Health policy
Australia needs a Centre for Disease Control
It is well-known that our health care arrangements are structured around a historical need to deal with acute conditions requiring episodic care. Those arrangements are not so well-suited to the growing need to deal with chronic conditions.
The Grattan Institute’s Report The Australian Centre for Disease Control (ACDC): highway to health, written by Peter Breadon, Lachlan Fox, and Owain Emslie, develops the case for a CDC. They base their case on the growing burden on our health care resources imposed by chronic conditions, noting in particular the rise this century in the number of people with osteoporosis, mental and behavioural conditions, and diabetes.
The incidence and impact of most chronic disease can be reduced most efficiently by attention to risk factors, and such attention can have high returns for individuals and the community at large. They estimate that the cost of dealing with chronic disease caused by modifiable risk factors is around $25 billion a year.
While we have made good progress on smoking and sun exposure, and are starting to come to grips with high alcohol consumption, there are other risk factors requiring more serious attention: they mention obesity in particular. In comparison with other prosperous countries our spending on preventative health measures is low, and in some cases that is because of effective resistance by vested interests.
They believe that a CDC, at some distance from political pressure, can pull together resources and coordinate programs to deal with chronic disease, particularly in policies towards disease prevention and health promotion.
That Strengthening Medicare “Taskforce” – what exactly was its task?
Always be worried when a government refers to the work of a “taskforce” – a term connoting images of dedication, rigour, expertise, physical effort, and a tangible objective. But in government circles it usually refers to yet another committee, with a brief to kick a policy problem down the road.
That is how Martyn Goddard, in his Policy Post, sees the Strengthening Medicare Taskforce. His article – Is Labor serious about health? Doesn’t look like it – lists several problems in our health care arrangements, and opportunities for reforms that are crying out for removal of road blocks.
He suggests, for example, that there would be no net budgetary cost to the Pharmaceutical Benefits Scheme if the government were more assertive in dealing with Big Pharma and directed the savings towards making all medications free to consumers.
But while some savings can be made, and resources can be more efficiently deployed, health care – Medicare – needs more funding. The government talks about its appropriation of $750 million for health care reform but that’s over 3 years. That comes to 0.23 percent of the Commonwealth’s spending on health – somewhere between an insult and a rounding error.
In last week’s roundup I presented a case, based on the real value of the Medicare rebates ten years ago, for raising the rebate for a standard GP consultation from $40 to around $45-$48. But Goddard goes one better: he uses the real value in 1975 as a base, and argues convincingly that it should now be $65.
The real problem, Goddard argues, is the government’s obsession with “budget repair”. (I haven’t noticed that the budget is broken.) The economy will probably need a fiscal injection if we are to avoid a recession, and Medicare could provide the ideal opportunity.
Goddard’s reforms are mainly about changes that can be made within the existing broad framework of Medicare. Writing in The Conversation Henry Cutler of Macquarie University calls for more basic structural reform of health funding. He goes through the history of what has passed for health care reform, suggesting that there has been no substantial change since 1984.
In my view Cutler understates the period we have coasted along without reform. We need to go back to 1959, when the Nimmo Report provided the groundwork for the Whitlam Government’s later introduction of Medibank in 1974. That was the last time the sector got a thorough look-over. Since then all moves to reform have left untouched the distorting influence of the financial sector in the form of private health insurance, even though the sine qua non for health care reform is abolition of PHI. PHI is a high-cost privatized tax that pushes up the cost of health care, and misallocates scarce resources, forcing distortions in other areas of heath care.
Health risk factors: living alone in the bush is unhealthy
Henry Lawson described the bush as “the nurse and tutor of eccentric minds, the home of the weird, and of much that is different from things in other lands”.
Sub-optimal lifestyle
Unfortunately one of those differences is that people who live in non-metropolitan Australia have much lower life expectancy – up to a 5-year gap – than those who live in capital cities. The more remote from state capitals the lower is one’s life expectancy, and the higher is the risk of suicide.
That is the main finding of Kate McBride’s paper: The unlucky country: life expectancy and health in regional and remote Australia. Part 1: NSW, published by The Australia Institute. It is based mainly on New South Wales data, which shows an almost direct relationship between reduced life expectancy, particularly as a result of suicide, and distance from Sydney. It presents basic comparative data from other states showing similar disparities: in fact the life expectancy gap between Darwin and the rest of the Northern territory is 7 years.
At the beginning of this century there was no discernable difference in life expectancy in Sydney and the rest of New South Wales, but while life expectancy has risen in Sydney it has not increased in the rest of the state.
Another finding on health risk factors comes from the “Royal” Australasian College of Physicians, which draws attention to research published in its Internal Medicine Journal revealing that being single and living alone is one of the most significant predictors of unnecessary hospitalization, lifting such risk by 243 percent.[1]
1. The College’s press release calls it “new research”, but the article was actually published in September 2021, based on research conducted up to June 2019, which pre-dated Covid-19 and its requirements for isolation. It is probable therefore that even that high figure understates the health cost of social isolation . ↩