Health Care Expenditure v Expenditure on Early Intervention & Prevention The World Health Organization defines prevention as 'approaches and activities aimed at reducing the likelihood that a disease or disorder will affect an individual, interrupting or slowing the progress of the disorder or reducing disability' If we are to cope with the challenges of a greying Australia ….we must also put more money into prevention stopping people needing medical treatment in the first place. Much of the burden of disease and associated costs are preventable, making disease prevention an important approach for improving the public’s health and to control health care costs Spending on prevention For the financial year 2011–12, $2.23 billion, or 1.7% of total health expenditure, went to public health activities, which include prevention, protection and promotion. This amount does not include spending in non -health sectors such as road safety, the environment, and schools. Immunisation, health promotion activities that encourage a healthy lifestyle and reduce health risk factors, and cancer screening programs, were the major areas of public health spending (AIHW 2011, 2013). Between 2000–01 and 2010–11, government expenditure on public health activities grew at an average rate of 3.8% per year. Much of the growth resulted from implementing the human papillomavirus vaccination (HPV ) program in 2007–08. While public health expenditure estimates are subject to data quality issues that affect international comparability, comparisons suggest Australia spends less on prevention and public health services than most other OECD countries, ranking in the lowest third in 2010–11.

(Source: AIHW 2014) Further readings:

National study proves prevention better than cure (8/0/10) https://www.vichealth.vic.gov.au/media-and-resources/media-releases/national-study-proves-prevention-better-than-cure

Prevention is always better than cure (24/12/12) http://www.smh.com.au/federal-politics/political-opinion/prevention-is-always-better-than-the-cure-20121223-2btf5.html Is prevention really better than cure? And how much does it cost? (25/7/12) http://tasmaniantimes.com/index.php/article/is-prevention-really-better-than-cure-and-how-much-does-it-cost Focus on prevention to cure the growing health budget (14/5/13) http://www.ausmed.com.au/blog/entry/focus-on-prevention-to-control-the-growing-health-budget

4/29/2015 The government is missing the point with its health pricing ideas

http://www.brisbanetimes.com.au/comment/thegovernmentismissingthepointwithitshealthpricingideas2015021513egnz.html 1/2

The federal government's focus so far on the use of a "price signal" to reduce its health spending entirely misses the nature of the problem with currentand future health costs in Australia – and the obvious options for improvement.

Without an aggressive focus on reducing the risks of preventable illness and improving the management of chronic diseases, government fears of theincreasing health costs of the growing and ageing population will become a certainty.

Australia's health policies, funding and service models are failing about one in four people living in Australia. Preventable diseases and chronicconditions, like diabetes, heart disease and stroke, affect a substantial and growing proportion of people living in Australia, and this lies at the heart of thecurrent health cost debate.

Our funding and service models are principally geared towards treatment rather than prevention; to be chronically ill seems to be an acceptable state forsome people in our healthcare system, and it would seem access to preventative healthcare is an optional extra for some Australians. Reducing the risksof preventable illness for everyone would deliver huge benefits on a population scale; it would address the very real fear of escalating health costs and agrowing, ageing and increasingly sick population.

This idea is not new, and it is certainly one the current government has acknowledged as a real problem. In its 2013 election policy statement, theCoalition said: "The challenges facing the Australian health budget and Australian health services are well known to be the increasing prevalence ofchronic disease, demographic changes with an increasing and ageing population, and the tyranny of distance faced by many rural and remotecommunities."

Given this, a focus on reducing funding for primary care services in isolation demonstrates a remarkable lack of understanding of the available evidenceof how best to address these challenges.

Medicare is one of three critical funding sources for health care in Australia – the others include private health and public hospital funding. Pulling onelever, to deliver savings in one area of the system, without considering the other two, will have unintended consequences for the other two – and forpeople and their healthcare, including the healthcare costs incurred by consumers – currently 16 to 17 per cent of all health expenditure.

These three levers are operated by three players – the federal government, state and territory governments, and private health insurers – but none ofthem act alone. Two of each are coupled in the delivery of the funds and of the services that are funded.

The complexity of our federated system and the funding contradictions that are created, coupled with rising health costs, an ageing population and thegrowing impact of preventable chronic diseases, means that unless we make changes, health will continue to be a blinding headache for governmentsand individuals alike.

For Australia's health budgets and health services to begin to meet these challenges, policy and funding must be based on the evidence of what works tomeet these challenges. We need to reorient Australia's health policy and funding to a network of healthcare services located across Australia. There isstrong evidence that this system of healthcare delivery is most effective when delivered locally by primary care providers – both general practitioners andother health professionals.

Similarly, it is very well known that the care of chronic and complex conditions, whether lifestyle or agerelated, is most effective when provided through arange of health services at the primary and community care level.

Encouragingly, the 2014 budget's introduction of primary health networks goes some way towards potential improvement in the alignment betweenhealth services and how they are funded by different levels of government. This offers the potential to better align GP primary care services that arefunded by the Australian government with hospital acute care services funded largely by state and territory governments.

Highcost health services primarily acute hospitals are increasingly overwhelmed by the continuing rise in the incidence and burden of chronic diseaseon the Australian population across all ages.

Reduction in funding to primary care services – the services of general practitioners and other health professionals – in isolation from other measures toimprove preventative health and chronic diseases care can only accelerate these pressures.

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Unless we focus on reducing preventable illness and improve how chronic diseases are managed, we willnever address the root of our escalating health costs.

Rosemary Calder

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The government is missing the point with its health pricingideas

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4/29/2015 The government is missing the point with its health pricing ideas

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The federal government has recognised the significance of the pressures emerging from the traditional roles of governments within the Australianfederation and has initiated a discussion about federation. The health measures that the government wants the Australian public and healthprofessionals to consider need to be considered in that context.

The federation discussion offers Australia an excellent opportunity to construct an effective and efficient national health system – one that maintains andsustains the best of its traditional capacities whilst better focusing available funding and resources on prevention and early intervention as well astreatment – to reduce the risk of avoidable diseases and better control the growing impact of chronic diseases on highcost health services.

The 2014 federal budget included a little recognised commitment to establish a national health commission. Little if anything has been said about this bythe government, yet it offers a critical opportunity to work with state and territory governments, and with health system experts, to work collaboratively on"the challenges facing the Australian health budget and Australian health services."

Instead, the entire political debate has focused on how to limit access to GPs – with a predictable furore from health professionals and health consumersalike.

The national health commission should comprise all governments as members, the federal, state and territory governments, with independent expertsfrom the health sector including consumers, to enable an Australian health system to finally be the focus of health policy and funding arrangements.

Realignment of the work of primary care practitioners through funding and service arrangements should be considered in tandem with the role andfunding of hospital services – they are both central to the care of people with chronic diseases.

Rosemary Calder is director, Health Policy of the Mitchell Institute for Health and Education Policy, based at Victoria University inMelbourne.

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Activity: Squares, Triangles, Circles On completion of the research, students list: Practice HSC Question: Identify reasons for the differences in health care expenditure and health promotion expenditure in Australia. (5 marks) ………………………………………………………………………………………………………………………………………………………………………………

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4 things that “square with my thinking”

3 angles they disagree/agree with; or 3 things for which I

need more information

1 question “circling” in my head