Imagine if the campaign catchcry was “We’ve got enough. We just need to use it better!”
It could have a big social media push with some shareable hasthags …. #nomore4healthcare and #wehaveenoughalready
Because in some ways it could be true. If you reflect on the funding of the Australian health system – and medical science for that matter – and you can’t answer the question “How much exactly is enough?”, then there’s always the possibility that the true answer is the amount it already gets.
And if you can see some waste in the system via a casual perusal then perhaps that is a sign that there is much, much more waste and inefficiency to be found if you look harder.
Because all the big issues and big questions in healthcare are essentially about finding efficiencies, minimising waste and making the most of what we’ve already got.
The Australian Commission on Safety and Quality in Health Care launched the second version of its Atlas on Health Variation this week. It points to enormous discrepancies between regions in how certain health issues are managed. Procedures including spinal surgery, appendix removal and rates of hysterectomies are all subject to enormous unjustified variation.
The most efficient use of those resources can’t possibly be evident in a range of regions given the differences. Or put another way, the health system has a range of views about the most efficient use of scarce resources but the clinical implications of those views will vary depending on where you live.
This is partly why the government has commissioned a major review of the Medical Benefits Scheme (MBS). It’s about making sure what is reimbursed and supported by the tax payer is also supported by the very latest research into what works and what doesn’t.
Caught up in this review is the question of after-hours medical services. Again it’s a question of efficiency. Will increasing funding for after-hours GP services help keep people out of expensive hospital emergency departments or will it just help make money for the corporate sponsors of the programs?. At least the focus of the question is right – efficiency and return on investment.
Medical research is not out of scope for these questions of efficiency either. The $20 billion Medical Research Future Fund (MRFF) “aims to provide a sustainable source of funding for vital medical research over the medium to longer term”. This is a massive investment and $65M was released in the last budget.
Can the medical research community guarantee tax payers hand on heart that there is a framework in place to make sure that money will be invested as efficiently as possible and each program supported will be analysed for its potential to deliver a return on investment? I don’t say that to be churlish. I’m just making the point that medical research – given its fragmented management via hundreds of research institutes and self-styled “innovation hubs” - is not immune to questions of efficiency.
In my job I’ve interviewed plenty of medical researchers over the years. Usually I’m looking for content for newsletters, educational content or media releases. Many times I’ve come away from those chats thinking the research was probably headed absolutely nowhere – and very, very slowly.
The whole recurring private health insurance fiasco in Australia is driven by questions of efficiency. Is it fair to force insurers to pay inflated fees for surgically implanted prostheses, human tissue items and other medical devices as is the case under the current arrangement with the prosthesis list?
Is it fair for health insurance funds to pay again when the problem is caused by an original visit to the hospital?
Give more power to the Gods of efficient distribution I say.
I picked up The Australian today and noted that feature articles about the importance of finding efficiencies in healthcare are finally making their way into the national mainstream media. Well done Sean Parnell.
So who wants to join my campaign? It starts with an assumption that asking questions about a more efficient use of existing health-related resources is a better use of energy than the constant “hand out, we want more” mentality. It invites people to reflect on the possibility that we’ve already got enough. That if we could just trim the fat, apply the evidence-based blow torch and rip away at the historical vested interests we’d likely end up with much better systems for healthcare delivery and medical research.
Because it could be true. It might be that our lofty aspiration for a modern health system that delivers longer, healthier lives for everyone is achievable within our existing resources and funding models. It could be that #wehaveenoughalready.