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Friday, June 15, 2018

Our Health System Looks To Be At A Crossroad In Terms Of Sustainability. Digital Health Is Almost Certainly NOT The Answer!

This appeared late last week:

Clinics, hospitals and policies in need of intensive care

  • The Australian
  • 12:00AM June 6, 2018

Sean Parnell

To look at it, Australia’s health system is, for the most part, healthy.
Our practitioners are among the most talented and well-regarded; our hospitals are kept to a high standard; public and universal ­access has served us well; and Medicare remains a trusted brand.
On face value, the health system is what keeps Australians happy and active: our average life expectancy is among the highest in the world. But test the system’s vital signs and you soon realise things aren’t quite as rosy as they seem. As with many of the Australians who rely on it, the system is no longer fit and fabulous, and it is grappling with issues of self-image, public expectations and how it can possibly meet the ideal.
Perhaps the greatest worry, however, is that those responsible for running the health system can’t agree on a course of treatment. Partisan politicking, ruthless lobbying and a deadly combination of ignorance and misinformation are making things a whole lot worse for everyone.
Last week alone, there were suggestions, from all sides, the vital signs weren’t good. Some received more attention than others, yet all centred on the rising cost of healthcare and the impact it was having on access and availability, whether that be the price paid by patients or how long they wait.
This is not to say that rising costs haven’t been an issue before now — they have been, reported extensively in The Australian — but to caution that the prognosis for the system remains unclear. This is as true for Medicare as it is for private health and public hospitals.
In 2015-16, more than $170 billion was spent on healthcare in Australia: almost 67 per cent ($114.5bn) came from governments, 17 per cent from individuals directly, 9 per cent from health insurers and the remainder from injury compensation insurers.
Next financial year, 16 per cent, or $78.8bn, of federal government spending will be on health; more than education and defence combined, and second only to social services and welfare.
Late last month, the Australian Medical Association held its national conference and, going into an election year, attracted speeches from federal Health Minister Greg Hunt, opposition health spokeswoman Catherine King and Greens leader Richard Di Natale. Melbourne GP Tony Bartone was elected the new president, declaring the AMA — the health lobby group politicians fear the most — wanted more money for primary care.
“General practice has been systematically starved of funding, putting at risk its very survival,” Bartone told delegates, to much applause.
Then, the ABC’s doctor-broadcaster Norman Swan had Four Corners look at the problem of privately insured patients being left with unexpected costs. Swan gave shocking examples of a persistent problem. In relation to one $16,000 gap fee, Swan acknow­ledged none of the individual fees were “ridiculous” but questioned whether the system should leave patients so exposed.
Swan said: “In the meantime, it’s up to us to ask questions, get second opinions and negotiate, because a large fee doesn’t mean you’ve got a good doctor.”
Predictably, many responded by reiterating their faith in the public system (or criticising Swan for not going after the insurance sector). Yet federal and state governments, Coalition and Labor members, argue over the cost of public hospitals. Depending on who you listen to, the Abbott and Turnbull governments have stripped billions of dollars from public hospitals or delivered record funding and a new agreement with most states.
The fact the states finally will receive funds this week that they are owed for ser­vices delivered two years ago, after a dispute over unexpected cost blowouts, tells you money doesn’t come easy anywhere in the system.
With several by-elections next month, the federal opposition has petitions going, and leaflets being distributed, declaring “only Labor will fight to fix our hospitals”.
As it pledges $2.8bn more for public hospitals, so they can do more for patients without charge, Labor is also vowing to cap insurers’ premium increases in the private sector and hold an inquiry. Not happy with how insurers raise their revenue, Bill Shorten has accused them of “treating Australians like mugs, gouging people on the basis of a con”.
In Canberra last week, a Senate committee went over the recent federal budget. Amid the usual argy-bargy and calculated responses came a surprisingly candid observation from Health Department secretary Glenys Beauchamp. After the Coalition’s divisive first-term efforts to make the health budget more sustainable, and the damage inflicted by Labor’s “Mediscare” campaign, Beauchamp hinted at unfinished business.
……
So where does that leave Australia as we enter the winter of 2018? For starters, patients desperately need to inform themselves about their health needs, their rights and options, to protect themselves now and into the ­future. Whether you go public or private, there is already considerable variation in the quality and cost of care, and persistent pockets of inequality and the vital signs point only to more pain.
But the question of informed ­financial consent really needs to extend beyond the doctors’ rooms and into the community generally.
Australia needs to have an educated, mature debate about the state of the health system, whom it should serve and how to pay for it into the future.
Otherwise, the blame-shifting and buck-passing will only worsen, confidence will suffer and people will make poor decisions about their healthcare rather than let the system treat them poorly. This can be the beginning of a conversation or the beginning of the end.
The full article is found here:
This is a very useful summary outlining just where we are with our health system. As Sean says (He is the Health Editor for the Australian and an experienced watcher of the system) overall we are doing quite well but there are signs of the wheels beginning to come off and there are a few hard questions we will need to address as he outlines in the last few paras.
One thing I can suggest as an evidence based approach to expenditure in digital health but I guess that is just going too far!
Well worth a read.
David.

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