Home' Policy Magazine : Policy Vol 31 - No 3 Contents 18 POLICY • Vol. 31 No. 3 • Spring 2015
At the heart of spending rising faster than tax
is health and welfare, the two biggest items in the
federal budget and the two fastest-growing items in
the federal budget. Frankly this is unsustainable and
whilst I understand that service providers enjoy that
growth of spending—I would too if I were a service
provider. There is nothing better than an industry
growing at double-digit rates. As a consultant,
those were the industries I always looked for. But
as a purchaser of services, which is what the federal
government is (and we can debate about whether or
not they should be), that is simply not sustainable.
The second part of the problem is on the customer
and the population side. Rohan articulated this well,
I thought. The crucial issue here became very clear to
me in my first week as a candidate in the electorate
of Hume. Soon after I was preselected I got access to
the previous member’s database of every constituent.
Every local member or candidate has access to a big
database, and if your previous member likes you,
they will allow you into their database. In that
database there are many years of records about what
people care about most. The overwhelming thing I
saw was that the number one issue in my electorate
by a country mile was health.
Now in my electorate, which runs from south
of Sydney down to Canberra and west from there,
there is an older demographic, but even when I
looked at the regions with younger demographics
it was the same result. Health was the number one
priority. People care deeply about this, this is a big
issue for them, it is a big political issue and it’s a big
real-world issue that they have to deal with.
That is the fundamental collision we’ve got going
on. This is the number one issue, certainly in my
electorate, and we’ve got spending growing at a
totally unsustainable level.
So what do we do about it? As I said a moment
ago, the solution has to be broad and I bring it
down to four different areas. The first is technology,
specifically medical technology — and I’m using
that term broadly to include both hardware and
software information management. Second, we need
breakthroughs in how we deliver health, including
workforce and organisational models. Third, we
need breakthroughs in how we fund and purchase
health services. Fourth, we need breakthroughs
in the governance model and that includes the
intergovernmental relationships and the relationship
between the private and public sector. Let me just
expand on each of those four areas for a moment.
In terms of medical technology, there is a lot
of focus on eHealth Records and that is just the
beginning. When you look at the whole information
flow around the health system it is much more
complex, much richer than just eHealth Records.
There is patient registration, provider bookings,
care tracking, the common patient record (which
is the eHealth system effectively), patient portals,
performance management and analytics, and the
financial side of it. All of these have to be linked across
multiple providers; hospitals, doctors, specialists,
pharmacists, allied health practitioners. Without
that level of integration you don’t solve the problem.
So that integrated information management is
absolutely fundamental if we are going to solve the
underlying problem that I’ve described.
Of course, on the hardware side we have got
a revolution happening in remote sensing and
monitoring — not just in health but in many
industries — and of course there’s no doubt that’ll
have a big impact on health in the coming years.
So that’s the technology side and there are many
elements to that which are a good starting point but
none of that is even remotely useful if we don’t solve
problems in the delivery model.
Right now we have a system which is based on, at
least in primary care, high levels of activity by GPs
through consultations with a Medicare provider
number which is used very regularly — and I would
argue heavily overused — for a basic consultation,
and you are rewarded for activity. What we actually
need is a system where you have flexible team-based
integrated workforces that don’t overuse that simple
model of the GP meeting the patient. I’m talking
particularly here on primary health care, which is
the federal government’s problem, but of course the
same principle applies as you move to hospitals and
specialist care and so on.
On the hardware side we have got a
revolution happening in remote sensing
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