Improving Australia’s health system beyond the election
Tuesday, May 14, 2019, 01:17 AM | Source: Pursuit
By Kim Dalziel, Maarten IJzerman
Australia has one of the best performing health systems in the world.
International evidence from the CONCORD-3 study, a global program which records world-wide cancer survival rates, repeatedly confirms that cancer survival in Australia outperforms many other countries, as does general life expectancy at birth and at age of 65.
And with estimated spending of about 10 per cent of Gross Domestic Product, or about A$5200 per capita per year, Australia also performs above average according to the annual health indicators report of the Organisation for Economic Development.
However, a more detailed analysis of Australia's healthcare sector doesn't justify complacency with the status quo. And the country's three major political parties in the upcoming federal election provide interesting perspectives.
Firstly, while all three parties have different plans to further invest in healthcare, there's little emphasis on improving the performance of the health system as a whole.
Second, all parties promote universal health coverage (UHC) but this requires more thought than simply who is paying the bill. UHC typically is about three questions: Who is covered? What is covered? And what share of the costs are covered by state and federal governments?
Finally, there are global concerns about the sustainability of healthcare systems that aren't addressed by any of the three parties.
Specifically, the emergence of new technologies such as genomic testing and new expensive cancer drugs are placing increasing financial pressure on health systems globally.
These pressures have been referred to as a climate of financial toxicity and it is widely recognised that different approaches to health service financing and delivery will be required to achieve further and sustainable improvements in health outcomes.
Alongside concerns about the growing cost of healthcare are public concerns about equitable access to health services and an equal opportunity to achieve health. And one of the greatest disparities is experienced by Australians living in regional and remote areas.
So, what do the major parties have to say on these issues?
The current Coalition government provided significant investments in biomedical research fostering better treatments and stating that innovative healthcare should be accessible for all.
They also claim increases in public hospital funding and announced several new, expensive drugs listed on the Pharmaceutical Benefits Scheme (PBS), reducing out of pocket expenses to dollars instead of thousands of dollars. But these new drug approvals follow existing bipartisan protocols.
The Coalition promotes reform of the private health system, strengthening primary care, improving access to health services in remote areas and reducing disparities in minority populations.
Unfortunately, with these priorities identified, the Coalition fails to provide an overarching view on how to achieve this and how they will support a more equitable and accessible health system.
Also, the Coalition haven't explicitly raised long-term sustainability of the health system as an issue. They neither refer to financial toxicity – not being able to pay for expensive cancer drugs – or acknowledge the increase in these drugs as a policy issue.
Financial toxicity is expected to become one of the most important problems in cancer policy and a recurring issue when it comes to the sustainability of health systems.
The Australian Labor Party
The ALP has a more comprehensive view of an equitable and accessible health system and have proposed several policies to implement UHC that ensure a transparent and affordable health system.
The ALP also propose governance arrangements to support integration and coordination of services at a regional level (including primary, community, acute, sub- acute, aged and disability).
To do so, the ALP says it will invest in research that addresses health systems efficiencies and promotes public reporting of hospital performance, sometimes referred to as value-based healthcare.
Interestingly, recent public debate has focused on the ALP's $A2.3 billion package to improve cancer services, which includes additional public hospital outpatient funding to reduce waiting times, a new bulk-billing item for consultations and more funding for MRI machines for cancer diagnosis.
But the proposed investments cause some concern.
Firstly, what is the rationale of investing in a single disease when there are more pressing public health concerns? And why do we need an additional investment in MRI screens? This seems a rather isolated investment for which the public benefits aren't clear if one is concerned with integrated cancer services.
For instance, there is quite a bit of evidence that more (and free) imaging also increases false-positive rates at an overall increased cost.
As part of its election promise, the ALP also proposes new cancer drugs are listed on the PBS once approved by experts.
But remember, listing pharmaceuticals is bipartisan, ongoing and subject to protocols unlikely to be changed by an election cycle. However, global experts expect cancer drugs and promising new treatments, like immunotherapy, will become unaffordable and other policies will be needed to control rising costs.
So, the policy to list cancer drugs is more of a signal of ALP's general support for the PBS going forward.
The Australian Greens
Many policies of the Greens are similar to the ALP, but the Greens are keen on further investments in health prevention.
They also have more pronounced ideas about UHC, as well as investments in mental health programs and dental care. The Greens also promote incentives and policies for team coordination in the management of chronic diseases, although those details are thin.
But unlike the ALP, the Greens don't specifically implement policies for cancer patients.
A SHARED VISION?
All three political parties have a shared vision related to their view of how a health system should be designed. UHC and reform for a more transparent health system are priorities for all parties.
This is essential because our ageing population, the growing burden of chronic disease and an increasing life expectancy will all put pressure on our health system, alongside escalating healthcare costs associated with new treatments.
But improving health care isn't simply a matter of investing more dollars. It's also a matter of investing wisely and ensuring our health system is improving health outcomes in the best possible and most efficient way.
Any further discussion about how Australia can move toward more transparent outcomes measurement promoting value-based healthcare should be encouraged.
All three parties are also committed to UHC, but the Greens and the ALP tick most of the boxes – they both propose investments in dental care and make explicit statements about transparency regarding outcomes, access for everyone, affordable and transparent out-of-pocket costs, availability of mental health programs and reform of the private health care.
Labor's proposed investments in cancer services is good news for cancer patients but perhaps need to be thought in terms of justifying policies that improve integrated cancer services instead of single interventions and identifying just one condition.
And, while access to health care is a key-priority, long-term sustainability isn't an issue that's currently addressed as part of the election.
None of the parties have clear views about how to pay for additional investments, which will be the greatest issue for all health systems in the near future.
For instance, policies to implement new treatment and technologies (like dental care and new drugs on the PBS) should be followed by a discussion on how to disinvest in low-value health services.
A version of this article also appears on Election Watch.