Here we go again with next to nothing on health reform

We recommend improving the way in which general practitioners, primary health care professionals, and medical and other specialists manage the care of people with chronic and complex conditions through shared care arrangement in a community setting. These arrangements should promote good communication and the vital role of primary health care professionals in the ongoing management and support of people with chronic and complex conditions in partnership with specialist medical consultants and teams who provide assessment, complex care planning and advice.

Amen to that - taking better care of really sick people. You can imagine this being one recommendation the government jumps on.

Not all of the recommendations (pdf here) are so fluffy though. You can read summaries of them all over the internet today (some links below), but a few that are worth highlighting beyond the headline stuff:

• hospitals should report publicly on performance against a national set of indicators which measure access, efficiency and quality of care provided. League tables for hospitals, anyone?
• the proposed use of “citizen juries” to help set “National Access Targets”. People helping to decide how long it should be acceptable to wait for treatment.
• a personal electronic health record for every Australian by 2012 - owned and controlled by the individual. Includes a rider on legislating to protect the privacy of the data.

(I won’t reprint it here but I can also careful reading of 88.2, which spells out how the federal government could end up funding the entire cost of public health care.)

Trouble is, the Accenture model is one of the least complex graphical representations of a health system you might come across. And it’s just focused on how patients should, ideally, move about the system. It doesn’t take into account the relentless turf wars inside the hospitals, clinics, and surgeries on what type of doctor, nurse, ambo or dietitian should be making which decisions and when. That’s before you get to who pays for it.

Ultimately, of course, that’s Mr and Mrs John P. Taxpayer. Today The Daily Telegraph reports average income workers could have to shell out an extra $1000 a year.

Rudd’s problem here is he hasn’t shown any stomach for unpopular decisions. He could barely bring himself to utter the amount the government planned to borrow in the federal Budget this year.  Healthcare reform involves picking fights with a long line of people - not just doctors, nurses, and various specialists, but healthcare lobby groups, pharmaceutical companies, and, most terrifying of all for our politicians, voters.

Having a more efficient health service means closing down some services. It’s that simple. There can’t be a community clinic on the main street of every town. The commission even puts a figure on it: only towns which service 12,000 people or more should get one of the “multi-purpose service models” which is the proposed heart of community healthcare provision.

A medical industry source told me last night his organisation was “less for absolute reform and more for looking at what needs to be fixed”. This is a widely-held belief among medical practitioners from various disciplines - aren’t they all doing their own jobs really well? They are. Australian doctors, nurses, ambos and primary care providers are among the very best in the world. The system they work in is broken, with lines of accountability as strong and straight as spaghetti.

Frankly, between Rudd’s form on populist government and the inevitable uproar that will greet anything resembling significant change to the health system, the PM’s reluctance to press ahead with wholesale change should surprise no-one.

Which is why we are in the exasperating situation we are today. The Accenture submission was one of about 500 given to the commission when it sought input from individuals and organisations on how the nation’s health system should run. When they released their final report yesterday, Rudd said he would ... seek input from individuals and organisations on it. Talk about a chronic condition.

It’s good we’re talking about healthcare reform again. Along with jobs and education it’s consistently among the issues that voters say are most important to them.

It’s not cynicism, but the despairing reality, that the likely end result will be piecemeal change and continuing chaos and confusion for voters when it comes to the funding and delivery of health services.

Do you agree? What do you think? Let us know in the comments.