Healthcare reforms – How much more is necessary?

By Dr. Ananya Mandal, MDMar 29 2010

A lot of media attention has been focussed on Australian healthcare reforms lately. Although parallels are being drawn between the American health care policy and its counterpart in Australia, the latter fails to satisfy the public as the former even tries to.

Provision of more health care personnel like doctors, nurses etc. are looked upon as desperate attempts made by a failing system rather than brand new policy schemes. The American healthcare policy seems to be trying to make real changes in the system with an aim to providing the public with better care. Their Australian counterparts seem to be falling short in terms of real gains. Although the insurance coverage extension in the US seems to be superficial in their attempts the other plans seem effective for the present.

The topics for changing healthcare polices in both countries deal with basic issues like finance, primary care and training of staff.

Another issue is treatment of short versus long term patients. Surgical one time management compared to treating long term illnesses like diabetes and heart disease have been issues for debate especially regarding health insurance. Payments for service are hotly discussed and new schemas for payment structures are planned in the US reforms. There are directives towards group or bundle payments that can be shared by multiple providers in each of the sittings where care is provided as opposed to one time procedure payments. Accountable Care Organisations (provider groups providing care in federally funded programs) will also share in any cost savings they pass on.

US federal government hopes to target 100% of the costs of preventive care to the the Medicare and Medicaid and also allows the primary care physicians to get a 10% bonus payment for their services.

The issue here is the “primary care paradox” that deals with the inability of primary care to meet the needs of the community when compared to specialized care when compared to the broader benefits of primary care to the community.

A non-profit making organization that will be Patient Centered Outcomes Research dealing with evaluation of clinical efficacy and effectiveness of therapy will be established.

Training and education are other areas of research and development under the new policies. Additional Title VII and VIII funds are to be made available to medical, dental and nursing schools to boost education and training in healthcare. These ideas aim at luring people to serve as healthcare providers especially focussing on primary care.

Australia’s plans to open and staff hospitals seem to be inadequate in this aspect. This approach to induce training of more personnel seems to address the problem directly and from the roots. Training focus should target GP’s as well as nurses and physicians assistants as they form the basis of primary care. However, Australian Prime Minister continues to define primary care as "GP and GP-related services" only.

Prime Minister Rudd’s program – GP Superclinics in a bid to improve health services seems to be quite opposite of what the US reforms have in mind which is to move health care from hospitals and specialized set ups to community levels with a broader look at primary care. Whereas Australia has US-style reform written into the pages of a report by the National Health and Hospital Reform Commission, political leaders seem to be against real reforms and health gains and more interested in political ends.

The recent health policy debate between the Prime Minister and Opposition leader has brought to the forefront the needs of the hour versus popularly discussed strategies that may just be too implausible to achieve financially. More finances as discussed in the debate do not necessarily translate into better health care.