Reform of health: revolutionary or evolutionary?

Should an extraterrestrial visit our land, he would soon discover that all is not well with our health system. He would uncover a dysfunctional system that causes much distress and discontent for patients, health professionals and politicians.

Given the current context of an uncontrollable escalation in costs, there is mounting pressure for change. The expenditure blow-out reflects many competing factors, including the high cost of new technology and drugs, the increased demand for services in an ageing society, a growing prevalence of chronic disease, and an unquenchable demand for health care by both the sick and the “worried well”. In short, we have reached a stage where the demand for health care has outstripped the capacity of our system to deliver.

The time has come for us to embrace reform. But will it be evolutionary or revolutionary? William Beveridge, the economist whose 1942 report led to the founding of Britain’s National Health Service (NHS), said that “a revolutionary moment in the world’s history is a time for revolutions, not for patching”.

At a recent conference on the state of the Australian health system, I proffered the view that health care reform belongs to the young and suggested they should be in the vanguard of revolutionary reform. Not surprisingly, this “call to arms” went down like a lead balloon! The psyche of the profession tends to be conservative by nature, always acutely aware of the centrality of the patient in all deliberations.

Admittedly, some celebrated revolutionary moments in medicine have indeed evolved from astute scientific observation, such as Semmelweis’s insistence on hand hygiene to prevent puerperal fever. However, other revolutionary moments, such as the foundation of the NHS in Britain or Medibank and the Pharmaceutical Benefits Scheme in this country, were driven primarily by politicians, not the profession.

So, will the changes in Australian health care presaged by the recommendations of the recent proliferation of inquiries and reports represent “a time for revolutions” or will they be nothing more than “patching”?