Ahead of the federal election predicted for May 2019 the Shadow Health Minister Catherine King has announced Labor’s new policies on her portfolio area. This comes in the wake of Labor’s “Medi-scare” campaign in the previous election, still drawing criticism, and now, comparison with the Coalition’s scare campaign on boat borne asylum seekers.
Speaking at the National Press Club Ms King outlined her party’s vision for Medicare funding and the future of Australian general practice.
It has long been recognised that many of the difficulties in the Australian health system arise from the split in responsibilities between the primary and secondary health sectors, which are under the control of the Federal and State governments respectively. Far too much time and money is wasted in driving patients, hence costs, from one sector to the other and back again.
Australian politics in recent times has seen a succession of changes in leadership and changes in government, the latter on a two-term, six year cycle. The current polling suggests this cycle will continue with the next Federal election.
Each new government comes to power with a mandate for its policies, often opposed to those of the previous government. However, changes in health, like many other areas of government responsibility, can take decades to plan, implement and refine.
To overcome this destructive cycle, Labor is proposing a national Health Reform Commission (HRC). Inspired by the Productivity Commission an HRC would be an independent authority charged with improving systems and outcomes and reducing inequality in health. It will report jointly to the Federal and State Health Ministers through the Council of Australian Governments. COAG ministers will be able to direct the Commission to certain areas for development and this, combined with the joint reporting, is hoped to make it less likely for the Commission’s reports to be buried by the government of the day.
The second plank of the Labor initiative is primary care reform. Shadow Minister King reports that the Treasury estimates given to the Coalition government prior to the 2013 first Coalition “horror budget” correctly identified that the increase in out of pocket costs would drive patients to use more hospital Accident and Emergency services. This cost shifting has in turn been countered by the States through increasing the number of hospital specialist outpatient clinics and services that require referral from a general practitioner. The cost of these bulk billed services goes back to the Commonwealth.
The Federal government's glacially slow thaw of the Medicare freeze (as previously reported in GPSpeak) started almost two years ago. Under the Coalition’s arrangements some items continue to be frozen and will not return to increased funding until 2020. Under Labor the freeze would end immediately.
Over the last six years $3.0 billion have been shaved from Medicare rebates by the freeze. Since the money is a rebate to the Australian public for fees incurred, it is impractical for the money to be returned to them. Australian GPs will look askance at this reasoning.
The Shadow Minister notes that the current Health Care Homes (HCH) trial has essentially been a failure. However, the lessons learnt from the trial are invaluable and should lay the foundations for a better and wider implementation of the HCH principles.
Primary health care reform is a difficult issue and will take time and careful negotiation. Labor sees primary care delivery such as that provided by Aboriginal Medical Services as a model for future general practice. She wants more emphasis on health care promotion rather than treatment and laments the $300 million cut from the Coalition’s National Preventative Health Agreements with the States in 2013.
It is calculated that 1.3 million patients delay or skip medications, tests and medical appointments due to costs. As an immediate response to hefty specialists’ out of pocket costs, Labor is looking to expand the role of hospital OPD departments. It is not clear from the announcement how these extra services will be apportioned and funded.
The Shadow Minister is also critical of the disbandment of the Medicare Locals under the Abbott government’s then-Health Minister, Peter Dutton. In her view, the destruction of the previously established networks has put primary health care development back several years. However, no announcement about the Labor Party’s intentions for Primary Health Networks was made.
The Shadow Minister concludes that Labor is a better steward of the Australian health system. She notes that at every election the Liberals break their promises on health.
Tony Abbott’s 2013 “No cuts to health” was immediately followed by $2.8 billion cuts to hospital funding over a 10 year period; an attempt to introduce co-payments on doctors’ visits; the Medicare freeze, which resulted in a virtual co-payment system; mooted but an ultimately withdrawn proposal to outsource Medicare processing; cuts to the PBS and Medicare safety nets; and cuts to preventative dental programs and diagnostics.
She continues that in more recent times Health Ministers Dutton and Hunt destroyed the Medicare Local system and could have ended the Medicare freeze at any time in the last five years.
Health policy has been a major strength for Labor going back to the days of Medibank under the Whitlam government. They campaign strongly on the issue, while the Coalition’s record is weak and Health Minister Hunt has been fairly passive in his portfolio.
The Shadow Minister claims that under Labor there will be better hospital funding, stable health insurance premiums, affordable GPs and specialist visits, and that Medicare will remain the core of the Australian healthcare system and its long term development will progress more smoothly under the new national Health Reform Commission.
Australian GPs may not see it as all puppies and rainbows. They will recall that it was Labor who first introduced the Medicare freeze in 2013. They will recall the market disruption caused by Labor’s Super Clinics following the 2007 election. Labor sees health centres such as those run by the AMSs as the future for Australian general practice delivery and this is also the approach favoured by the NSW Greens.
The details of the proposed restructuring of primary care are scarce. Consensus building by bringing together State and Federal governments, doctors, pharmacy, health insurers, the hospital sector and consumer representatives sounds fine in principle. However, such a “consensus” may see one group objecting strongly to a reduction in their incomes.
Medical practitioners are advised to proceed with caution.