In part 4 of Croakey’s election series, public health specialist Associate Professor Peter Sainsbury, from the Sydney School of Public Health, analyses the Government’s record on health and health reform.

Good intentions aren’t enough, he says. We need radical change if we’re to see a better, fairer system.

Peter Sainsbury writes:

“The government seems to have good intentions for health care in Australia and most of its initiatives for increased funding and workforce and infrastructure support seem to be heading in the right direction.

However, its proposals for the public health, hospital and primary health care services themselves leave a lot to be desired.

The proposed hospital networks are taking us back 25 years (in NSW anyway) and will in my view prove to be financial and service disasters, but I want to focus here on the government’s plans  for public health and primary health care.

To be frank, the government hasn’t got a plan for public health; it hasn’t got a clue about the issues, never mind what to do about them.

Its response to the report of the Preventative Health Taskforce (which had been hobbled from the start by very restrictive and unimaginative terms of reference) demonstrated no understanding whatsoever of the underlying determinants of health and illness.

Certainly the government has endorsed the taskforce’s much needed proposals for the control of alcohol, obesity and tobacco but we didn’t need the taskforce and months of government consideration to develop those. The proverbial visually challenged husband of Princess Mary of Tasmania could have done that.

But does the government have any awareness of the social and economic determinants of health in Australia? Does it have any commitment to creating a more health promoting, more equitable society?

Or is its vision in this regard limited to instigating outrageous assaults on citizenship and human rights with programs like the Northern Territory intervention and the extension of compulsory income management?

Does the government have any idea how public health programs are delivered across Australia and how services are organised?

Just for the record, I don’t share most of my colleagues’ unbridled enthusiasm for the proposed national preventive health agency. It should be able to achieve some useful social marketing at the national level, but I very much doubt it will have any effect on the underlying causes of illness and health inequalities or have much success working with public health services in the states and territories.

The situation is little better with the proposed primary health care organisations, or Medicare Locals.

Does anyone seriously think that general practice and community health services are going to be improved by these glorified divisions of general practice or by the simple co-location of services in superclinics?

If we are going to improve primary health care in Australia we must change the model radically: progressively reduce dependence on fee for service payments to GPs; move the vast majority of GPs into group practices that also contain a range of other health professionals and practice support staff, all part of the same organisation and management structure, and all located in purpose built facilities.

According to Carla Cranny’s recent report on proposed Medicare Local boundaries, in Sydney approximately 50% of practices and 20% of GPs are still solo practices – this must change.

But the Medicare Locals have no power whatsoever to create these changes. All they can do is ‘work with’ GPs and other service providers. There will be no substantial improvements in primary care until there are tight contractual relationships, covering funding and outcomes, between general practices and Medicare Locals.

The government’s health policy is generally seen by the public and the pundits as one of its electoral assets, and this may well be true.

But whether it’s an asset for the health of the nation over the next 20 years is another matter altogether.”

To see the previous posts in the election series:

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