Shifting the balance of power

The health debate must be shifted away from "hot button issues" such as hospital beds to longer-term issues.

Improving Australia's health care sector - particularly rural health - will not be achieved by more doctors or more money. And it definitely won't be improved by increasing the number of hospital beds.

We already have enough of all three; we just aren't using them efficiently. This was the message from John Menadue, a director at the Centre for Policy Development and long term health advocate, when he spoke at the recent National Rural Health Conference.

In a biting critique of the nation's health sector, Menadue said power was the single biggest problem in delivering health care to rural people, as well as Aboriginal people and those with mental health difficulties. Currently power in the health sector, he said, was driven by providers and stakeholders who direct health resources to areas of self-interest, such as hospital care and to people living in the city.

This is at the expense of many. It has been well documented that health outcomes differ between those living outside major cities and those living within them. In 2008, according to the Australian

Social Trends report released last month by the Australian Bureau of Statistics, people who lived outside major cities were more likely than people in major cities to die from certain causes. They were almost twice as likely to die from high blood pressure, 1.7 times as likely to die from heart failure and 1.6 times as likely to die from diabetes.

Different levels of access to, and use of, health services may also contribute to differing health outcomes. In 2009, the report found people living in outer regional and remote areas of Australia were more likely than those living in major cities to have reported that they had waited longer than they felt was acceptable for a GP appointment (23 per cent compared with 16 per cent) and more likely to have gone to an emergency department because the waiting time for a GP appointment was too long (12 per cent compared with 2 per cent).

For things to improve for these groups, an informed community debate must take place. It also had to be acknowledged that the inequity in health care in Australia could only be effectively addressed through primary care, not hospitals, Menadue said.

As part of the much needed primary health care reform, workforce issues must be closely looked at - particularly the expanding role of nurse practitioners, other allied health, pharmacists and ambulance officers.

"We have a 21st century health sector mired in 19th century work practices. Tens of thousands of clinicians should be upskilled and multi-skilled," Menadue told the conference.

"We have about 400 nurse practitioners when we should have thousands. We should have nurse practitioner-led clinics as has been successfully established in Canberra."

While there has been much press about a rural doctor shortage, Menadue said it was more a case of misallocation.

"It is not that we don't have enough doctors. Australia has more doctors per head then New Zealand, almost double, and more than the UK and US. We have problems because doctors refuse to share territory with other clinicians in the name of 'safety' - a notion that ignores the danger of people finding it difficult to access any services," he said.

Throwing more money to the health sector also won't solve the problems that exist.

"Clearly more money is going into health these days, but I'm not satisfied that the principal problem in Australia and health is money. I estimate we waste about $10 billion - 10 per cent of health expenditure - because of various inefficiencies and problems."

And health care costs continue to rise. However, Menadue said while it is popular to place the brunt of the blame for this on the ageing population, he doesn't believe it to be the case. Rather, driving up the costs is the fact that everyone, regardless of age, is seeing their doctors or specialists far too much.

"In the last 13 years the number of times we see out doctor has doubled. Doctors are prescribing too much, are referring too much and we go to see them too much. That is why costs are rising and it can't be sustained," he said.

But of all the problems Menadue believed was hindering total health reform - that includes rural people - was the "continuing obsession with hospitals".

The Productivity Commission, in 2008, said that every year 450,000 admissions to public hospitals could have been avoided if there was better community care available.

"But the continual drum-beat in Australia is for more hospital beds. Hospital beds are like the family refrigerator. Regardless of the size of the family it will always be full. Yet we want more and more at the expense of other areas," Menadue said.

The debate has to be shifted away from these "hot button issues" to longer-term issues of priorities, such as rural health, he said. And the timing couldn't be better for rural communities to find their voice.

"When it comes to a question of power, given the role of country Independents in parliament, there is a once in a lifetime opportunity to deliver improved health care for country people," Menadue said.

"That window is not going to be open for long and it will shut quickly. But it is an opportunity which should not be missed and may not come again for another generation."

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