“It’s a smarter spend than Labor’s, not a greater spend,” Tony Abbott said. Yesterday’s announcement of Coalition health policy should thus be judged on how the money is spent.

  • No funding for dental (like the ALP).
  • More funding for mental health than the ALP but still nowhere near enough.
  • More funding directly for hospital beds (whatever that means) but less for funding elective surgery and sub-acute hospital beds. So it’s just a different way of getting to the same place.
  • Funds to increase the rebate for GP after hours services but nothing to control the co-payments doctors can charge for those desperate for care.
  • Cutting funding for super clinics (which is almost all just infrastructure funding), and spending it on GP infrastructure for existing clinics (which we know are not predominantly in areas of greatest need).
  • Redirecting ALP funding from salaried nurses and diabetes initiative to more fee for service payments for after hours, chronic disease management, practice nurse activities.
  • Local control of hospitals. The detail indicates these are hospital networks. As acknowledged, the model suggested is similar to Victoria, and the model suggested by the ALP is still not clear but also probably similar.

Then there’s the possibility of taking total control of hospital funding but only if the states agree. It’s probably a non-core idea, but if it ever happened one could confidently predict that Abbott would continue to under-fund the hospitals as he did while health minister. After all, a strong public hospital system would be a threat to the private hospital system.

The Coalition, and sadly many within the ALP, believe that the private system must be supported at all costs including at cost to taxpayers.

Essentially for primary care this policy finds $165 million to improve after hours services and an alternate way to provide some infrastructure grants. It resists any moves away from fee for service  with all its associated problems of inequitable distribution of health funds (must follow provider), co-payments, and barriers to teamwork.

It finds $3.1 billion over a few years for hospitals when we know the shortfall for 50:50 federal/state funding is about $3 billion yearly.

It’s a more simple policy, but with no vision for change except the move to local hospital networks. It requires shelving good initiatives designed to monitor and improve quality. It isn’t clear how this compares in size with the ALP policy but there’s nothing to indicate that the way it is being spent is any better.

If one was looking for a policy that addresses the gross inequities of our health system that are based on financial and geographical barriers to access, then there is little to see.

If one was looking for a policy that redirects our health system away from hospital-based tertiary care towards primary care and preventive health, it is not here.

If one was looking for a policy that recognised the huge challenges of reforming primary care to enable it to provide a patient-centred, integrated multidisciplinary approach to care, forget this policy.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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