Over the last few years, a large amount of effort and resources has been invested in health care reform. Will it all end up in the dustbin?
This is a distinct possibility. I’ve compiled a short summary below, based on the Australian Healthcare and Hospitals Association election analysis, of what we might expect to find in the bin under a Coalition Government.
But of course these are fluid times, and pre-election commitments may prove to be quite different to what emerges from post-election negotiations… ( this list will give you a sense of the independents’ priorities, including a briefing from Department of Health and Ageing, and here is the PM’s response)
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1. The Coalition proposes to reverse COAG’s commitment to establishing a National Health and Hospitals Network (NHHN). The network was agreed by all jurisdictions (except Western Australia) at the April COAG meeting
2. The Coalition proposes not to proceed with the myhospitals website and has no alternative proposal. The website has been envisaged as a first step in public reporting of hospital performance
3. A key component of the COAG Agreement is national standards for service delivery, measurement and funding. New entities include the Independent Hospital Pricing Authority, the National Performance Authority, the Preventive Health Agency, the National Workforce Agency and the expanded Australian Commission on Safety and Quality in Health Care. The Coalition has made no commitments to national oversight of the health system and would not fund the new bodies established under the COAG Agreement.
4. Rather than the Local Hospital Networks and Medicare Locals, the Coalition would establish a community-controlled hospital system involving individual hospital boards for the 750+ public hospitals in Australia. This policy includes a caveat that, in some areas, major referral hospitals (as yet unspecified) would be associated with smaller hospitals under the same board of governance.
5. Under the COAG Agreement, the Commonwealth Government would fund 60% of the efficient price of public hospital services using activity-based funding formulae and 100% of agreed primary and community healthcare. Under the Coalition’s proposals, the Commonwealth Government would fund 40% of the efficient price of hospital services based on activity and continue to fund ad hoc programs in primary health care.
6. Labor has funded an expansion of elective surgery to ensure more timely access, with more than 76,000 elective surgery procedures delivered in the last two years and over 125 hospitals receiving new elective surgery equipment and operating theatres. The Coalition policy is silent on this issue.
7. Labor has injected $1.5 billion in public hospital emergency departments for emergency department upgrades as well as expanding capacity to rollout a new four hour cap on emergency department waiting times. The Coalition policy is silent on this issue.
8. Labor is committed to build 31 GP Super Clinics that locate a range of services in one location. It will also fund a national after hours GP service with a 24 hour hotline and follow-up visits where appropriate and support to upgrade around 425 GP practices and health clinics. The Coalition will scrap GP Super clinics (except for existing contracts). Instead, it will invest in payments for after-hours GP services. The Coalition will also commit to increasing Medicare rebates for longer consultations, reducing red tape for doctors and increasing and expanding Medicare rebates for practice nurses.
9. Labor has established the Health and Hospitals Fund to make long-term investments for national health infrastructure. This fund has invested $3.2 billion in 32 projects around the country. The Coalition policy is silent on infrastructure support.
10. Funding in the 2010-11 Commonwealth Budget which provided $467m (over 2 years) to implement a person-controlled Electronic Health Record is a small but important start to implementing the National E-Health Strategy. The Coalition has stated that it will not proceed with developing the e-health record.
Oral and dental health
11. Both the major parties have remained silent on what they intend to do about oral and dental health, particularly for those in most need and who can least afford care. The COAG Agreement does not recognise oral and dental health services as a component of primary health care to be transferred to the Commonwealth government and does nothing to advance oral/dental healthcare within the broader health agenda – particularly as oral health is such a vital component of overall health and wellbeing.
12. Mental health is one of Australia’s eight National Health Priority Areas and yet this is not reflected adequately in the health plans of either of the major parties. Mental health problems have a major impact on the community and families and yet there is no attempt by either party to address them through a whole-of-government approach. The Coalition has promised $1.5 billion to increase the number of acute and subacute beds (800) and to expand and establish new Headspace and early psychosis centres, but would be funded largely from savings from cutting ehealth and GP SuperClinics. The Labor party has committed to developing systematic policy in its second term, and in the interim has announced $277 million to fund suicide prevention.
Private Health Insurance rebate
13. The Labor party has promised to means test the private health insurance (PHI) rebate while the Coalition is committed to maintaining the rebate unchanged. The AHHA ideally would like to see the PHI rebate removed with the saved funds directed straight into hospitals (as per the Australian Greens policy), but as a first step recommends means testing the rebate in order to divert some expenditure to the public healthcare sector. The Coalition would retain the PHI rebate.
14. Maldistribution of the health workforce is a serious problem, affecting access to health services outer metropolitan, rural and remote regions. Both Labor and the Coalition have addressed workforce numbers. Labor has promised training for 6,000 more doctors including doubling the number of GPs trained each year; funding for 4,600 practice nurses; and 1,000 additional allied health clinical training scholarships. The Coalition is proposing to double the number of Medical Rural Bonded Scholarships to 200; create 100 nurse practitioner scholarships; provide incentives for nurse practitioners to practice in remote towns without doctors; and pilot a bonded scholarship scheme for 20 dentists in rural and regional areas.