Why it’s time to get out of our comfort zone when deciding how to spend health dollars…

If you were a benevolent dictator with $12 billion to splurge on fixing the healthcare system (the equivalent of Queensland’s health budget), what would be the fairest and best way of

Melissa Sweet — Health journalist and <a href=Croakey co-ordinator" class="author__portrait">

Melissa Sweet

Health journalist and Croakey co-ordinator

If you were a benevolent dictator with $12 billion to splurge on fixing the healthcare system (the equivalent of Queensland’s health budget), what would be the fairest and best way of spending the funds? This was the challenge given to speakers at an Australian Centre for Health Services Innovation (AusHSI) Thought Leaders Forum in Brisbane last week, previewed previously at Croakey. As journalist Mardi Chapman reports below, the discussions reflected nationwide tensions in the health system as expectations and demand for services continue to rise against a diminishing capacity to supply. Her series of articles covers:
  • Intensive care specialist calls for a greater focus on public health measures and low cost interventions
  • Citizens' juries can help decide health priorities: a case study from Queensland
  • German and French health systems have lessons for Australia
  • Call for increased spending on health promotion and illness prevention
**** Talking himself out of a high tech job? Professor John Fraser is director of the Critical Care Research Group at The Prince Charles Hospital and director of the Intensive Care Unit at St Andrews War Memorial Hospital. One of his many achievements is leading a team that has advanced artificial heart technology, which is relevant for an ageing population. However, he acknowledges that he practises at the high and costly end of medicine. He said the starting price for an intensive care bed, public or private, is $3,500 per day. Knowing that a disproportionate amount of health dollars are spent on people in the last six months of their lives, he isn’t afraid to question whether our system achieves the distributive justice we might want. “Higher spending on health doesn’t always equate to better care or better outcomes. Cheaper health care can be more efficient,” he said. For example, long term exercise training and thermal clothing can be effective and cost efficient management strategies for heart failure patients. 

Yet these low cost interventions were often missed opportunities against investment in hospitals and medicines, he said. Along with the basics such as clean air and water, he said tobacco control and obesity control were important priorities. Smoking costs Australia about $31 billion per year, ties up hospital beds and is associated with the seven leading causes of death, including heart and lung disease and some cancers. Overweight and obesity, currently affecting 61% of Australian adults and 25% of children, costs us $58 billion. Early intervention would prevent the human and financial costs of sequelae such as diabetes and kidney disease. Professor Fraser said it would be short-sighted to cut funding to health and medical research. Instead, given the current 17 year lag between research expenditure and health benefits, more rapid adoption of research findings would lead to improved savings and better outcomes.  **** Let citizens decide health priorities In an environment of increasing demand on the health system and decreasing resources, politicians and policy makers need help allocating funds between competing priorities. According to Griffith University PhD candidate Rachael Krinks, citizens’ juries are an effective mechanism for encouraging genuine deliberation on the tough issues such as how to spend a $12 billion health budget. (Click to enlarge the image below).


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