Prime Minister Kevin Rudd has been attempting to persuade state premiers to agree to his government's health reform proposals. The negotiations have produced an unseemly display of political brinkmanship, chiefly from Victorian Premier John Brumby, who is anxious to show some political muscle ahead of this year's state election.
His proud boast that Victoria has the best health system came unstuck during his 'Putting Patients First' address to the National Press Club last Wednesday. He was particularly rattled by this question from Sue Dunlevy of the Daily Telegraph:
Victoria's hospitals see fewer emergency and elective surgery patients within the recommended time than hospitals in NSW. You spend $123 less per patient than NSW. Your hospital system provides fewer beds per thousand people than NSW. And your hospital performance has been going backwards for five years. Why should you be regarded as some kind of authority on health? And why should patients in other states have to put up with a second-rate system because someone who can't run his own health system is behaving like a bully?
It doesn't matter which state has the best health system. And a state boasting that its system is better than other states' systems is not putting the wellbeing of patients first. It is a source of shame that some states have better health systems than others. Having so many separate health systems is most likely holding us back.
It's even worse that a leader appears to be proudly endorsing this inequality in health services available to Australians. There's no question that all Australians must be equal in the eyes of the nation's federal and state health policymakers. Perhaps Brumby's brinkmanship is the best argument in favour of the Prime Minister's attempt to wrest control of health from the states.
A recent collection of essays from social advocacy group Catalyst Australia titled "Equality Speaks: Challenges for a Fair Society" includes a succinct analysis of Australia's health care system that points to the need for greater coordination.
Australia's ability to tackle inequitable health outcomes is greatly hampered by a complex health delivery system traversing Federal and State jurisdictions and private and public health services. In all there are nine departments of health in Australia for just 20 million people.
Moreover putting patients first for a fairer and more equal society involves forgetting not only about state fiefdoms, but departmental fiefdoms as well. Catalyst Executive Director Jo-anne Schofield, who wrote the health policy analysis, believes undue attention to performance indicators such as hospital emergency waiting times can miss the point of health reform. She says it's about 'building communities where opportunity can flourish'.
Even lifestyle interventions through preventative programs can fly in the face of genuine health reform, as evidence shows that such targeted interventions mostly succeed among more advantaged groups. Schofield says prevention will have little impact if the social determinants of health are not considered, including factors which result in social exclusion such as poverty, disability, poor social support and lack of education and skills.
Putting patients first is about understanding the social context of those with the most acute health challenges, not the construction of political ego.
Article first appeared on Eureka Street, April 19, 2010.
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