Australian health system faces ‘triple whammy’, says KPMG health expert Mark Britnell
Global health expert Mark Britnell says Australia’s world class healthcare system could be at risk of failing to care for ever older and sicker patients because of a “triple whammy” of structural problems.
Britain-based Mr Britnell warned that although Australia’s healthcare system has “served it well”, political blame games had thwarted real rejuvenation.
More importantly, he stressed, the split between federal and state governments, which sees the Commonwealth fund and manage primary care like doctor visits and blood tests, while the states run and fund hospital care, is not suited to the needs of modern healthcare.
These functional and funding splits between the two tiers of government constitute the first two parts of the issue.
The system’s third structural problem is the remuneration of doctors being too closely linked to volume or fee-for-service, he said.
“I think your strengths that have taken you so far may now become structural weaknesses,” KPMG’s global health partner said.
The reason these trio of issues are problematic, Mr Britnell said, is that for developed countries the ageing of the population and the increasing incidence of long-term diseases like diabetes are the main reason behind ballooning healthcare costs.
Australia is prone to both, he said. “Perhaps surprisingly to the rest of the world you are now the fifth country for obesity, just behind America and Mexico and let me tell you, that takes some doing.”
To address these two problems requires better collaboration between primary and hospital care but the federal state split prevents that.
“If the answer is accountable, integrated and co-ordinated care. you will have to simplify these processes and structures wherever possible and your triple whammy doesn’t help you do that,” he said. “It takes super human effort to overcome these obstacles.”
The Canadian system where “taxes are raised and spent federally and passed through to provinces” to manage all healthcare was a good alternative, he said. “The federal government should steer, not row, and the states need to have much more control.”
Mr Britnell has spent the past six years investigating the healthcare systems of 60 countries and has written a book In Search of the Perfect Health System.
In Australia, the Harper competition review recommendations to introduce more contestability into the provision of health services provide a unique opportunity to shake up the system, he said.
“There is an opportunity if the federal government and [Health Minister] Ms Ley and Prime Minister Turnbull want to take it where they can move to the states becoming more active commissioners, which means planning for healthcare, purchasing for healthcare, and thinking much more about the outcomes you want.”
This would allow healthcare suppliers – both the public and private sector – to be more innovative.
More to learn
Mr Britnell has tracked the progress of the Australian system since he worked at Melbourne’s Austin Hospital in 1991 while on a training scheme for Britain’s National Health Service. He said Australians were “blessed” to have a system where “reasonable” spending of about 9 per cent of gross domestic product delivered life expectancy of 82.3 years – in the top six of developed countries.
However he said there was much to be learned from developed countries like Hong Kong and Singapore, which spend less.
As one of 12 members of a council that advises the World Economic Forum on the future of healthcare Mr Britnell said greater collaboration and faster adoption of best practice from around the world is needed. “We all broadly die of the same things, it’s just a question of when.”