Health Policy: A Critical Analysis Report (Assessment)

Executive Summary

The Australian Health Care System faces many challenges that affect efficient delivery of services. The challenges range from lack of a clear distinction between the roles of the State, Commonwealth, and the private sector. Issues of persistent health insurance wrangles, influx of untested technologies, little emphasis on preventive health care, and prohibitive cost are the other challenges.

According to Palmer and Short (2000), the apparent lack of good policies has worsened the situation. With clearly spelt out responsibilities between the Commonwealth, State, and private sector, stakeholders in healthcare will contain the problems inherent in the system. Dr. Andrew Southcott, the Shadow Parliamentary Secretary for Primary Health Care, in the run-up to the 2013 election, proposed a raft of reforms in the health care sector.

If elected, the opposition coalition promised to review the structure upon which the State delivers primary care. The opposition was concerned that in spite of heavy funding, Medicare Locals do not deliver quality and uninterrupted services. The proposed health policy will inevitably have social, political, economic and epidemiological effects.

Socially, the policy will affect access to primary care especially by those in the low economic substratum. Economically, the health policy portends little expenditure by ensuring resources are spent in a transparent and accountable manner. The policy will however face resistance from health care providers and lobbyist who will see it as a threat to their economic lifeline.

Introduction

Gardner and Barraclough (2002) identify the origin of Australia’s Health Care problems to the paradox of “the federal government financing a medical care system where most services are provided by private practitioners” (54). Like in other states, government ought to have high levels of control over a program that falls under its financial purview. It is against this background that the opposition coalition sought to exercise more authority in policymaking especially with Medicare locals.

Through its shadow parliamentary secretary for primary health care, the coalition expressed desire to ensure that Medicare locals follow the general medical practice. The proposed reforms also sought to ensure that more funding goes to clinical services rather than administrative functions of Medicare locals. Additionally, the federal government sought to oversee all tendering processes and ensure disruptions to clinical services are non-existent.

The Medicare Local spokesperson expressed displeasure with the move citing that the Medicare locals are the true essence of decentralized services. Further, the organization lambasted the opposition coalition for planning to deny local communities access to clinical services in spite of the strong benefits of scale in the Medicare locals’ favor.

This paper will demonstrate that the proposed health policy is not the panacea to challenges bedeviling health care system in Australia but the coalition needs to consult and circumspect before full adoption. To do so, the paper will apply economic, social, political, and epidemiological yardsticks.

Proposed Health Policy: Analytical Perspective

Political Perspective

The originators of the Medicare Locals idea wanted to take clinical services closer to the communities. They gave local practitioners total control over the program despite the funding by federal governments (Barraclough & Gardner, 2008). Over years, the system has entrenched itself into Australia’s health care psyche to an extent that any disruption or change will elicit resistance.

From a political perspective, opposition coalition’s proposals will face resistance from professional monopolists, corporate rationalists, and community interests. The reaction by the Medicare Locals association fired the first salvo when it accused the opposition of “putting at risk the very real opportunity for communities to have, for the first time, health services tailored directly to their local demands” (Patrick, p.32, 2013). It is evident that medical professionals are for the retention of the status quo.

The other resistance came from corporate rationalists and community interests. A good example is insurance sector. Health care pundits cite insurance lobbyists as a great obstacle in reforming the sector, all over the world (Taylor, Foster, & Fleming, 2008). With the proposed reforms, insurance profits will plummet as they hide most of their cost within administrative rather than clinical functions.

Insurance cartels thrive through stringent bureaucracies in the health sector. If such bottlenecks diminish, federal government will force cartels out of business. Designers of Medicare Locals envisaged a devolved health care in which communities will have considerable control over clinical services and facilities within their neighborhood. Community interests will therefore oppose the move with all their might.

Economic Perspective

The proposal by the opposition coalition sought to minimize cost and maximize efficiency of Medicare Locals. This underpins the success of any health policy. By funding and auditing the locals, the federal government will ensure hegemony in clinical services and reduce disruption of services.

Rather than allow clinical services, there should be concerted efforts form the federal government to ensure that service providers do not treat health care as a commodity (Gauld, 2005). However, limiting federal funding to clinical services, and excluding administrative services, will be a financial burden to Medicare Locals and subsequently, the communities.

As it currently stands, Medicare Locals charge a fee for services they render to customers. Taylor, Foster, and Fleming (2008) indicate that in 2007, Medicare Locals charged a combined 16.5 billion Australian pounds. In contrast, the federal government managed a paltry 8.5 billion Australian pounds from levies on Medicare Locals.

In essence, therefore, practitioners at Medicare Locals make a lot of money by charging a fee, an aspect that can diminish quality of services in attempt to serve many people. Financial incentives are leading to poor services in what the initiators intended to be quality services closer to the people. The health policy by the opposition will exacerbate this situation. Medicare Locals will pass on this extra burden to consumers, further taking primary health care services beyond the reach of ordinary citizens.

A great concern in Australian health care system is the little concern with preventive health. Rather, the system is reactive, focusing more on treatment of illness. Proponents of Medicare local structured it to take primary health services to the communities but the focus on “pay-for-service” has provided an incentive towards curative rather than preventive services. This perpetuates rather than curb the myriad challenges the paper referred to at the beginning.

Will the health policy by opposition coalition curb this malady? The answer is a resounding no. The new policy proposes to recognize “general practice as the cornerstone of primary care in the governance structures” (Development O. F. E. C. O. A., p.34, 2013). The policy effectively takes the health care system to where it was before 1980s. Decentralization of primary health aims to suit clinical and preventive services to the needs of the local communities.

The health policy intends to take this away. As much as there are challenges in the system, the coalition has gotten it wrong on how to fix it. Ramon (2005) criticized the reforms that the government initiated for “dumping” all services to the Medicare locals and thus setting them up for failure. The opposition is proposing this same path.

Epidemiology Perspective

Taylor, Foster, and Fleming (2008) propound that a sound health policy, from an epidemiology perspective, should “promote intersect oral collaboration, coordination, partnership, and community involvement” (54). Further, the designers and proponents should structure it in a way that places emphasis on preventive health.

The health policy that the opposition proposes is failing in this respect. Understandably, a press release cannot provide data to back up a supposition. However, the coalition, in subsequent debates, failed to provide evidence how imposing general practice in Medicare Locals will contribute to preventive health.

Sociological Perspective

Any policy, and more so a health policy, should be focused on promoting equality and be mindful of cultural value. The health policy by the opposition coalition is more inclined towards the financial perspective more than any other thing. The assumption seems so be that stringent financial discipline will improve health care system, which may not necessarily be the case.

The originators of the Medicare Locals wanted equality and accessibility in provision of primary health care. Any improvement would therefore go towards making health care even more affordable to many people. The Aborigines for instance are a marginalized group and Medicare Locals strife to provide tailor-made clinical services for the group (Bell, 2010).

Any health policy should be towards make it more accessible. The health policy therefore ought to go towards increasing funding to clinical services as well as catering for the administrative cost (Lofgren, De & Leahy, 2011). The current practice in which practitioners offer services based on the financial capabilities only serves to perpetuate the discrimination.

Good Policy: Winners and Losers

After analyzing the four perspectives, it is incumbent to review characteristics of a ‘good’ policy against the one the opposition coalition is proposed. The first one is access and affordability (Lewis, 2003). The health policy does not commit more resources to health care but it is refreshing to note they want accountability and transparency in the current amount. However, the policy fails to scrap the system that provides financial incentive to practitioners out of numbers served rather than quality.

A ‘good’ policy should be economically efficient and geared towards public interest accountability. One cannot help but feel a sigh of relief at the thought that the federal funding will go towards clinical services.

In spite of the apprehension that practitioners may pass the administrative cost burden to patients, it is refreshing that the quality may improve. The policy is, however, a blanket statement by an aspiring opposition and it would have been prudent for them to give an indication that they will invite various stakeholders for consultations and deliberations.

Conclusion

In conclusion, it is instructive to note that Australian health care system problems are many and only a multi-pronged solution will work. The solution should outline proper delineation of the roles of different stakeholders within the sector. The federal government, by dint of being the funder, should have its way when it comes to policy but it should consult other stakeholders (Enright & Petty, 2013).

Health care in many countries is struggling because of unscrupulous cartels that want to take advantage of unsuspecting patients. The government, including the opposition, should work out a formula that elevates the health of its citizens against corporate interests. However, there should be no attempt to reverse decentralization of health care in Australia.

References

Barraclough, S., & Gardner, H. (2008). Analysing health policy: A problem-oriented approach. Sydney: Churchill Livingstone/Elsevier.

Bell, E. (2010). Research for health policy. Oxford: Oxford University Press.

Development, O. F. E. C. O. A. (2013). Waiting time policies in the health sector: What works?. S.l.: Organization For Economic.

Enright, M. J., & Petty, R. (2013). Australia’s Competitiveness: From Lucky Country to Competitive Country. Hoboken: Wiley.

Gardner, H., & Barraclough, S. (2002). Health policy in Australia. South Melbourne, Vic: Oxford University Press.

Gauld, R. (2005). Comparative health policy in the Asia-Pacific. Maidenhead: Open University Press.

Lewis, M. J. (2003). The people’s health. Westport, CT: Greenwood Press.

Lofgren, H., De, L. E. J. J., & Leahy, M. (2011). Democratizing Health: Consumer Groups in the Policy Process. Cheltenham: Edward Elgar Pub.

Palmer, G. R., & Short, S. D. (2000). Health care & public policy: An Australian analysis. South Melbourne: Macmillan Education Australia.

Patrick, A. (2013). Downfall: How the Labor Party ripped itself apart. Sydney, N.S.W: HarperCollins Publishers.

Ramon, S. (2005). Mental health at the crossroads: The promise of the psychosocial approach. Aldershot [u.a.: Ashgate.

Sorensen, R., & Iedema, R. (2008). Managing clinical processes. Sydney, N.S.W: Elsevier.

Taylor, S., Foster, M., & Fleming, J. (2008). Health care practice in Australia: Policy, context and innovations. South Melbourne, Vic: Oxford University Press.