Health reform cycles

In the World Health Organization’s ranking of health services worldwide, Australia falls in the top 10%. Despite this accolade, there continues to be widespread dissatisfaction with the performance of both our primary and institutional health care. The traditional political response to this community disquiet has always been to initiate yet another inquiry and report.

The most recent of these was the report of the National Health and Hospitals Reform Commission. Like its predecessors, the Commission recommended substantial reforms, which, predictably, became the proverbial political football kicked about in the public arena as politicians and health commentators strove to score in true adversarial fashion.

Earlier this year, the Rudd federal government scored a goal when it announced an extensive program of health reform, as outlined in the document entitled A national health and hospitals network for Australia’s future. A sustained flurry of media commentaries followed, led by the usual experts and professional organisations. The Prime Minister frenetically crisscrossed the nation like a busy bee building a hive of support, after depositing billions upon billions of dollars into a flagging health system.

And all this climaxed at the meeting of federal and state leaders at the Council of Australian Governments. Here, the focus of the debate shifted to political gamesmanship and arguments about administrative structures, accountability and alignment between hospitals and primary care, as well as the protection of state revenue and budgets. But in the end, the lure of more dollars won the day.

This scenario reminded me of a gaggle of physicians in a bygone era, gathered around the bed of a febrile patient, arguing about how to treat the patient with an array of emetics, purgatives, blood-letting or colonic washings, totally oblivious to and ignorant of the underlying disease.

The promise of billions of dollars to treat symptoms of a failing health care system without fundamentally addressing the underlying disease with innovative and revolutionary reform will only inevitably lead to more inquiries and more reports.