Health reform is hitting the headlines, and the PM is due to address the National Press Club tomorrow at 12.30pm on Building Australia’s Future: Better Health, Better Hospitals.
Croakey has put out a call to the Crikey Health and Medical Panel: what are the key questions journalists should ask Rudd about his health reform plans?
Here are some suggestions from a range of experts.
Andrew Podger, President, Institute of Public Administration Australia (and former federal health department secretary)
1. Will the new system allow a community or region to re-allocate resources between in-patient, out-patient, sub-acute and primary care to respond to their health priorities?
2. What standards of governance will the Commonwealth insist upon? Will there be requirements for merit-based appointment of hospital boards? Will boards appoint CEOs? Under what circumstances would a board be dismissed, and by whom?
3. Do you support the NHHRC proposal to progressively increase to 100% the Commonwealth contribution to the costs of public hospitals?
Carol Bennett, Consumers Health Forum:
1. Can you explain how this change in funding and governance arrangements will improve health outcomes and put patients back at the centre of the health system, especially given you, your health minister and the NHHRC have consistently argued that health reform should achieve these two goals?
2. What input will health consumers and the community have in the governance arrangements either at a national level or for each hospital and does this make hospitals more responsive to their communities?
3. Will information on hospital patient outcomes be made available to the whole community, and if so, how does knowing your nearest hospital is a poor performer improve your options or local health outcomes?
Professor Stephen Leeder, director, Menzies Centre for Health Policy, University of Sydney:
1. How will he measure outcomes – improvements in health – as opposed to outputs which at present he proposes to reward? Outcomes concern the nutritional value and flavour of the sausages. Outputs as in case-mix are just sausages – neatly packaged, vacuum sealed, but untested sausages of variable quality nevertheless.
2. How will health professionals innovate in this brave new anal-retentive world – try out new ideas for care with a serious risk of failure – if the funding is all tied to outputs (toilet training a three year old comes to mind)?
3. How will linkage of hospital and community services actually occur to benefit patients with chronic illness if all the funding limited to hospitals masking look alike sausages (or poos)?
4. Where does teaching and research fit?
Professor Ian Hickie, executive director, Brain and Mind Research Institute:
1. How does activity based funding do anything for the major inequalites in health care, specifically mental health, dental health, Indigenous care, and aged care?
2. How does activity based funding support health innovation and specifically a decreased reliance on in-hospital care and short term treament options?
3. How does activity based funding reward those who focus on better outcomes especially those with chronic disease?
Health policy analyst Yvonne Luxford:
1. How will the measures you are proposing improve the health of Indigenous Australians?
2. a) Given that the stated objective has been to keep people healthy and out of hospital, why haven’t comprehensive announcements been made about prevention before addressing hospitals?
b) Will the Government commit to adopting all of the recommendations detailed within the report of the National Preventative Health Taskforce?
3. How will these measures assist in the care of the growing number of Australians suffering from chronic disease?
Dr Patrick Bolton, health service manager:
The lead question for me is “what is the problem that he is trying to fix and how will he tell that it is fixed?”. There is a lot of dissatisfaction with the system, but we enjoy the best health as measured by life expectancy of almost any nation, we pay in the middle of the pack for healthcare. It is more accessible and affordable than some. Sure, there is the issue of the aging population, but the intergenerational report also said that wealth was going to grow by 80% in the next 40 years and health is a superior good, so the argument that we can’t afford it needs careful scrutiny.
The other question is “where’s the equity?” It may of course be obvious when all is revealed, but I don’t think this is likely. We don’t currently have equity of dollar allocation, with rural and Aboriginal communities getting less than affluent communities because dollars follow the providers and the providers like to treat and live among the rich. This however could be fixed if there was the political will. Equity of service provision would be harder, even for those services which do not require a population base for quality and economy. Given the work of Marmot and Wilkinson we know that equity is the key determinant of health in first world nations. It would be nice to think that a policy to advance the health of Australians built on this evidence.
Retired GP, Dr Peter Arnold:
1. What sustainable plans does he have for providing health care to rural and remote Australians?
2. Does he have any commitment to evidence-based health-care?
3. If so, why is his Education Minister proposing that Chinese traditional medicine, which has no scientific basis, be taught in the school science curriculum?
Health economist Professor Gavin Mooney:
1. Why don’t you ask the Australian people what they want by way of a health service?
2. Why are you doing little or nothing on inequities in Australian health and health care?
2. Why don’t you ask Aboriginal people what they want to improve their health?
Ian McAuley, a Centre for Policy Development Fellow and lecturer in Public Sector Finance at the University of Canberra
1. Assuming PM’s focus is on hospitals – how will you integrate hospital and primary care?
2. Will you bring private hospitals into Medicare funding?
3. How is your government’s strong encouragement for high income people to hold private health insurance compatible with your government’s policy of “social inclusion”?
Dr Peter Mansfield, Healthy Skepticism:
1. Given that misleading promotion of health products (including pharmaceuticals) has killed far more Australians than terrorists during the past decade, why isn’t the government giving the issue proportionate attention?