Labor will reform Medicare to save our world-class public health system

Australians have been sending a very clear message for some time now on health:

• Australians want a world-class health system with a universal Medicare at its centre.
• Australians know our health system needs real reform.
• The push for reform is gathering momentum.

The Australian Health Reform Alliance, led by Professor John Dwyer, brought 250 health professionals together last August to plead the case for health reform.

Last August the states and territories were blackmailed into signing the Health Care Agreements by a Howard government that short-changed public hospitals by a billion dollars and ignored the promised reform agenda.

Despite this, the states have all engaged in considerable efforts to drive reform forward. The Howard government may be standing still but the states understand the consequences of not planning for the future.

Labor’s reform agenda

Labor has already outlined important health policies for the next election, including our plan to get doctors bulk billing again, our Australian Dental Care plan to get half a million Australians off dental waiting lists and into dentists’ chairs, and our plan to bring Medicare Teams of doctors and nurses to health hotspots around Australia.

Labor has also committed to a comprehensive health reform process.

Within the first month of the election of a Labor government, we will establish a National Health Reform Commission to drive the reform process. The head of the commission will not be a medical professional, but an expert in change management - a person agreed by the Commonwealth and State Ministers for Health and definitely not a politician.

Within three months the National Health Reform Commission will bring all the major players together in a Health Summit to develop an action agenda for the reform of the health system. Significant reforms will be in place within 12 months.

I want to outline some good ideas which should be considered as part of the reform process. They have great potential to deliver a better, healthier Australia.

(a) Prevention & Primary Care

Australia desperately needs an integrated primary health care and prevention strategy.

General practitioners are the backbone of our primary health-care system that today increasingly has a team approach. The team now includes practice and community nurses, and allied health professionals.

If we are ever to be serious about the prevention of illness, then ensuring a regular pattern of appropriate health checks and health advice provision is vital. But in today’s world, too many people do not have a nominated general practitioner who looks after their health.

This loss of connection between patients and primary care providers has been greatly exacerbated by the bulk-billing crisis and the shortage of general practitioners.

We could set a goal, to be achieved over time, that every person in Australia is registered with a primary health care service. Such a service could be a local private general practice or a community health centre or clinics associated with a hospital or Indigenous health services. This way, patients will receive timely reminders about attending for appropriate health checks and follow-ups.

(b) Responding to the Real Burden of Disease – Mental Health

Increasingly, the burden of disease in modern Australia lies in chronic conditions. As part of developing quality relationships between patients and primary care providers, we must develop models of care for people with chronic illnesses.

Beyond that challenge, we need to make a far better attempt to deal with the burden of mental illness in our society.

Every year some 20 per cent of the population experiences a mental-health problem and three per cent of adults have a serious mental illness such as a psychotic disorder. Currently, only 38 per cent of those with a mental health problem access care, and that care is provided largely by GPs.

Doctors would like to see an expansion of the Better Outcomes for Mental Health Initiative. This program is really meeting a need. In the 18 months since it was initiated one in seven GPs nationally has signed up and in small country towns participation is as high as 40 per cent.

Unfortunately for those with mental illness and their families, mental health does not rate with the Howard government. Tony Abbott is so uninterested that he has relegated responsibility for mental health to his Parliamentary Secretary.

As Health Minister in a Latham Labor government, I will personally take responsibility for dealing with mental health as an important area of policy and ensuring that mental health needs are on the health reform agenda.

(c) Unifying the Health System - Money

The debate about who is responsible for which parts of the health system is one that leaves people cold. They just want to know that when their elderly parents or children need a hospital bed or urgent attention from a GP that they can get it.

At the last federal election, Labor promised a Medicare Alliance, a system of better co-operation with the states on health, including establishing a Medicare Joint Account for each State and Territory to combine the State and Federal components of separately funded health programs.

This would effectively end destructive cost-shifting and mean that targetted programs could be introduced for individual regions. Layers of bureaucracy and cost-shifting could be deposited in the wastepaper basket of history.

It would mean better opportunities to integrate primary, acute, rehabilitation and aged-care services.

The Medicare Alliance approach was one of having both tiers of government having one account. It would be possible to drive this further with monies pooled into a regionally administered pool. Regional models of health care exist in most states and these could be adapted to become fund holding in this manner.

(d) Unifying the Health System – Information

We must get smarter at linking together the information that currently sits scattered across the health system.

A second-generation Medicare Card would be one way to enable the management of a seamless health system for patients.

By using "smart card" technology it would be possible to track the use of health services and allocate costs against federal, state and private funding sources while eliminating duplication and transforming the way health outcomes are measured.

Clearly, privacy concerns need to be addressed and I am not suggesting that full electronic health records be available on the card.

The real opportunity is to use this type of card as a key - a key to a secure system of electronic health records, a key to linking health service providers and a key to tracking the total costs across the health system.

Conclusion

These and other ideas for health reform need to debated and tested. Major reform always requires bold thinking and courage.

Australians want a world-class health system with a universal Medicare at its centre. Judging from their own day-to-day experiences, Australians know our health system badly needs reform.

Only the Australian people can save Medicare by making it their number one priority at the next federal election. At the next election, Australian voters will have a clear choice about the health system they want. A choice between Labor’s real reform and Howard and Abbott’s political fix. Saving Medicare and implementing real health reform will only be done by a Latham Labor government.