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Year 2 of the Abbott
government – where should its
health policy go?
Presentation to 2014
Future of Medicare conference
TERRY BARNESPrincipal
Cormorant Policy Advice
14 August 2014
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The future always looks foggy…
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Points of discussion
• Where are we now?
• Lessons learned from the GP bulk-bill co-payment debate.
• Is big-bang healthcare reform really possible?
• The Abbott government’s “to-do” list for its second year.
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Where are we now?
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Lessons for new ministers from
GP co-payment debate
• Public is conservative about healthcare institutions including MBS, PBS, public hospitals.
• Significant changes need careful planning and explaining as well as doing
- Till the ground long and well!
• You can’t rely on canaries in the coal mine to do the policy advocacy job for you.
• Don’t underestimate the malign potency of unelected vested interests – and don’t pander to them in negotiating compromise.
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Big-bang healthcare reform is not
politically possible
• Public is conservative and clingy about MBS, PBS, public hospitals, and this shapes the politics of health
- Makes scare campaigns all too easy.
- Oppositions campaign on 19th century issues rather than 21st century best practice (eg maintaining public hospitals as “cathedrals of care”).
• Toxic battles over co-pays, federal hospital funding make cooperative reform less rather than more likely.
• 2014-15 state elections in Victoria, NSW, Queensland won’t help either.
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Abbott and Dutton’s to-do list for Year 2
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1. Use Commonwealth power for good,
not evil
• Don’t be afraid to use purchasing power over MBS, PBS, public
hospitals in pursuit of sound policy outcomes.
• Stop vested interests controlling their own patches.
• Combat Medicare racketeering – eg IVF industry’s shamelessly
exploiting MBS for shareholders, investors ahead of patients.
• Take excessive out-of-pocket expenses fight right up to the AMA
and specialists.
• Break down demarcation barriers stopping more flexible and
economical primary care and CDM.
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Partner with states re
public hospital sustainability
• Keep working with states to bed down national ABP, performance benchmarking and reporting.
• Make reduced federal funding growth a acute care reform asset – use Commonwealth funding dominance as an efficiency driver
- That’s what happened in the Canberra-Victoria funding standoff in 2012-13.
• Incentivise states to be more productive and innovative re public hospital service deliver/admissions risks management, error reduction and out-of-hospital care.
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2. Allow private health insurers
into primary care• Regionalised trials to date are encouraging.
BUT
• Government needs to clarify and codify acceptable PHI involvement in primary care, and its relationship to Medicare and “universality”.
• Encouraging PHI equivalents of Victoria’s HARP programme is a good thing.
• Learn lessons from GP co-payment handling mess and head of scare campaigns by informing, explaining and consulting.
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3. Private health insurance reform
• Intertwined with the future of Medicare.
• Medibank sale gives Government a golden opportunity to clarify PHI coverage, deregulate its operation.
• End ministerial premium approval, remove costly and age loadings from rebates – both awful and obsolete policy.
• Modify community rating to reward at least some good risk behaviours and discourage bad.
• Get personal responsibility more in the picture for PHI and, by extension, Medicare and ED access.
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4. Merge MBS and PBS safety nets
• Co-pay debate focusing on affordability and cost impacts
highlighted that current safety nets are obsolete.
• Should be a single combined MBS/PBS safety net that pools
overall personal spending on medical and pharmaceutical
services.
• Simply have a safety net, thresholds focusing on $
incurred by general and concessional patients.
• Start work in 2014-15 to have new single safety net in
place by January 2016.
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5. Clean out federal Health bureaucracy• Too many public servants means too much government
- Too capable of duplicating state and private sector capacity and brainpower.
• Health, DVA and aged care functions of Social Services should be consolidated and shrunk
- Get rid of hanger-on agencies too.
- Contract out policy advice and break pernicious influence of the healthcare establishment.
• Payments and coordination agency first and foremost, not policy and political advocacy.
• New DoH Secretary about six years overdue. Needs to come from outside the Department, and preferably outside APS.
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What Abbott and Dutton should do
(but probably won’t)• Draw Peter Dutton’s various thought bubbles together
- A Medicare sustainability White Paper or other policy road map.
• Declare a single government funder is a 2020 goal
- Contestability in delivering public hospital services is a good thing, BUT delivering it will take up to a decade and require a huge and difficult selling job.
- Regrettably, probably beyond the competence of this government and beyond Labor’s imagination.
• Making health insurers active rather than passive payers
- Insurers as HMOs is not necessarily a bad thing.
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They won’t because these are the
health data that matter most...
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Further information
www.cormorant.net.au
Twitter: @TerryBarnes5