Australia's Health At Crossroads

Main Category: Public Health
Article Date: 24 Nov 2007 - 0:00 PDT

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Australia urgently needs a well thought out, substantial reform programme achieving better health outcomes for all, not more of the same which is the approach of the Howard Government, says an Editorial in this week's edition of The Lancet

. The Editorial says Australia's current health minister, Tony Abbott, writing in the Australian Medical Journal, makes the Howard government's position clear: "An 11-year-old government doesn't change its spots", while the piecemeal pre-election announcements of more money for various initiatives failed to disguise the clear message of 'more of the same'. The Editorial says: "Kevin Rudd released Labor's vision New Directions for Australian Health in August. He is aiming for an overarching reform agenda with: a National Health and Hospitals Reform Plan; the suggestion of 'general-practice superclinics'; a focus on preventive health, including major initiatives aimed at children; an Indigenous health strategy as part of the overall strategy but tackling maternal and child health as a priority; and an overall rural health strategy." However, critics have highlighted this is only a vision and the devil lies in the detail, which is oddly lacking in Labor's health manifesto."

To be fair to the Howard Government, the Editorial points out that at first glance Australia's health system is "exemplary", with data showing that of all OECD countries, Australia has the third highest life expectancy for women (84 years) and the second highest for men (79 years), and has also reduced adult tobacco consumption from 35•4% in 1983 to 17•7% in 2005 - one of the lowest rates in OECD countries. But it adds: "However, some of the figures hint at the problems all too familiar to Australians. The number of beds (3•6 per 1000 population) and the number of physicians (2•7) are lower than the OECD average (3•9 and 3, respectively). The average life expectancy rates hide a shameful inequality gap: Australia's Indigenous population has a staggering 17-year-lower life expectancy. The average physician number does not show the incredibly low ratio of fewer than 1 per 1000 population in Australia's rural areas."

Other complexities of the Australian health system are also explored. Federal and state and territory governments blaming each other for the underfunding of public hospitals for which both are responsible. The cutting in capacity in public hospitals by 60% in the last 20 years, leaving many working at or above maximum capacity. The fact that only 67% of total health-care spending comes from government funding, either state or federal, with average out-of-pocket spending on average AUS$750 per year per person, an increase of 50% over the past 10 years. And waiting times for non-urgent procedures and specialist out-patient appointments have increased substantially.

The Editorial says: "The medical workforce is heavily dependent on overseas-trained doctors and there is a dangerous lack of general practitioners (GPs), especially outside large cities. Access to health care is severely restricted, and often absent, for the Indigenous people of Australia. This situation makes a much needs focus on preventive public-health interventions an almost impossible task. Perhaps this explains why Australia is one of only four countries who have opposed the long awaited adoption of the UN Declaration on the Rights of Indigenous Peoples."

The Editorial ends with a look at the choice faced by the Australian government - more of the same from Howard, or the reform agenda proposed by Rudd. It says: "What Australia urgently needs is a well thought out and substantial reform that achieves better health outcomes for all - not more of the same."

http://www.thelancet.com