Health care: good, better, but for goodness sake give up on ‘the best’!

In Australia these questions need to be addressed but at the moment are not. There is no serious effort made in this country to debate and set priorities. Yet this is very necessary if we are to build a sensible, sustainable, rational, “better” health service.

Priority setting is not difficult. It involves looking at the economist’s notion of opportunity cost - the benefit foregone in the best alternative use of the resources. If spending more in program A results in greater benefit than in B, then spend it in A. If taking money out of B and spending it in A means overall greater benefit, then do so.

In Aboriginal health for example we can say that what is needed to be equitable in Aboriginal primary health care is to spend about four times what we currently spend. To do this we could halve the 30 per cent rebate the federal government introduced for private health insurance. We then need to debate which is the better buy. Again if the rest of us forewent 1 per cent of the spending on our health care, we could increase the spending on Aboriginal health care by 50 per cent.

Which is the better buy is what priority setting is all about, but currently such questions do not get asked. I can’t answer these questions. It is not my role to do so. I think the only people who legitimately can are informed Australian punters.

In one of the citizens’ juries I facilitated, in the wake of their desires for more funding for Aboriginal health, greater equity, mental health and prevention, when asked where the money was to come from, their answer was clear: from small inefficient hospitals and Emergency Departments. The people are not stupid and they can deal with priority setting. Yet, Paul Skerritt, the President of the WA AMA has argued leaving such matters in the hands of the public is not the way to “make big decisions”. Oh yeah?