Policies/Health

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Official Party Document
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Transparent, efficient health services

Pirate Party Australia believes that ensuring universal access to affordable, high-quality health care is a core responsibility of government. However, with resources tight it is necessary to accomplish this by improving the quality and priorities of existing spending, which already accounts for around 25% of overall federal, state and local government revenues.[1]

Making better health affordable

The trend of rising health expenditure in many countries partly reflects growing demand due to the increasing effectiveness of clinical practice and ever more sophisticated medical research and technology.[2] However, rising costs may also be driven by rent-seeking in an industry which is often far removed from the economic ideal of a free market due to high entry barriers and large information asymmetries.[3] A key role of governments is to enforce effective regulation to protect patients from over-servicing, price-gouging and treatments which lack a solid evidence base. Ideally, the regulatory framework should allow maximum flexibility for medical staff, and avoid undermining the intrinsic, non-monetary motivations of health professionals.

Ideological cost-shifting between public and private sources should not be a priority for health reformers. Rather, the goal should always be to minimise the total public and private cost of achieving desired health outcomes. This can be done partly by removing the private health insurance rebate, which, by most estimates, provides poor value for its $5 billion per year cost. Removal of pharmaceutical patents and their replacement with alternative research incentives will also lower health costs by reducing medicine prices, creating huge savings for hospitals, patients, and consumers.[4]

Health spending could be made more sustainable with a greater focus on preventative practices such as vaccinations and harm prevention. There will also be strong payoffs from efforts to reduce causative factors such as homelessness, drug abuse, and domestic violence.[5]

The fragmented nature of Australia's health system, with responsibilities split between federal and state governments, requires reform in order to reduce perverse incentives to minimise costs within each funding silo instead of minimising the overall cost of treatment. In order to improve accountability and co-ordination, we also advocate financial support for general practitioners to take on the role of designated treatment coordinator[6] for patients, particularly where patients have complex chronic conditions.

Plugging the gaps

Australia's health system faces several old challenges and several new ones.

Pirate Party Australia would seek to maximise the benefits of the NDIS by making items purchased for disability support tax-free. We also believe mental health efforts within the NDIS may need additional direct support. Suicide is the leading cause of death for Australians between the ages of 15 and 45[7], and the fact that mental illness is itself a significant risk factor for physical ill-health means that better resourcing of treatment for the former often pays for itself by savings for the latter. A priority is to improve coordination of services to ensure that recovering patients have stable and appropriate housing, with access to ongoing support. Mental health advocates also stress the potential for better coordination between agencies to improve outcomes and reduce costs.[8]

While most Australians can afford dental treatment and have adequate dental health, severe and chronic dental health issues have become concentrated among some lower income groups, with around one-third of Australians receiving no dental care at all.[9] While some have called for a universal dental scheme, the Australian Dental Association has warned against it on the grounds that thinly rationed coverage across the board will prove unnecessary for the majority and insufficient for those in greatest need. Pirate Party Australia instead supports a model which focuses intensive resources on the poorest and most needy, and thereby achieves better outcomes at less overall cost. Such a dental plan could be easily funded out of savings from removing the Private Health Insurance Rebate.

Australia should also do more to avert the risk of growing resistance to antibiotics.[10] Antibiotics for treating human infections are quite closely regulated in Australia, but better public education would help further reduce the number of unnecessary prescriptions for antibiotics. Pirate Party Australia also supports better monitoring of growth promoters in animal feed [11] and antibiotic residues in imported fish and animal products.

Data and IT infrastructure

Pirate Party Australia supports moves by the Federal Government to establish a national system of electronic health records, provided strict privacy safeguards are enforced. Once in place, such a system promises to provide better medical care at a lower cost by avoiding duplication of diagnostic tests and by reducing the incidence of medical errors. The data gathered, once suitably anonymised, will be of great value to researchers for epidemiological and other studies, and free access should be maximised with public funding of the necessary IT infrastructure. At the same time, to avoid an incentive to falsify medical records, the public must be assured that the data gathered cannot be used to discriminate against them, for instance by employers or insurance companies.

Pirate Party Australia advocates the following reforms:

Undertake measures which ensure best-value for money in the health system

  • Abolish pharmaceutical patents and substitute a 'bounty' system to support pharmaceutical research (see patents policy).
  • Remove private health insurance rebate and utilise savings (of around $5 billion) to support other policy priorities.
  • Revise health budget guidelines to ensure public subsidies for health services are determined by:
    • The seriousness of the patient's illness or injury,
    • The proven effectiveness of the treatment,
    • The financial capacity of the patient,
    • The wider public benefit (e.g, 'herd immunity' resulting from immunisations),
    • The opportunity cost for the rest of the health system.

Support general systemic improvements in Australia's health system

  • Provide additional $2.5 billion annually to the public health system to manage any increased patient need resulting from lower private health coverage.
    • Base fund allocations on existing funding ratios.
  • Improve privacy safeguards for electronic health records (see civil liberties policy).
  • Conclude development of a national system of electronic health records.
    • Ensure personal files incorporate strong cryptographic protection, and utilise a format easily processed with standard, free software.
  • Trial a new annual payment for GPs to coordinate the care of patients with complex treatment needs.

Undertake new measures to close gaps in health coverage

  • Provide $2 billion per year to fund Australian Dental Association recommendations on improving dental health.
    • Fund direct service provision for those currently lacking access to dental care, including people facing financial disadvantage, people in remote areas, the elderly, children of health card concession holders, and those with special needs.
    • Increase incentives for dental students to accept rural placements by expanding the existing scheme for medical students.
  • Support preventive and promotional health initiatives and integrate dental care into Australia's health plans.
  • Provide $500 million to support initiatives to curb homelessness, including:
    • Direct investment in expanded accommodation services for mentally ill people facing homelessness;
    • Seed funding to extend successful community programs including Common Ground[12] and Journey to Social Inclusion.[13]
  • Establish a national centre to coordinate Australia's response to antibiotic resistance.
  • Improve treatment of transgender and intersex persons.
    • Adopt United Kingdom National Health Service recommendations as a starting point for treatment approach to transgender persons,[14] and specifically WPATH[15] with practice guidelines sourced from the Royal College of Psychiatrists.[16]
    • Extend Medicare to the long-term coverage of hormone replacement therapy, and sexual reassignment surgery where recommended by medical and psychiatric professionals.
    • Prohibit normalising surgery for intersex infants and children unless medically necessary (as determined by the Family Court), pending informed individual consent as an adult.[17]


References

  1. AIHW 2014. Health expenditure Australia 2012-13. Health and welfare expenditure series no. 52. Cat. no. HWE 61. Canberra: AIHW. http://www.aihw.gov.au/publication-detail/?id=60129548871 (refer to Figure 2.4)
  2. AIHW 2014. Health expenditure Australia 2012-13. Health and welfare expenditure series no. 52. Cat. no. HWE 61. Canberra: AIHW. http://www.aihw.gov.au/publication-detail/?id=60129548871 (refer to Table 2.14)
  3. Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality - David A. Squires, The Commonwealth Fund http://www.commonwealthfund.org/~/media/files/publications/issue-brief/2012/may/1595_squires_explaining_high_hlt_care_spending_intl_brief.pdf
  4. Pirate Party Australia, Pharmaceutical patents policy. https://pirateparty.org.au/wiki/Policies/Patents#Pharmaceutical_patents
  5. Australia's domestic response to the World Health Organization's (WHO) Commissionon Social Determinants of Health report "Closing the gap within a generation". http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Completed_inquiries/2010-13/socialdeterminantsofhealth/report/~/media/wopapub/senate/committee/clac_ctte/completed_inquiries/2010-13/social_determinants_of_health/report/report.ashx
  6. http://johnmenadue.com/blog/?p=4154 (accessed 05-07-2015)
  7. http://www.aihw.gov.au/deaths/leading-causes-of-death/
  8. http://mhaustralia.org/sites/default/files/docs/blueprint_for_action_on_mental_health_system_reform_nmhc_review_4th_submission_2014.pdf
  9. Fryer, real reform that will work, Australian Dental Association, May 2012, https://www.chf.org.au/pdfs/chf/HV-MAY2012_Fryer.pdf (Accessed 1 July 2015
  10. Finance and Public Administration References Committee, Progress in the implementation of the recommendations of the 1999 Joint Expert Technical Advisory Committee on Antibiotic Resistance, June 2013.
  11. http://www.pewtrusts.org/en/about/news-room/press-releases/0001/01/01/its-not-chicken-feed-antibiotic-resistance-adds-billions-to-health-care-costs
  12. http://www.commongroundcanberra.org.au/
  13. Milman, Experimental Victorian scheme could virtually eradicate homelessness, Guardian, April 2015. http://www.theguardian.com/society/2015/apr/30/experimental-victorian-scheme-could-virtually-eradicate-homelessness (Accessed 14 July 2015).
  14. http://www.nhs.uk/Conditions/Gender-dysphoria/Pages/policy-guidelines.aspx UK NHS, Gender dysphoria - Guidelines
  15. http://www.wpath.org/site_page.cfm?pk_association_webpage_menu=1351 World Professional Association for Transgender Health - The Standards of Care
  16. http://www.rcpsych.ac.uk/files/pdfversion/CR181_Nov15.pdf Royal College of Psychiatrists - Good practice guidelines for the assessment and treatment of adults with gender dysphoria.
  17. http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/b01 Recommendations of the parliamentary committee on "The involuntary or coerced sterilisation of people with disabilities in Australia"