Investing in health | |
Healthy medicine. Challenges facing Australia's health services. Stephen R Leeder. Sydney, Australia: Allen and Unwin 1999 (155 pp.). ISBN: 1 86508 054 3. |
Starting from the proposition that the promotion of health, as well as the care of those who are sick, is the responsibility of society, Leeder describes the complex interactions at every level of organisation that should contribute to achieving health gains. He describes the health of Australians and refers to the totally unacceptable state of Indigenous health. A better health policy, which is concerned with the overall outcomes for society rather than the cost of items of service for individuals, is needed. Arrangements for the payment for medical services and the present funding of healthcare in Australia are described. Differences between the Australian system and those in the United States, United Kingdom, Canada and New Zealand are analysed. Are there lessons to be learned about how Australia could better deal with the public/private mix, centralised or local decision-making about priorities for funding, and control of hospital costs? Leeder concludes that a strategic approach is needed which embraces outcomes of health gain across society. This strategic approach to health policy will need the involvement of doctors. Difficulty is encountered when doctors find themselves obliged to implement a policy which limits their power to investigate and to treat. Ethical challenges occur in deciding what can and can not be done when it is impossible to pay for everything. Who should make the decisions about resource allocation? What is the role of consumers (society itself) in the generation of health policy? In spite of the well developed medical education system in Australia and the laudable achievements of medical researchers and the National Health and Medical Research Council, we do not have a means to measure the health gains which Leeder describes and which flow from investments in policies and procedures. We rely on cost estimates for items of service, casemix funding, and measures of quality and effectiveness of services which are inadequate (using readmission and infection rates). We need to know how to measure broader health gains for society in order to assess the value of society's investment in health. It may be, as Leeder suggests, that investment in health promotion will produce greatest gain. Robert Porter
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