Saturday, February 16, 2008

Australia moves towards primary health care

The Rudd Government health strategy signal a move towards increased expenditure on primary health care. This assumes the consumer will take greater responsibility for their own health. It also suggests an increased level of expenditure by the Federal Government on creating awareness amongst the public off the consequences of poor nutrition, low levels of exercise, excessive imbibing and inadequate self care.

A recent media release by Federal Minister for Health and Ageing, Nicola Roxon, outlined the following:

  • National Preventative Health Strategy to tackle issues of alcohol, tobacco and obesity
  • An increased focus on preventative health care to be included in Australian Health Care Agreements with the State Governments.
  • A review of the Medicare fee schedule

With the exception of the review of Medicare fees, which may or may not, increase the cost to the Federal Government, the other two outcomes require substantial, and prolonged investment, in creating public awareness. As has been witnessed by the billions spent over decades to create awareness of issues associated with driving motor vehicles, it will likely take the same level of investment, maybe even greater, to shift the perception of the public away from their current expectation that the health system will cater for all their needs; to a perception where each individual takes personal responsibility for their own health outcomes.

As suggested in an earlier entry to this blog, one impediment to consumers taking responsibility for their own health outcomes is the perceived low cost of health care. It would be easy to simply suggest the Government should increase the cost to the individual in an effort to discourage each of us from living decadent lifestyles. This is unlikely to be effective. Our past experiences with raising direct costs associated with motoring, smoking and drinking alcohol have shown that such increases rarely, if ever, have a sustained impact upon consumption. On the other hand, extended and comprehensive public campaigns have served to raise awareness amongst consumers.

If, as the Government appears to believe, the answer lies in primary care, in creating increased awareness, in providing information and education and in the consumer taking responsibility for their own health outcomes, then the program to achieve this is likely to consume the major slice of health spending by the Federal Government.

Add to this an expectation that each State Government will increase their focus on preventative health, suggests also that a significant portion of State Government spending on health will be directed towards education and public awareness. For every dollar spent on preventative health, one less dollar is available to spend on maintaining and expanding the hospital sector.

Now here is the rub. Assuming the Rudd Government has set the correct long-term strategy and assuming State government health ministers will be able to stand the heat and maintain a good working relationship with Federal ministers and assuming subsequent Federal Governments continue in this direction then at some point in the future people will spend less time visiting their GP or specialist and less time in hospital. At that point the savings from reduced health costs may equal the cost of Medicare. When this occurs both the cost of maintaining Medicare and the public hospital system will become sustainable.

In setting this direction the Rudd Government has lifted the lid on the Pandora’s Box of public healthcare and it may not be possible to ever put the lid back again. It is possible, the consequences of this direction, though not highly visible at present, may revolutionise public health delivery throughout Australia for ever.

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