Jun 5, 2015
Women make up 55% of all medical graduates, 57% of all doctors under 30, 59% of endocrinologists, 58% of pathologists, 53% of paediatricians, 50% of rheumatologists, 49% of obstetricians and 43% of GPs. In fact, it is only in the surgical and procedural specialities that women are out-numbered significantly by men.
Women overwhelmingly dominate the broader health workforce, comprising over 90% of nurses and midwives and the majority of allied health professionals. In addition, women also make up 50% of consumers and 70% of carers of people with an illness or disability.
However, women comprise only 17% of the Government’s new Medicare Benefits Schedule (MBS) Review Taskforce, announced yesterday by Health Minister Sussan Ley. In the following piece, Croakey moderator Jennifer Doggett and ARC Discovery Indigenous Research Fellow Dr Mark J Lock from the School of Medicine and Public Health, University of Newcastle, discuss the implications of the Committee’s membership limitations and suggest what can be done to increase the transparency and effectiveness of this process.
The MBS Review Taskforce, which is tasked with reviewing the $20 billion Australians spend on Medicare annually through services categorised into 5 500 item numbers, includes only two women out of a total of twelve members (with one consumer representative yet to be named).
This is the first time such a comprehensive review has occurred and, according to the Consumers Health Forum, this process could result in ‘a landmark makeover’ for Medicare. Advice provided by this Committee is likely to lead to long lasting changes to the way in which we allocate our Medicare dollars, affecting the delivery of health care and impacting on all Australians.
However, the ability of the Committee to provide advice which accurately reflects the experience and priorities of the Australian community will be hampered by the limitations of its narrow membership base.
Another major gap is the lack of any Indigenous members or indeed anyone with specific Indigenous health expertise (as far as we can tell).
One of the greatest challenges facing the future of Medicare and our health system as a whole is to close the gap between the health and life expectancy of Indigenous Australians and non-Indigenous Australians.
This will require coordinated efforts from all components of the health system, including Medicare. There are existing Medicare-based initiatives targeting Indigenous health, such as specific item numbers which reflect the multiple disadvantage experienced by the Indigenous community and the resulting higher complexity involved in providing Indigenous Australians with equal access to health care.
These item numbers trigger a dedicated pathway of care for Indigenous Australians which has been developed over a twenty year history with proven benefits.
There are no doubt many ways in which we can improve the way in which Medicare serves the needs of Indigenous Australians. However, without explicit representation from experts in Indigenous health on the Committee this is unlikely to be achieved.
This is no reflection on the expertise or competence of the individuals selected by the Government to sit on these committees. These people all have relevant knowledge of Medicare, are leaders in their fields and the potential to make significant contributions to the Review process.
However, collectively they do not represent the diversity of the general community and in particular lack the unique knowledge and experience of gender and race which could inform the work of the Committee.
The inclusion of a single consumer representative is also likely to impede the effectiveness of the Committee. Research has shown that the benefits of consumer input are maximised when more than one consumer representative is appointed to a Committee.
While we have many highly skilled and experienced consumer representatives in Australia, even the most competent would find it difficult to adequately represent the views of all consumers as a single representative.
The planned ‘public consultation’, while a positive step in increasing community input into the process, does not replace the need for robust consumer input at the Committee level via trained and experienced consumer representatives, supported by a consumer peak body.
This is not about tokenism or political correctness.
It is generally accepted elsewhere in the health system that better outcomes are achieved when high level committees and boards include a greater diversity of members. For example, Primary Healthcare Network Boards (and previously Medicare Locals Boards) are required to be reflective of the population as a whole.
The Royal Australian College of General Practitioners and the Royal Australian College of Physicians both focus specifically on including Indigenous doctors in their governance processes.
Promoting diversity within high level health committees does not mean sacrificing expertise. There are women at the top of almost every specialty area of medicine in Australia.
We have women deans of medical schools, professors of medicine, clinical leaders, health economists and medical and health researchers.
Similarly, there are highly skilled and experienced Indigenous doctors, health care experts and academics with research expertise in relevant areas.
These people could offer both the medical and technical expertise required on this committee as well as ensure the Committee reflects the diversity of the Australian community.
Given the Committee’s membership has already been announced, one possible solution would be to create sub-committees of key groups not adequately represented on the Committee, including women, Indigenous Australians, people with rural and remote healthcare experience and others.
Also important is to increase transparency of the Committee’s governance and processes. Currently, the Committee has no terms of reference and no work plan (at least none that are publicly available).
For a group whose advice affects the distribution of $20 billion of shared resources and is likely to impact the entire population, we recommend adhering to the ASX corporate governance standards.
At the very least, the TaskForce should have to meet the governance and transparency standards required of a community-based organisation on the receiving end of even the smallest of government grants.
The Government deserves credit for responding to calls from experts and consumers for reform of Medicare – a review of the current MBS pricing structures is long overdue. But the Medicare ‘male-over’ announced yesterday falls short of the genuinely representative process that the Australian community deserves.