50 years.
Our current course is unsustainable, and many of the 500+ submissions to the Commission last year chorused the same tune: that the Australian health system is struggling under the weight of antiquated service delivery and funding structures, a workforce under stress, confusing and ineffective arrangements regarding the responsibilities and accountability of governments, and it is all leading to waste resources and poorly coordinated care.
This is not the sort of health system that will assist us in emerging stronger from the current economic crisis.
Keeping our nation well and able to rise to the challenge of reforming the economy, of creating the green economy we need for long term survival, means keeping people well — keeping everyone well, to reduce the costs of illness and to maximise the productivity of those people as we emerge from the downturn into a new and improved economic future.
Developing countries know that emerging from poverty and financial strife requires investing in the wellbeing of their populations. Witness the example of Cuba, which has high quality primary health care, a strong public health system, a skilled workforce, a healthy research infrastructure, and an impressive record in arresting the spread of disease. They even manage to contribute to the health needs of less developed countries — this poor nation, Cuba, provides a significant number of doctors to boost the workforce in Papua New Guinea and Timor Leste, wealthy Australia’s nearest neighbours! Per capita income in Cuba is in the order of $3,000 — $7,000 per year.
What is important, and what the Cuban example amply demonstrates, is that it is possible to obtain significant improvements in health status if investments are targeted and evidence based. Modest investment, combined with a well-developed public health strategy, have generated health status measures in Cuba comparable with those of much wealthier countries.
As the former health minister of Mexico has said of investing in health: it is not about “providing more money for health; it’s about getting more health for the money”.
Investing in our future requires much more than handouts to help middle class families pay their bills. It requires looking to the future and predicting how the community’s needs will best be met in coming decades, and what infrastructure, skills and services will be required to keep our population well into the future.
The Productivity Commission has clearly demonstrated the potential benefits to the economy of investing in health — a report in 2007 estimated that investments in health promotion and illness prevention could help yield billions of dollars in savings, avoid 97,000 deaths (by 2030), and provide an additional 175,000 people for the workforce (at the time we will need it most — when the baby boomers retire).
Meeting the community’s future health needs cannot be achieved with our current system however. Pressure on our hospitals will only continue to build unless we shift the focus of our health spending and service provision by improving access to comprehensive primary health care, exercising policy that takes into account of the impact of the social determinants of health (income, housing, education, social support, food, environment etc) and ensuring equitable access to health care.
The most cost effective and equitable means of funding health services is through tax-based universal health insurance, through which we all provide health insurance for each other.
The Californian Nurses Association believes a single insurance system is the pathway to economic recovery in the US, with a report released last week outlining how sweeping health care reform could drive that nation’s economic recovery. Extending Medicare to everyone would create 2.6 million new jobs, create $317 billion in new business and public revenues, and provide another $100 billion in wages for the U.S. economy, the report said.
The economies of scale offered by a universal health insurance system provide protection for individual and communities against the costs of health care. This is what Medicare was designed to do, but it is now a shadow of its former self, held together by safety nets, gap payments, and out of pocket charges. For those who struggle financially, who live beyond the metropolitan perimeter, health care is not always available.
Access to health care is about more than just financial access; it must also deal with physical access (health professionals available within a reasonable distance to where one lives); cultural access (services that are culturally appropriate); and it must be appropriate (i.e. evidence based and cost effective).
Here in Australia we talk a lot about fairness. Many people believe our attitude towards it defines us as a nation and a people. But the “fairness” we talk about is not being realised in our current health system, where health care is not available to all. A commitment to fairness should demand that we give everyone access to the same opportunity to be healthy. This means some people may need more access to more care for the same health problem than those with more money, better social support and better opportunities. After all, in the words of Sir William Deane, “the moral measure of a society is how it treats its most vulnerable citizens”.
There is not yet any evidence in the national health policy arena that there is a commitment to investing in health care to realise either the principle of equity, or the recognition that investing in health is a necessary (and sound) investment in our collective future. This needs to change.
The Australian Health Care Reform Alliance (AHCRA) www.healthreform.org.au is an alliance of 50 health professional, consumer, and health service organisations. AHCRA will hold a National Health Reform Summit in Melbourne on 2-3 March 2009 to consider the NHHRC Interim Report. Fiona Armstrong is the current AHCRA Chair.