Flaws in health system exposed

Much has been said about the poor leadership of the Prime Minister on Covid-19 with confusing messaging and ad hoc and changing decisions but the lack of preparedness for this emergency has its roots in the longstanding incoherence of our health system governance.

Infectious disease has caused many deaths in Australia over time and none so virulent as this, however, had Australia acted in January we would be better prepared than we are today. That lack of action can probably be put down to the following:

  • Recent outbreaks in Australia have been confined to small and often marginalised groups, eg those at risk of HIV. The last wide-scale threat was polio in the 1950s. It’s the current 70-90 year-olds who remember this and who are again most at risk.
  • SARS was largely confined to Asian countries, adding to our complacency
  • Our National Medical Stockpile was only ever intended to cover early responders and essential personnel, hence the lack of masks, testing kits, and other protective gear.
  • Our health system is fragmented because it is funded and/or governed by three layers of government. There are also many grey areas of responsibility and gaps in planning for, for instance, who should do the testing and who to test.
    • The Commonwealth has responsibility for primary health care, Medicare, regulation of therapeutic goods, aged care, and the National Medical Stockpile.
    • The states are responsible for public hospitals, disease surveillance and quarantine, ambulance and community health.
    • Local government does health promotion and regulates environmental services like swimming pools and food services.

The Australian Parliamentary Library warned in 2005:

As recently as the late 1990s, there appears to have been a distinct complacency within government about Australia’s vulnerability to infectious disease SARS and avian flu in particular have driven a renewed interest in the detection and control of infectious disease overlapping.

Commonwealth/state responsibilities and divisions between clinical health practitioners and public health policy-makers were identified as two broad problem areas in Australia s national arrangements for responding to an infectious disease outbreak.

Research Paper no. 3 2004-05
Critical but stable – Australia’s capacity to respond to an infectious disease outbreak

The evidence from Singapore, Taiwan, and South Korea is that early testing is crucial. However, as the ABC data shows, rates of testing vary considerably from state to state.

To date, SA has tested 1,423 for every 100,000 residents and 1,146 for NSW. This compares with just 588 in Victoria (up from 419 two days ago). Victoria’s new confirmed cases lept from a steady 50/day to over 111 as testing was ramped up. (See here for the latest figures from the ABC.)

How much confidence can we have in figures for new cases without more testing? If Singapore controlled its new cases with early testing at 680 for every 100,000 residents, what rate is effective for Australia on its current trajectory?

“Unfortunately, the extreme pressure on our personal protective equipment stocks continues, and the situation regarding pathology test kits, reagents and swabs is deteriorating rapidly, with kits no longer being available in some regions of the country.”

“Pathology collection centres have also experienced large backlogs in testing appointments in some parts of Australia, and emergency testing facilities have had to be established in some areas to ensure that urgent patients can get access to testing.”

Chief Medical Officer, Professor Brendan Murphy, 14 March

Australia’s private health insurance sector spent ~$17 billion in 2017-8 and it costs the public purse ~$5 billion/year in rebates. However, it is unclear whether or not private hospitals will share the burden of Covid-19 patient care or that those insured will be covered. The AMA said today that the states should transfer public patients to private hospitals for urgent and semi-urgent care, no doubt at public cost. Meanwhile, many private hospitals look set to close because of elective surgery ending.

This pandemic will change Australia in many ways. Once this is over, we think it would be wise to consider major reforms in our health sector so that one level of government – preferably states and territories – has the responsibility for delivering health care. Let’s also have a critical analysis of our private/public health system. Is it good value for money, does it serve us well in times of crisis and is it fair and equitable?

The answer is probably no.

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