Putting patients before premiers' egos
April 19, 2010
Prime Minister Kevin Rudd has been attempting to persuade state premiers to agree to his government's health reform proposals. The negotiations have produced an unseemly display of political brinkmanship, chiefly from Victorian Premier John Brumby, who is anxious to show some political muscle ahead of this year's state election.
His proud boast that Victoria has the best health system came unstuck during his 'Putting Patients First' address to the National Press Club last Wednesday. He was particularly rattled by this question from Sue Dunlevy of the Daily Telegraph:
Victoria's hospitals see fewer emergency and elective surgery patients within the recommended time than hospitals in NSW. You spend $123 less per patient than NSW. Your hospital system provides fewer beds per thousand people than NSW. And your hospital performance has been going backwards for five years. Why should you be regarded as some kind of authority on health? And why should patients in other states have to put up with a second-rate system because someone who can't run his own health system is behaving like a bully?
It doesn't matter which state has the best health system. And a state boasting that its system is better than other states' systems is not putting the wellbeing of patients first. It is a source of shame that some states have better health systems than others. Having so many separate health systems is most likely holding us back.
It's even worse that a leader appears to be proudly endorsing this inequality in health services available to Australians. There's no question that all Australians must be equal in the eyes of the nation's federal and state health policymakers. Perhaps Brumby's brinkmanship is the best argument in favour of the Prime Minister's attempt to wrest control of health from the states.
A recent collection of essays from social advocacy group Catalyst Australia titled Equality Speaks: Challenges for a Fair Society includes a succinct analysis of Australia's health care system that points to the need for greater coordination.
Australia's ability to tackle inequitable health outcomes is greatly hampered by a complex health delivery system traversing Federal and State jurisdictions and private and public health services. In all there are nine departments of health in Australia for just 20 million people.
Moreover putting patients first for a fairer and more equal society involves forgetting not only about state fiefdoms, but departmental fiefdoms as well. Catalyst Executive Director Jo-anne Schofield, who wrote the health policy analysis, believes undue attention to performance indicators such as hospital emergency waiting times can miss the point of health reform. She says it's about 'building communities where opportunity can flourish'.
Even lifestyle interventions through preventative programs can fly in the face of genuine health reform, as evidence shows that such targeted interventions mostly succeed among more advantaged groups. Schofield says prevention will have little impact if the social determinants of health are not considered, including factors which result in social exclusion such as poverty, disability, poor social support and lack of education and skills.
Putting patients first is about understanding the social context of those with the most acute health challenges, not the construction of political ego.
The Catalyst collection is a print publication, but Catalyst has kindly made a PDF file of the health chapter available to Eureka Street readers for download here.
Michael Mullins is editor of Eureka Street.
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19 Apr 2010
An excellent and most relevant appropriate comment on the Federal health reform proposal.
19 Apr 2010
Well said, Sue Dunlevy. Politicians need to hear more straight talking like that from a fearless, informed media.
19 Apr 2010
It's patently clear that the present Victorian Labor government is behaving like a runaway totalitarian ruling clan, aided by the business sector. With Labor at the helm, the top end of the city finds a willing listener. Unlike the Libs, Labor politicians tend to come from a class of wannabees; who'd give their right arm to be wined and dined by the state's A list. On retirement, most of the Labor pollies would be engaged as consultants by the very class (of people) they vehemently oppose. Brumby is no exception. The pity of it all is that here in Victoria, HRM Opposition is not fit to take the reins even if they were given to them. It's also a pity that ES is not widely read by the intelligent portion of the electorate.
19 Apr 2010
It has been very frustrating and disappointing listening to what has purported to be a debate about a national health system. Like much else in Australia it has been reduced to sound bites and simplicity rather than addressing the complexity of meeting health needs across the spectrum, from early life through to old age. Instead as Professor Ian Hickie points out in today's Age, there has been an overemphasis on the acute sector at the expense of wider health needs (see Unhealthy Focus on Acute Care). For healthy communities we need to keep people out of hospital. Even now hospital admissions represent only a small proportion, albeit important and highly visible, of most people's encounters with the health system. Yet where is the detailed discussion and analysis of primary health care and preventative programs? The National Hospital and Health Reform Commission reported on a system out of balance, with its overwhelming focus on the acute sector, emphasising the need to 'embed early detection and prevention'. Media contributions have been mostly superficial and simplistic. It's all very well to sling off at John Brumby and to congratulate Sue Dunleavy on her apparently insightful question, but she misses the point. Victoria does have something to defend- of all the states, Victoria has made a concerted effort over several years towards integrating primary health care and chronic disease management, much of it through coordination between agencies and community health services delivering community-based care. Victoria's approach is not perfect but it has much going for it as a model for other states. Victoria is rightly concerned that with the funding and policy focus mainly on hospitals, the other components of the health system will be diminished. Maybe it is not just political ego out of control as you imply.
19 Apr 2010
Victorian hospitals fall down in a number of ways: there are too few beds for the demands ( although some of the demands are due to poor primary and aged care services...Feds!), and this pressure makes each of the bigger hospitals behave like fortress states protecting their turf rather than sharing the burden with weaker outer metropolitan hospitals in particular (and outer met health services are really big bad issues in Melbourne, while rural gets all the headlines!). When Labor dismantled Kennett`s health networks, which they did presumably just to be different (and because they could!), things got decidedly worse.Single hospital boards just make for more inter-hospital competition rather than cooperation.Sue Dunlevy is quite right.
Brumby is probably right in that funds would be best pooled at State level, with States responsibile for running public hospitals, while Commonwealth sets standards and funding norms, and audits/publishes outcomes.
Commonwealth should get out of subsidising private specialist care in any form, though the private sector could tender for public work. The huge amount of money that procedural specialists make out of the taxpayer through medicare, subsidies on private insurance and so-called safety net etc is a national disgrace AND SCANDAL, but not apparently yet part of anyone's reforms!!!
19 Apr 2010
An excellent analysis of the situation, and a poignant point about creating a fairer Australia for all its citizens.