Here she shares with Croakey readers some of the background to the book and her writing of it:

“Flying with Paper Wings is a story of survival. It begins in Ballarat of the 1950s and 60s with painful childhood memories. Sitting in my mind’s eye is the image of my drunken mother, slumped in the passage, bruised and battered, after a beating from my raging father.

Although I shared with my older brother and sister the fear that one day my father would kill my mother, or that she would commit suicide as she so often threatened, the three of us rarely spoke of the constant horror, never daring to share it in or outside our small Ballarat home.

After leaving home, I stumbled through university, graduating in 1975, only to be diagnosed with schizophrenia in 1976.

My fall into madness was catastrophic. Suddenly the person I thought I was became a stranger. With each psychotic episode I went further into the mire of madness. Depression also held me in its sway.

My struggle with madness has been long and arduous. Flying with Paper Wings documents this in detail. My poetry has been a potent force in countering the debilitating effects of my schizophrenia.

In writing about my madness, I have turned disaster into celebration. Poetry gave me back an identity which had been stripped away with the onset of my schizophrenia. The book is also a celebration of friendship.

A decade ago, I decided to retrieve the records of my admissions to mental institutions. It prompted me to begin writing my story – of being drawn into the underworld of madness and returning to tell the tale.

In its telling, I seek self-understanding, but also to discover to what extent nature or nurture are implicated in my  illness, how an ill-formed and fracturing identity can be rebuilt, and how, as a society, we might better treat the mentally ill.

This was a painful and confronting book to write because to see my life on the page, warts and all, left me wondering: why have I revealed so much of myself?

We all have our story to tell and perhaps by me telling my story someone else may be inspired to tell their story too. I wrote the book because I wanted to understand better the life events that have shaped me; to trawl the foul, murky world of my voices; to understand my wildly fanciful delusions.

At the heart of the book is the little girl who watched her parents fight; who experienced her own sexual assault; who left home with a hope for a better life, who flirted with Catholicism to nourish her soul; who fell into the dungeons of madness – she is desperately trying to make sense of these huge life events.

Melbourne writer, Helen Elliot, describes Flying with Paper Wings as ‘anything but a misery memoir. Glittering with black humour and without self-pity, it shifts other people’s perceptions of mental distress beyond kindness, compassion, sympathy and fear into some deeper perception.’”

Flying with Paper Wings is published by Vulgar Press and can be bought from Sane Australia ($33) by visiting here or by ringing 03 9682 5933. It has been warmly endorsed by Anne Deveson and Andrew Denton.

Dr Mark Ragg, a health and communications expert, believes the history of smoking among people with mental illness holds some lessons for those working to tackle Indigenous smoking, and also gives cause for optimisim.

He writes:

“David Thomas’ article is fascinating, as well as providing very good news. I’ve come recently to the issue of smoking in Indigenous populations after doing some work in smoking among people with mental illness, and have been struck by the similarities in approaches towards these two disadvantaged groups.

In both cases, there is a false belief that smoking is uniformly high and unchanging, leading to an almost nihilistic belief that nothing is possible. So if nothing is possible, nobody needs to act. And in both cases, smoking is excused by many health workers on grounds like ‘they have nothing better to do’ or ‘I don’t want to jeopardise our relationship by bringing up a difficult issue’.

There are certain things that clearly work to reduce smoking rates in populations – reducing the opportunities to promote smoking, reducing the opportunities for people to smoke, increasing the price and having health professionals give advice, support and medication such as nicotine replacement therapy when needed. Legislation, regulation, social marketing and specific health programs are all means to achieve these ends.

Certainly in people with mental health, and it seems in Indigenous populations, the problem has been that the basics have not been applied. People with mental illness have not had health professionals giving them advice and support. In fact, many people with mental illness are still told to smoke by their doctors.

But some progress is being made. In the US, psychiatrists have specific training programs in smoking cessation which are proving popular and effective, and similar approaches are being considered here.

In Australia, various health services are running smoking cessation programs for people with mental illness, and providing training for employees involved.

Croakey encourages bold predictions, so here’s one.

In 20 years time, policymakers and academics will look at smoking among people with mental illness, and among Indigenous people, and see that these high prevalences were a blip. A troubling time with severe health consequences, but a blip. Once these disadvantaged groups received the same resources and support as others, the problem began to recede.”

• Mark Ragg is director of the health and communications consultancy RaggAhmed and adjunct senior lecturer in the Sydney School of Public Health, University of Sydney.

Now a senior mental health advocate, Sebastian Rosenberg, is weighing into the debate, asking what such a model might mean for those with mental health problems. He is a Senior Lecturer at the Brain and Mind Research Institute and Deputy CEO of the Mental Health Council of Australia.

He writes:

““Plus ca change” the French say – the more things change, the more they stay the same. That is the justifiable concern among many in the mental health sector as the Federal and State Governments contemplate the recommendations of the National Health and Hospital Reform Commission.

In mental health, the status quo just isn’t an option.

Ten years of so-called mental health reform has seen Australia fail to lift the rate of access to care for people with a mental illness – 38% of people with a mental illness were in care in 1997 and 35% in 2007.

So debates about concepts like Medicare Select take on particular significance.  For areas of health that are well serviced, the old axiom not to fix something that ain’t broke may well apply.  Rates of access to care in other chronic illness are more like 70-80%, with the majority of people getting the care they need.

This is clearly not the case in mental health and has spurred calls for fundamental reform.  It is no surprise that some of the leading proponents (occupying a telephone booth near you) of Medicare Select highlight mental health as a key potential beneficiary of a new approach.

But the motivations underpinning their support vary.  For some, Medicare Select represents a chance to promulgate an individualised approach to health care, taking funding decisions out of the hands of health professionals or the nanny-state, and giving choice instead to each consumer.

These supporters talk of ‘cashing out entitlements’ and giving each consumer ‘leverage’ to buy tailored packages of care.  This is certainly a model which exists in the construct of packages of care for the support of profoundly disabled children, though the extent to which these packages are really based on understanding the costs of care is debatable.

What is clear is that in such situations, governments work with families to develop packages of care that can be worth hundreds of thousands of dollars in order to enable health, community and other services to be available.  These packages are regular features of disability support but, of course, there aren’t lots of them.

So what are the entitlements of a person with a mental illness?  While there is plenty of evidence about what treatments, services and programs work, what is the right package of care for a young person showing early signs of psychosis?  How much does it cost?  How will a person with a mental illness know what to buy? And who will ensure they get what they pay for?

Other mental health supporters of Medicare Select seem to come from a more secular school. They would simply point out that we need more money and more services provided in new ways to new clients.  Attracting some of the missing 65% into care will almost certainly cost more than the mental health system currently spends.  And much of this spending will not be in the ‘health’ system but more broadly, in a range of community services, some clinical, some psycho-social.

Medicare Select is seen through this lens as being a vehicle by which to drive a general argument that business as usual won’t wash and this is completely understandable.

But would establishing Medicare Mental Health Select, by pooling funds (however calculated) really drive the establishment of new models of service provision?  If we build it, will they come?

This question really requires more analysis.  It is a business question as much as a health question.  The New England Journal of Medicine again published evidence of the benefits of collaborative care and the drawbacks of fee-for-service medicine.

Would a Medicare Select approach to funding drive new models of employment and payment for health professionals to work collaboratively?  Would it end the cycle of fruitless incentives which have failed to entice mental health professionals out of metro areas and into the bush?  Which organisations or new collaborations can we identify who might be willing to take on the business of meeting the holistic needs of people with a mental illness?  What happened in Holland – did new mental health service providers emerge?

Despite the recent prominence of mental health as an issue, its consideration by CoAG, the Reform Commission and repeated investigations by the Senate and others, it is still reasonable to suggest that Australia remains in crisis.

Unless the Federal Government decides to pursue fundamental reform arising from the Commission’s recommendations, then some tinkering of responsibilities between the Federal and State Governments is the likely minimalist outcome of current deliberations.  It is ironic that is the precisely the community-based mental health services that are most critically needed that fall right into the grey area of responsibilities now. There is some evidence that some state governments may be withdrawing from this field in anticipation of a Federal takeover.

Perhaps the real allure of a concept like Medicare Select is that it could end the often tragically disconnected series of services that passes for our mental health ‘system’.  The programs which work in health offer integrated care.  Financial planning services offered to parents in children’s hospitals, employment officers working in psychiatric wards of a Melbourne hospital.  These are exceptional glimpses into a system of care that attempts to manage a whole person, rather than just a limb or a symptom.

I am quite sure that mental health consumers and carers don’t care a jot for who holds the money or which level of government runs which type of service.  The current debate about health reform needs to be about more than this.  In mental health it needs to be about establishing evidence-based sustainable models of community care in which health, employment, education and other services each play a role.

For mental health in Australia, ‘plus ca change’ just isn’t an option. And if Medicare Select can drive reform then it deserves support.”

• For more Croakey posts on Medicare Select, see here, here, here, here, and here, as well as this Crikey piece by John Menadue.

We’re not even close – and if you’re expecting anything meaningful to happen before 2020, you’re just not paying close enough attention.

That’s  the assessment of Professor Ian Hickie, executive director of the Brain and Mind Research Institute at the University of Sydney.

And he thinks the Federal health reform bandwagon now visiting a hospital near you is just a distraction from the main game.

He writes:

“As I’ve expressed in an editorial in next week’s Medical Journal of Australia, this ‘consultation’ process is a major distraction.

What is clear is that the Government (assisted by the final report of the National Health and Hospitals Reform Commission) is rapidly retreating from any serious reform agenda.

Medicare Select, the reform previously known as ‘Option C’ (i.e. competitive national social insurance) has been sent to the back-blocks of Woden for a well-earned period of long-service leave. Regional health providers (Option B) are not on the agenda either.

Inevitably, a future (and somewhat braver) Government will be forced to revisit the issue of genuine health reform (in about 2020). At that time it will dust off the NHHRC interim report and have another look at a
financing system that had some real chance of changing the way that health care is delivered in this country.

In health, as in most human endeavours in the modern world, you get the health care system you pay for. If you pay for disconnected services, a narrow focus on acute care and one-off (i.e. fee-for-service) procedures
and other interventions – then that is what you’ll get.

The really neglected areas of chronic disease management, dental care, mental health, indigenous health, youth health and coordinated aged care will remain at the bottom of the pile.

The Government has already demonstrated its real (political) priorities through its major new investments in acute care hospitals, cancer care and reducing surgical waiting lists.

While the major economic stimulus package prioritised the retail sector (do we really need two plasma screen TVs in every Australian home?) and basic educational infrastructure, the health services and medical research sectors were obviously low priorities.

In the meantime, this round of hospital-centric public relations events will keep everybody chattering till we all quit for Xmas.

Clearly it is designed principally to soften us up for another round of public ‘hospital’ reform (i.e. senior Woden officials telling the States to get their act together).

Any one who has sat through “the (powerpoint) presentation’ that goes with these hospital-based events will realise rather quickly that we are not on the precipice of major ‘health’ reform.

There is no serious discussion about changing how the money flows or opening up the sector to a new breed of regional or national health care providers.

The most likely outcome for the post-2010 election period is some more money, a lot more talk and the same old divided Federal-State delivery system.”

But at least we now have some idea of what sort of questions we should be asking, thanks to a report released this week by the Australian Institute of Health and Welfare, called Towards national indicators of safety and quality in health care (and available here).

The Australian Commission on Safety and Quality in Health Care funded the Institute to develop safety and quality indicators for various health settings, including primary care and community health care services, hospitals, specialised health services (such as palliative care, defence health services etc), and residential aged care.

Now that we at least know the questions to ask, we’re somewhat further down the path towards open public reporting of health service performance.

The report notes, however, that the issue remains extremely contentious and that “Australia has yet to follow the lead of countries such as the United States of America and United Kingdom which have adopted detailed regular public reporting at the provider level”.

While there are many concerns about the impact and usefulness of open public reporting, the report says it could have two purposes: to provide transparency and to inform decision-making about overall priorities and system-level strategies for safety and quality improvement; and to inform quality improvement activities of service providers.

It cites one study comparing the degree to which performance information stimulated quality improvement activity in hospitals if it was publicly reported or if hospitals received private reports.

The authors reported finding strong evidence that “….making performance information public stimulates quality improvement in the areas where performance is reported to be low. Since quality improvement efforts among the public-report hospitals appear to be significantly greater than in hospitals given only private reports, there is added value to making performance information public.”

To give you an idea of the indicators suggested by the report, they include:

For primary care and community health services:

• General practices with a register and recall system for patients with chronic disease
• People with moderate to severe asthma who have a written asthma action plan
• Mental health care plans in general practice
• Annual cycle of care for people with diabetes mellitus

For hospitals:

• Assessment for risk of venous thromboembolism in hospitals
• Pain assessment in the emergency department
• Stroke patients treated in a stroke unit
• Complications of transfusion
• Health care associated infections acquired in hospital
• Adverse drug events in hospitals
• Malnutrition in hospitals and residential aged care facilities
• Pressure ulcers in hospitals and residential aged care facilities

For specialised health services:

• Post-discharge community care for mental health patients
• Functional gain achieved in rehabilitation
• Multi-disciplinary care plans in sub-acute care

For residential aged care:

• Oral health in residential aged care
• People receiving a medication review
• Falls resulting in patient harm in hospitals and residential aged care facilities

The report note that indicators already exist for specific types of services, including Key Performance Indicators for Public Sector Mental Health Services, Australian Council on Healthcare Standards clinical indicator sets, for specific population groups such as the Aboriginal and Torres Strait Islander Health Performance Framework, and the COAG National Healthcare Agreement Performance Indicators.

Now that we have all these questions to ask, when will the answers be made available to the public? And will we make best use of them? So many questions searching for answers…

The importance of prioritising the needs of youth and children,  the unhelpful impact of the dominance of the medical model in mental health, and the potential to expand the role of consumers in service planning and provision – these were some of the issues raised. The results also sound something of a wake-up call for the psychiatry profession.

Professor Gavin Mooney, who conducted the survey, reports:

“The Mental Health Services conference is unusual in that it brings together a wide array of players on the mental health stage – mental health service consumers, carers, health care professionals, administrators, academics, government bureaucrats – the whole spectrum of interests in mental health.

This year the organisers arranged through me to conduct a survey of participants entitled  ‘what do you want from the mental health services?’

The survey looked at two things, first the sort of principles or values that participants want to underpin mental health services and second what they see as priorities on a number of levels.

One thing sticks out above all else in the responses. I had assumed that consumers would have very different views from health care professionals and again that academics would see things so differently from carers. Yet the pattern of responses across the groups was quite remarkably similar.

These people – diverse in terms of their roles in mental health services – know what is wrong and what needs to be done and are united in that!

On values and principles they argued for the idea that priorities should reflect the fact that even for people with the same problems, some have greater difficulties in accessing care than others.

The prime goal of the mental health services they see as looking after as well as possible the interests (both health and other) of those with mental illness and their carers and families.

Most interesting perhaps – certainly most radical – is that they want the values of consumers and people with mental illness to drive priorities. Now wouldn’t that be something!

At the same time, of the total of 164 responses not one person wanted the values of politicians or government or administrators to set priorities.

On priorities regarding extending services, there was strong support for more community services, none for general practice and very little for inpatient hospital services.

The top priority on age groups was youth with children second.

The participants were asked what type of staff they would most want if more staff could be attracted into the service. There was a big majority for more consumer advocates and peer workers. Nurses and social workers were second but a long way behind. Psychiatrists came last.

They were also asked about stumbling blocks to reform – both who and what. These open ended questions provided some fascinating but also sad comments.

Regarding who are stumbling blocks, government, the bureaucracy and clinicians came out of this very badly indeed. The participants suggest there is government neglect, no political will for reform, bureaucratic indifference and clinical elitism. Several respondents mentioned the inappropriateness of the medical model and the conservatism of clinicians in the mental health field.

On what is blocking reform the answers are again clear but sad – lack of resources, community attitudes, stigma and again the medical model.  Lack of coordination was also highlighted and the issue of power not resting more in the hands of the clients and their carers.

My reading of these results is that there are very real frustrations involved for many of the participants in their dealings with mental health services. There appears from these answers to be a very real need for the service to look at itself in a very critical way and especially for psychiatrists to be looking at what their role is, what it might be and what it should be.

What is most striking is that the participants believe that there is much that needs to be reformed in mental health services, they are remarkably agreed on what that is and they have some pretty good ideas about what needs to change. They know what is wrong and they know what needs to be done to fix it.

That knowledge needs to be heard – but will the current decision makers listen?”

Croakey was able to pass on the Evaluation of the National Suicide Prevention Strategy, which was listed on the CRUD back in April, and which helped inform this story.

Just a reminder to Croakey contributors and readers; if you’re aware of other unreleased documents whose release may be in the public interest, please drop us a line, and they will be added to the register.

Even better if you are able to share the unreleased documents themselves.

What is the point of reports sitting on shelves and gathering dust, if they could be helping to inform the community and public debate?

Dr Brian O’Toole, an epidemiologist specialising in mental health issues and the director of the Vietnam Veterans Study, has entered into the fray, arguing that the public health community doesn’t pay enough attention to mental health. He writes:

“This is a plea to extend the focus of public health and prevention beyond the  causes of death and their risk factors – heart disease, cancer, diabetes, etc – that seem to dominate public health in these days of chronic  disease epidemiology and the push to extend survival and postpone and compress the inevitable morbidity into a much shorter time. But public health seems uninterested in what actually happens to people as they move through towards the inevitable ending – many people’s lives are a  constant misery on this journey because of mental illness. Do we all “live lives of quiet desperation”?

There is hardly a family in this country that is unaffected by some  kind of mental illness, and mental illness (particularly depression and the schizophrenia spectrum disorders) make a mighty contribution  to the burden of disease. Yet research and funding for clarification and discovery of brain-based disorders and primary and secondary  prevention efforts are very poor. Enquiry after government enquiry has demonstrated the need for attention to understanding and preventing  the deterioration that accompanies mental illness, yet nothing has changed.

Ten years ago, with colleague Stan Catts, we mounted the First  Australian Schizophrenia Prevention Conference in Sydney (see Catts S, O’Toole BI, Dragen D (Invited Editors) First Australian Schizophrenia  Prevention Conference, Aust NZ J Psychiat 2000; 34 Supplement S1-S212). Since then, nothing has changed. Mentally ill people still  get shot by police and populate the jails. Thousand are still homeless. Even getting a differential diagnosis in early onset (usually teens and early twenties) disorders is a herculean task, reflecting the lack of knowledge about mechanisms of disease and  prevention in mental health. Three psychiatrists can give five opinions, and all that.

Sadly, there is almost no attention given to mental health in schools  of population/public health in Australia; a few epidemiologists can be found in a couple of enlightened schools of psychiatry, but there are far too few.

Wouldn’t it be a great idea to prevent schizophrenia? Bipolar disorder? Recurrent severe depression? Antisocial personality disorder? The madness that underpins extremist terrorism?

Sorry, I’ll stop the rant now, and go back to my ward…”

Thoughts of an ambitious Pollyanna have come to mind for Dr Michael Robertson, Senior Research Fellow at the Centre for Values, Ethics and the Law in Medicine, University of Sydney.

He has filed this analysis for Croakey:

“The parts of the NHHRC relevant to mental health care are short on detail but read as an ambitious agenda, which seems to make the right kind of noises. Mental health clinicians are getting used to such lofty proposals of reform; they are also adept at not holding their breath.

What is wrong with mental health care run at a State level? In short, it is entirely hospital focussed which reflects two fundamental issues.  First, there is a culture of risk aversion, which keeps the threshold for admission (particularly under involuntary status) much lower than it should. The second is the fact that the care of most severely mentally ill people is so difficult to coordinate in the community, that the hospital setting serves as the only means of resolving the recurrent crises they face. These crises are invariably born of the myriad of problems confronting such patients – physical ill health, homelessness, poverty and other gross social disadvantage. The asylum role of hospitals never really went away. Only the beds did.

The Federal-State split in mental health care reverberates throughout the patient journey. Primary care and access to Medicare funded clinical investigations, pharmaceuticals and psychological services are under Federal control. But the majority of psychiatrists who care for severely mentally ill patients are employees of the States, and are prohibited from utilising these services in this role, unless they are exercising their right of private practice. This then makes their role Federally funded, even though they remain an employee of the State.

If a State-employed psychiatrist requests a PBS prescription pad or a provider number for pathology services, these are usually refused as the Commonwealth argues that pharmaceuticals and investigations of patients cared for in State-funded clinical settings are the responsibility of the State. And so it goes.

The “big picture” reform agenda of the NHHRC argues for the availability of “Extended care services” – what are currently termed “Crisis Teams” or “Acute Care Services”. Such services already exist; the clinicians needed to fund them do not.

The reform agenda calls for ‘early intervention’ with an emphasis on the early phase of psychosis. Such services exist and do excellent work with the patients and families under their care. Problem is, such services are only effective when they are provided in an assertive (read labour and cost intensive) manner. When the team disengages, the patient’s mental health deteriorates.

What early intervention services appear to represent, is what adequately resourced services can achieve working with mentally ill people. In reality, these services have emerged at the expense of the care of other patient groups – unless an early intervention service is funded by a Commonwealth drip-feed, they have to be scrounged out of existing resources.

The NHHRC does seem to understand the subtleties of the current Federal-State shambles in mental health care. The patience of many fee-for-service providers (like GPs and bulk-billing private psychiatrists) is stretched when the disorganisation or amotivation of chronic mental illness leads to inconsistent attendance at appointments.

The proposed block funding of a case-mix (being paid an agreed amount based upon the likely composition of the mix of patients) is a well-established and sensible solution. The notion of  “Connected care” (integrating clinical services across different specialties) acknowledges the fact that the physical health of many mentally ill people represents a greater threat to their well being than their psychopathology.

The NHHRC also acknowledges that the main determinant of one’s mental health is the level of access to social goods and not just access to clinical services. For many people with a mental illness, a safe home, a job or a vocational role, and adequate nutrition are elusive.

If the Commonwealth seeks to guarantee access to stable housing linked to social support services for our mentally ill fellow citizens, bravo.

Other than the forced removal of mentally ill people and mental health services to areas where housing is affordable, jobs abound, and one can buy fresh fruit and vegetables on the pittance the Disability Support Pension provides, I cannot see how the Feds will do this in our horrendously overpriced big cities.

A final challenge is the prospect of “Person controlled electronic health records”. Experience in other jurisdictions, and in abortive trials locally, indicates that mental health information is problematic in such systems. Most mental health records are kept deliberately separate from other health records and many mental health consumers wish to keep it thus.

Given the well-known negativity mental health consumers receive at the hands of other parts of the health system, there will need to be a separate system of recording personal mental health data to the main one.

Good luck guys. You’ll need it.”

The executive summary identifies several priorities, including:

Indigenous health

• Establish a National Aboriginal and Torres Strait Islander Health Authority to buy services and to hold services accountable

• Strengthen community controlled health services, develop Indigenous health workforce and upskill existing workforce to provide culturally appropriate services

• Improve nutrition in targeted remote Indigenous communities

Mental health care

• Expand sub acute services in the community

• All acute mental health services should have a rapid response outreach team available 24 hours a day

• National access to youth friendly, community based services for encouraging good mental health in young people

Rural and remote

• Top up funding on a per capita basis to ensure receiving equivalent funding as well-served communities

• Increased funding for patient travel and accommodation

Dental Care

• A new universal scheme for access to basic services, Denticare Australia

• Expansion of preschool and school dental programs

Public hospitals

• Public hospitals with major emergency departments be funded to ensure enough beds are available

System redesign

• Establish National Health Promotion and Prevention Agency

• Strengthen primary health care with Comprehensive Primary Health Care Centres and Services to be established with extended opening hours

• Voluntary enrolment in a ‘health care home’ to encourage better continuity and coordination of care for people with chronic diseases and disabilities

• Current divisions of general practice should evolve into or be replaced by Primary Health Care organisations

Next generation of Medicare

• The Medicare Benefits Schedule should be “reshaped”, with the Commonwealth to decide what services should be covered and by whom they should be delivered

• A range of payment mechanisms including mix of salary, fee for service, grants, performance payments

• The Commonwealth should have full policy and funding responsibility for primary health care, basic dental care and aged care, as well as responsibility for buying health services for Aboriginal and Toress Strait Islander people

• The report lays open the way for the Feds to take over responsibility for health funding entirely. Initially the Feds would pay 100 pc of efficient cost of public hospital outpatient services with an agreed, capped activity-based budget and 40 pc of the efficient cost of every public patient admission to a hospital sub acute or mental health care facility and every emergendy department attendance. The Feds share could  be incrementally increased over time until it is completely responsible.  Under Medicare Select, the Commonwealth Government would become the sole government funder of health services, and all Australians would automatically belong to a health plan either operated by government, the not for profit sector or private enterprise. The NHHRC has recommended that over the next two years, the Feds explore the benefits, risks and feasibility of this recommendation.

In other words, two of the really hard-edged recommendations of the report – fundamental changes to the MBS and Medicare – are likely to be delayed long enough so as not to cause any pre-election grief for Rudd and co. It may also be worth noting that the report’s very first recommendation stresses the importance of private health insurance. Recommendation 92 adds: “We want to see the overall balance of spending through taxation, private health insurance, and out-of-pocket contribution maintained over the next decade.”

Strengthened consumer engagement and voice

• Build health literacy, eg as a core element of the National Curriculum in schools

• Foster community participation through citizen juries etc

• Every Australian should have a personal electronic health record that they own and control – by 2012

The Commission estimates the annual recurrent costs of their reforms are between $2.8 billion and $5.7 billion. A capital investment over five years of $4.3billion-$7.3billion is also required, they say. These figures do not include the costs of Denticare Australia, which it is estimated will cost the Feds $3.6 billion annually.

You can read more here from Crikey’s political correspondent, Bernard Keane.