Michael Page: WA health blame shift must end

While access to many forms of health care is in sharp decline, WA can still claim to have an excellent health system.

We have extremely high standards of medical training, and universal access to cutting-edge diagnostics and medical and surgical treatments.

Our strong private hospital sector is a major part of what has historically made our medical system perform well.

A healthy mix of strong private and public services, with a mix of funding sources, is key. State dominance of health services produces the sort of mess that is currently the once-proud National Health Service in the UK, which is becoming a blight on the prestige of that nation.

At the other end of the spectrum, free market dominance can reduce universal access to care, as seen in the US.

The public and private systems should be complementary, enabling patient choice, whilst supporting ready access to care for all.

The public system enables access to care for patients who cannot afford or choose not to have private health insurance. It also enables access to certain types of care that cannot currently be provided in the private system.

The private system, on the other hand, enables patients to choose to receive a similar standard of care but with more choice regarding location, timing and individual specialists.

Private healthcare is warmly embraced by West Australians. We have the highest participation rate in private health insurance in the country, with 54 per cent of West Australians holding private hospital cover compared with the national average of 45 per cent.

Overall, 68 per cent of West Australians hold a private health insurance policy. We have the highest per-capita number of private hospital beds in Australia, and 61 per cent of elective surgery is performed in the private sector.

But the public and private systems each face strong headwinds.

On the public side, access to care is quickly diminishing. We see this in long waiting times for public outpatient appointments, which for some specialities is now measured in years; long waiting times for elective surgery; long waiting times to see a doctor in the emergency department; and of course, the State Government’s least favourite topic of conversation: ambulance ramping.

The increased demand on our public hospital system arises from the ageing of our population, increased complexity of disease, and welcome advances in care that enable patients with chronic, incurable diseases to live better for longer. On the other side of the equation, the public system suffers from chronic underinvestment and inadequate long-term planning.

Meanwhile, the private hospital sector faces its own challenges. Operators have been expressing concerns about long-term viability for some time.

In the Eastern States there have recently been some high-profile spats and failed negotiations between private hospitals and the private health insurers, whose funding of private care is so central to the viability of the hospitals.

In the context of this gathering storm, the Australian Medical Association (WA) recently convened a summit of leaders from the private hospital and insurance sectors, the State Government and the Department of Health, along with clinical leaders. The parties agreed that a strong private hospital system that delivers comprehensive care across the full range of specialties and offers patient choice is critically important. It’s clear that the public system has no capacity to take on overflow work from the private sector, should the private sector be unable to offer care.

But that is exactly the nightmare scenario that State and Federal governments need to urgently contemplate and prevent by taking steps that support and protect private health care.

This must include working collaboratively with both the insurers and the hospitals, with meaningful input from clinicians and patients. If we want to have a functional health system in WA 10 to 15 years from now, finger-pointing and blame-shifting needs to end.

Dr Michael Page is the president of the Australian Medical Association (WA).