Hospital funding fight symptomatic of a much deeper problem
Australian Unity CEO Rohan Mead has dealt with 37 different health ministers and seen no substantive change. What is worryingly different now though: the patients.
Australia’s healthcare system is not fit to cope with the growing burden of chronic disease and, without urgent reform from the top, bitter state-federal battles over hospital funding will delay progress towards a healthier society, warns the Business Council of Australia’s healthcare lead.
“We’ve got to realise that we are in a mess,” said Rohan Mead, head of the BCA’s Health and Care Services Committee and chief executive of Australian Unity.
The ongoing public wrangling between first ministers and the commonwealth is about who should pay to ensure Australians have fair and timely access to hospital care, disability and aged-care supports.
“We have these absolutely regular dust-ups about fights over budgets and we have made no substantive progress on actually reforming the system,” Mr Mead said.
The negotiations, which have dragged on for two years, are stark evidence that change is urgently needed.
“I’ve been 20 years in my role in Australian Unity and I’ve seen 37 health ministers (state and federally), and I don’t know how many times we’ve had a ‘crisis’ in relation to the hospitals and funding agreement,” Mr Mead said.
‘We’ve got to get out from fighting the last war’
What has changed is the patient profile. Gone are the days when a diagnosis of cancer was an automatic death sentence. Medical advances mean more patients now have treatment options. Fittingly, where hospitals were largely established to provide acute care, they’re now required to support patients with chronic illness.
“We’ve got to get out from fighting the last war,” Mr Mead told The Australian.
“We’ve got to recognise that if we just continue to prosecute the old structural system, we are just condemning ourselves to escalating fights about escalating budgets that are increasingly ineffective at dealing with the burden of disease and the pattern of disease and community need that is actually out there.”
Mr Mead is outgoing managing director and CEO of Australian Unity, which provides health insurance and aged-care services. He’s spent 21 years in the job and will depart at the end of the year. As he prepares to leave, he is advocating for a stronger focus of policies and funding on preventive health.
“We spend less than 2 per cent of … recurrent budgets on preventive measures and that’s largely today taken up with the childhood vaccination programs and a few other programs,” Mr Mead said.
“When you think about the extraordinary expenditures and the small percentages that we spend on prevention … we’ve got to start getting ourselves into a community-minded position where we can tackle a reshaping of our healthcare systems and our care economy.”
Instead, Mr Mead looks at the hospital funding spat between first ministers and the commonwealth with an overwhelming sense of deja vu.
“This is like Finding Nemo, the movie; my name is Dory, I just go around and do the same old thing again,” he said.
NSW Health Minister Ryan Park is one leader who has grown increasingly frustrated by the standoff with his federal counterparts.
He estimates his state has 1100 disability or elderly patients stuck in hospitals because there is nowhere for them to go. Those beds, Mr Park said, could be better used accommodating the sick.
“That’s clearly not sustainable, nor is it fair on those patients but it’s certainly not fair on new patients coming in and the staff at those facilities,” Mr Park told ABC Radio.
NSW Premier Chris Minns has even warned the situation is so dire, patients may soon be turned away from emergency departments.
Appearing on Channel 7, federal Health Minister Mark Butler hit back at first ministers who are demanding billions more dollars than what is on offer.
“I get premiers always want more money, they always want more money from the commonwealth, but they also recognise what else we’re doing in health,” Mr Butler said.
“We’re opening more Urgent Care Clinics between now and Christmas. We’re putting more cancer medicines just this week on the PBS, and making those PBS scripts much cheaper. And also in four weeks, our record investment in bulk billing will start to take effect.”
With no progress in sight and no apparent appetite for change, health insurers worry the fallout of all of this will put even more pressure on them, private hospitals and the paying public.
“The pressure is felt not just by the insurers, but it is felt by people who have dependencies on insurers for funding and payments,” Mr Mead said.
“The burden of disease is increasing. In other words, larger percentages of the insured population are becoming sicker.”
As a result, he said, insurers need to either get more healthy members to start paying for policies or increase premiums to help offset the costs.
“The maths mean that that’s hard to do and unless the premium pool expands to deal with all aspects of inflation, in relation to that shifting disease pool, it would be apparent to you that what happens is that each year, the entire sector of health insurance takes out a slightly degraded product to the population because the health minister, politically, cannot fully reimburse the cost inflations that have occurred in relation to treatments, technologies, burdens of disease, patterns of disease, workforce costs and so on.
“The only way through this is by adoption of different business models, including a much higher emphasis on prevention, including secondary prevention, and business models that are much more flexible.”
A greater focus on preventive health is something doctors and others in the health space have long called for, arguing it would lead to a healthier population but also a more productive one. It’s an oversight many feel cannot continue and it is something the BCA is adding its voice to.
It has submitted its response to the Productivity Commission’s interim report in which it calls for a “shift in mindset” and a modernisation of the nation’s health and care systems.
The submission also calls for a streamlining of bureaucracy, and challenges the government to reduce the cost of regulation by 25 per cent by 2030.
One example, it suggests, could be amalgamating the Australian Commission on Safety and Quality in Health Care, the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission, arguing the “greatest efficiencies and improvements in outcomes will be through the greater alignment across health, aged care and NDIS”.
Mr Mead believes other fixes include a greater embrace of technology and better holistic patient care, which he suggests could be achieved by letting healthcare professionals, including nurses, work to their full scope of practice.
“We have a lack of co-ordination and responsibility for patient journeys through time born out of this highly specialised and sub-specialised and compartmentalised architecture of medicine … we’ve got to get past that. We’ve got to ask our clinicians to get past that.”
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