"Ultimately the federal and state health systems must create a modus operandi that addresses the nation's health in an integrated way". Photo: Gabriele Charotte
The recent news about NSW not meeting federally imposed targets for waiting times in hospitals should cause us grave concern, but not for the reasons most reports have cited.
The NSW Minister for Health, Jillian Skinner, is damned if she does not increase the efficiency and effectiveness of hospitals' emergency departments and increase the number of hospital beds. She is also damned if she (and her federal counterpart, Tanya Plibersek) do not invest much more significantly in ways to keep people out of hospital in the first place, which is a much better and more rational use of scarce resources.
It is generally accepted that more resources in primary healthcare will reduce avoidable hospitalisations. The trouble is that this is not "newsworthy" in the way that emergency department horror stories are.
A recent report on a useful chronic disease management program run in NSW shows that participants experienced a third fewer avoidable hospitalisations as a result of the program over 18 months. We know that most avoidable hospitalisations are due to chronic disease, so it makes enormous sense to invest in this sort of program - and the investment is substantial: $177 million up to 2014-15.
But compared to the money going into hospitals to fund emergency and acute care, $177 million is a mere bagatelle, with little hope of stemming the tide of chronic disease, which can only happen if we give responsibility to the whole of government (not just health departments) to address lifestyle, from school age onwards.
Another problem lies in the way we fund our nation's healthcare: the federal government is responsible for "primary care", GPs and specialists via Medicare, and medications via the Pharmaceutical Benefits Scheme.
If the federal Health Department spends more on programs that keep people out of hospital, it is the state governments that stand to make, and keep, the savings. As there is no way for the federal government to claw back these savings, the nation's health suffers because bureaucrats' budget accountabilities live in silos.
Another issue has been brewing about the role of 61 new Medicare Locals around the country and the best way for the activities of the 17 of them in NSW to be integrated with NSW Health's functions. Medicare Locals co-ordinate population health, integrate services between GPs and allied health professionals and organise after-hours access to GPs.
This should be straightforward but because there are entrenched interests at stake, and funding coming from different sources, there is little imperative to integrate.
The federal Health Department has just cut funding for the state-based organisations that support Medicare Locals, arguing that a national body funded by federal health, the Australian Medicare Local Alliance, can take their place, even though all other parties agree that this will not be an effective solution.
In NSW, Medicare Locals want General Practice NSW, its state-based organisation, to continue to provide co-ordination, education and support for projects such as e-health, immunisation and the roll-out of Aboriginal liaison workers in Medicare Locals, with economies of scale that every Medicare Local cannot achieve.
However, without the support of the Australian Medicare Local Alliance, there is the potential for competition in an area that should be all about collaborating and sharing.
While Skinner agrees that General Practice NSW should continue, the response to her advocacy by Plibersek is, in effect, "If you like the idea so much, you pay for it.''
Ultimately the federal and state health systems must create a modus operandi that addresses the nation's health in an integrated way, taking note that the former prime minister Kevin Rudd's idea to create a single national system to address the nation's health was too radical to implement in our well-off, and therefore relatively complacent, country.
Australians need to become involved in a conversation about why there is effectively bottomless funding for emergency and intensive care and why we (via the media) express such outrage when one person's healthcare experience in a hospital is not up to scratch, but there is relative community (and media) silence about preventable chronic diseases, such as the 100,000 people diagnosed with type 2 diabetes each year, of which fully 60 per cent is preventable.
Lewis Kaplan is the chief executive of General Practice NSW.