Volume 191 - Issue 7
Are we ready for the next big thing?
Author: Stephen J Duckett
Med J Aust 2009; 191 (7): 412-413. || doi: 10.5694/j.1326-5377.2009.tb02862.x
Published online: 5 October 2009
Published online: 5 October 2009
In reply: Notwithstanding the differences in tone, Cleland and Meyers make the same substantive point: that a challenge I ignored in my short piece was the costs of meeting the different expectations of baby boomers. Regardless of the changed expectations I discussed in my article, health costs over the next few decades are predicted to increase from just over 9% of gross domestic product to over 12%.1 Economists recognise that societies appear willing to devote more spending to health care as they get wealthier, perhaps to avoid confronting the difficult choices involved in some rationing decisions.2
But should we immediately jump to the conclusion that more rationing is inevitable? What other choices are there? First, we — policymakers and clinicians alike — need to address the waste and inefficiency inherent in the current system;3 and, second, change the health system so that it is better suited to respond to changing needs4 and potentially “bend the trend” of health cost projections.
Third, we need to recognise that rationing — or, to use a less emotive term, priority setting — is already part of our health system. Australia leads the world in terms of formal processes before listing new drugs on the Pharmaceutical Benefits Scheme or items on the Medicare Benefits Schedule, but here too, improvements are needed.
Clinicians are already involved in rationing choices, but different clinicians appear to have different thresholds of when (and what) treatment should be recommended. These differences may be cultural,5 and addressing these unexplained variations in practice patterns remains a policy work in progress.
Thus, we in the health system have a lot of work to do in putting our house in order so that any rationing debate can occur knowing that alternative strategies have already been pursued.
References
- Goss J. Projection of Australian health care expenditure by disease, 2003 to 2033. Canberra: Australian Institute of Health and Welfare, 2008. (AIHW Cat. No. HWE 43.)<eMJA full text>
- Calabresi G, Bobbitt P. Tragic choices: the conflicts society confronts in the allocation of tragically scarce resources. New York: Norton, 1978. 0_CBBDDFAJ
- Hurley E. The Australian health care system: the potential for efficiency gains. A review of the literature. Background paper prepared for the National Health and Hospitals Reform Commission. Canberra: NHHRC, 2009. http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/A5665B8B9EAB34B2CA2575CB00184FB9/$File/Potential%20Efficiency%20Gains%20-%20NHHRC%20Background%20Paper.pdf (accessed Jul 2009).
- National Health and Hospitals Reform Commission. A healthier future for all Australians — interim report December 2008. Canberra: Commonwealth of Australia, 2009. http://www.nhhrc.org.au/internet/nhhrc/publishing.nsf/Content/interim-report-december-2008 (accessed Jul 2009).
- Aaron HJ, Schwartz WB, Cox M. Can we say no? The challenge of rationing health care. Washington, DC: Brookings Institution Press, 2005. 0_i1091855