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Questioning medical dominance « Previous | |Next »
September 30, 2005

Do we have the beginings of health care reform in Australia, as opposed to the day to day political management of media headlines by the states in relation to to hospital queues and mental health? We saw some signs of this with federal Treasury's recent interest.

Treasury is obliged to do so because health spending is rising. Today's Australian Financial Review reports that the Australian Institute of Health and Welfare publication Health Expenditure Australia 2003-2004 states that health spending accounts for 9.7% of Australia's economy, that it is rising faster than both inflation and economic growth, and that households are bearing the brunt of rising health costs.

Yesterday the Productivity Commission released an issues paper on the health workforce. Entitled 'Australia’s Health Workforce' it acknowledges a key problem, namely:

There are considerable pressures on Australia’s health workforce — as evidenced by shortages of supply in some professions, particularly (but not only) outside the major population centres, and a significant reliance on overseas trained professionals. In the future, ageing of the population will compound the impacts of other factors that will increase demand for health workforce services.

This supply shortage is well known in terms of primary health care, emergency and acute hospital services and specialist services. The Commission then opens up two ways to address this shortage:
Initiatives to boost the numbers of education and training places will be an important part of the response to both current shortages and increased future demand for health workers. But there is also scope and need to increase the productivity and effectiveness of the available health workforce and to reduce its maldistribution. Addressing a range of systemic impediments will enhance the capacity of the workforce to respond in an efficient and timely manner to the challenges of the future.

That puts an emphasis on increasing the productivity of health professionals as well maintaining high standards. The AMA mostly talks in terms of safety and standards and protecting doctors as gatekeepers of the health care system.

The Productivity Commission's economic approach to health care reform has implications for GPs, biomedicine and medical dominance because the continual propping up of GP's and medical specialists to ensure high health safety standards will not ensure a healthy population or wellness. The medical bodies have a lot of poiltical clout, and their big union, the AMA, consistently runs a safety fear campaign whenever their patch protection, cash flow, closed shop culture and status is criticised and challenged.

The Federal Government does recognize this. Tony Abbott, the Minister of Health and Ageing, is reported as saying:

The Government has no wish to diminish the role and the standing of the medical profession. But while respecting the knowledge, the commitment and place of the medical profession we obviously want to make full use of the whole of our health work force.

That means an increased role for allied health care professionals. The writing is on the wall in that it challenges the AMA's position that health care reform threatens standards and that only doctors can, and should, deliver health care. As they see it, they own Medicare. However, as yesterdays editorial in the Australian Financial Review pointed out, Australia has needed health care refrom for decades. The health system can be reformed without threatening standards.

What does this mean in terms of health care reform? Does it mean simply streamlining the system to ensure a cost-efficient health service? Not necessarily. One pathway of reform is for the state governments to allow hospitals to step in and coordinate the allocation and supply of all health care workers. Another pathway is suggested by Federal Treasury in the 2005 Winter issue of Economic Roundup. The relevant article is by Janine Murphy and it is entitled ">Health Promotion. Another reform pathway is to shift the focus away the medical institutions and their patch protection battles to the consumer. This would loosen up the medical market through competition to allow consumers to express their choice and sovereignty about the health they wanted.

Good public health policy should move into a reform mode to ensure the wellbeing of the Australian population. That means making sure that the neo-liberals do not succeed in increasing tax cuts by cutting back on health services to deal with the rising costs of health. It also means making sure that growth expenditure is addressed through health care reform to achieve population wellbeing and not cost cutting by razor gangs in the Department of Finance to keep the budget in surplus.

Maybe, just maybe, the pressures within the health care system have built up to a point where the Howard Government will accept the Productivity Commission's recommendations to increase the productivity of the health care workforce.

| Posted by Gary Sauer-Thompson at 8:39 AM | | Comments (0)