Health Policy Working Group

The Policy Development Committee has established a working group to develop a Health Policy. Given the size and importance of the health system we feel that PPAU should have something to say about it. The working group would especially welcome comments from any members who work in the health system, as well as users of the health system.
Our patent policy calls for the abolition of pharmaceutical patents, and no doubt some other parts of our existing platform impinge on health policy (such as the privacy of electronic health records). However, we have not yet formulated a position on the really big questions around how to structure the health system to contain costs and guarantee universal access.

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For this policy, are we simply looking into structural & universal-access issues, or would it be appropriate to put forth some suggestions for issues which aren’t currently handled by our public health system, but in my mind, rightfully should be?

I don’t see any reason to limit the policy to structural and universal access issues (although obviously they are important). The working group will look at any ideas that members put forward.

There are a few things possibly worth noting in current policies. Pharmaceutical patents and health records (as Bill noted) but also the drug policy, which has a redirection of funds out of enforcement-related activity and into harm minimization and mental health services. This could be built up. Tax has cancellation of the private health insurance rebate which will save about $4.5 billion a year (co-incidentally, most estimates of costs for a ‘denticare’ scheme sit around that level). There’s an increase in research funding and fiber-to-the-premises, which might have applications in health. We might also have thoughts on what to do with the pre-existing funding increases (which are still mostly there despite coalition cuts).

I know people who’ve had some harrowing journeys through the public system. One thing that could be considered is a federally funded scheme to install patient advocates into hospitals. Patients need someone to join the dots for them, look in on them from time to time, help them navigate the complexity and work with hospitals to overcome systemic problems. It’ll free up doctors and nurses to do their core jobs and its a modular self-contained form of intervention which leaves state functions intact. It’s the kind of thing that can be trialled, probably in the hospitals with the very worst records of patient maltreatment. Many of the horror cases out there are the result of system failure rather than medical failure.

Best of luck to this work group, health is important!

Just some areas where I believe our current system’s a bit lacking (apologies in advance for the wall of text):

  • Mental health: The ten Medicare-covered psychiatrist/psychologist visits available per year really aren’t sufficient in a lot of cases. To me, it seems rather unconscionable to force those suffering to either go without (and potentially have their condition deteriorate), or put themselves through substantial financial hardship just to get the help they need. Even ignoring the humanitarian angle, if we consider that proper treatment would likely lead to an increased ability to contribute productively to society, then surely it must make some sense from an economic perspective too? Particularly worth considering that it may allow some people currently receiving the DSP (I’ve a few acquaintances who receive the DSP for severe, persistent depression / anxiety) to find sufficient work to support themselves without the DSP.
  • Dental: Barely covered by public health at all. Considering the growing body of evidence linking poor oral health to more severe / general health issues, there’s really no justification for this to only be available to the wealthy, or those with private health insurance (which is often simply not affordable to students & the un(der)employed).
  • Transgender issues: This is probably going to be the most contentious (amongst the general public - I’d expect most party members to be a good deal more progressive) of my recommendations. As things currently stand, the situation for those who suffer from gender dysphoria is far from ideal:
  • Despite hormones being required for life, long-term prescriptions are not available. As a result, otherwise avoidable GP visits are required every few months, simply to get a new prescription. Aside from being an unnecessary source of stress (scheduling issues can result in affected individuals sometimes forgoing hormones for some period of time, which can have a deleterious effect on mental wellbeing), this is both a waste of taxpayer resources, and an unnecessary personal expense, in the case where a bulk-billing GP isn’t available.
  • Sexual reassignment surgery is entirely uncovered, as it’s deemed “elective”, despite the growing body of empirical and anecdotal evidence supporting it’s substantial positive impact on the mental wellbeing of individuals suffering from gender dysphoria.

Admittedly, my evidence for the above areas lacking is rather anecdotal; simply a reflection of the issues encountered by those close to me and myself.

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I came across this interesting paper, Explaining High Health Care Spending in the United States. The authors’ conclusion is that the key factor is simply that Americans pay far more for the same services as people in other OECD countries. The reason is that doctors and corporations charge much higher prices. For instance, after adjusting for living costs, the average GP income is about $180,000 in the US, compared to half that in Australia. Another observation was “Of the countries studied, Japan has the
lowest health spending, which it achieves primarily through aggressive price regulation.”

This campaign asking doctors to sign a pledge not to see drug company reps was getting some media coverage last week. It’s probably a topic worth consideration.
http://noadvertisingplease.org/

Reform of the Federation White Paper: Roles and Responsibilities in Health

http://federation.dpmc.gov.au/sites/default/files/issues-paper/Health_Issues_Paper.pdf
http://federation.dpmc.gov.au/issues-papers

Brendan, the link is not working for me.

They moved the file after the fact because bureaucrats.

A lot of data here: Multinational Comparisons of Health Systems Data, 2014


John Menadue, Michael Keating and others been publishing a series of policy essays at this blog. Included is a series of five essays on health policy, that raise several ideas discussed by the health policy working group. For instance, the essay by Jennifer Doggett on copayments comes to much the same conclusions as we did. Some of John Menadue’s recommendations go further than what is in our draft policy, and in future we should revisit these ideas, such as those around private health insurance and commonwealth-state relations. Unfortunately, these essays are short on supporting references.

An op-article by Ross Kerridge from John Menadue’s blog.

tl;dr we need to have a Medicare payment for GPs being a person’s ‘designated coordinator’.

Hi alexjago,

I hadn’t noticed that article by Ross Kerridge that you mentioned, although I had heard the basic idea before and agree that we should support some kind of scheme like this. The current fee-for-service model undervalues the role that GPs can play in coordination of care. I will put you suggestion to the Policy Development Committee.