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September 4, 2007
The ALP has taken another step to shifting the focus of the health system from crisis care in hospitals to primary care and prevention. It indicates that a Rudd Labor government will continue the process of the reform of the health "system" that the Coalition sees no need for.
Rudd states that a Labor government will spend $220 million to establish "GP super clinics" in regional and outer metropolitan regions. Incentive payments are to be offered to encourage doctors and allied health professionals to bring a broad range of health services under one roof. The purpose of these one-stop shops is to provide local communities with enhanced preventive and multidisciplinary care, particularly for patients suffering chronic conditions. The goal is to improve public health outcomes, create a less expensive health system, and take the pressure off public hospitals.
Labor 's argument is that the new super clinics will provide bulk-billed services in underserviced locations with high levels of need, and that this will prevent non-urgent patients clogging up hospital emergency departments.
Jeremy Sammut, a research fellow at the Centre for Independent Studies, that Labor's argument misses the point:
...the problems in public hospitals are not caused by lack of bulk-billing. (New figures show GP bulk-billing rates have increased to just over 78 per cent.) Research conducted for the Australasian College for Emergency Medicine in 2004 found that non-urgent patients do not significantly add to emergency department workloads and are not the cause of hospital overcrowding. The real cause of delayed admission and long waiting times is high occupancy. The unavailability of acute and elective beds is exacerbated by the number of elderly patients who remain in hospital due to the shortage of ''high-care'' places in residential nursing homes.
This is true. Hence the need to develop residential nursing homes. However, that is not an argument against shifting the focus from hospitals to primary care and prevention, so as to slow the numbers of people entering the hospitals. Sammut acknowledges this as he says:
Labor's plan to address the twin challenges of population ageing and rising incidence of lifestyle disease is to reorientate the health system away from high-cost curative care in hospital towards lower cost primary care in the community. Once diagnosed with a chronic condition such as diabetes, chances are that some patients will work with their doctors to manage their illness and avoid the real risk of acute episodes.
He agrees that good management may well prevent expensive secondary medical interventions, but asks 'do we really need super clinics to provide the stock standard medical care that is delivered every day in doctors' surgeries throughout Australia?' This misses the medical workforce shortage issue and the need to use non-medical health professionals to deliver health care services.
This leaves us with the primary care argument. Sammut's response is a sceptical one:
Advocates of preventive medicine also talk of education as the key to prevention. Of course, health professionals can give commonsense advice about good diet and regular exercise. But I doubt that many people in high- risk categories will modify their lifestyles while the risk of harm remains relatively remote. Investing in primary care to keep people out of hospital sounds like a good idea. But spending more taxpayers' money on preventive medicine is unlikely to prevent lifestyle disease as promised.
Sammut doesn't seem to like the idea of spending money on public health. Is this because CIS is opposed to the public health care funded out of taxation.
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In a NYTimes column last week Paul Krugman puzzled over right wing objections to mandatory, government-funded health care and wondered why these people don't have the same objections to mandatory, government-funded education. Why don't we drop the requirement for children to attend school, close government schools and leave it to the market to sort out?