EXCLUSIVE: Question & Answer with Tony Abbott

| March 3, 2008
Tony Abbott

In an effort to facilitate a higher level of consultation between our community and decision makers, we are planning a number of “Question & Answer” sessions with Australia’s key thought leaders. Our first guest is The Hon. Tony Abbott MHR, former Federal Minister for Health and Ageing. Here are his thoughts on the national health care reform, hospital crisis, electronic health records, community consultation, and more.

In an effort to facilitate a higher level of consultation between our community and decision makers, we are planning a number of Question & Answer sessions with Australia’s key thought leaders.

Our first guest is The Hon. Tony Abbott MHR, former Federal Minister for Health and Ageing. Here are his thoughts on the national health care reform, hospital crisis, electronic health records, community consultation, and more.

(To read Tony’s paper on Health Care Agreements, click here).



OF: A 2007 report by the Australian Institute of Health Policy Studies argues that current health reforms are ineffective and that “unfinished business” remains from 2000. It claims the health improvement agenda is rendered unsustainable by its piecemeal nature and that it lacks of comprehensive vision. Why is it proving so difficult to translate good ideas and intentions into concrete action? What benchmarks for success need to be set and how can the government be held accountable for its performance?

TA: Almost by definition, the health “system” will leave much to be desired.

Patients want the best, immediately, for free. In practice, it will be the best immediately but won’t be free; it will be the best for free but with a queue; or it will be immediate and free but not necessarily cutting edge.

Policy makers want a system that conforms to the best organizational logic. Even if such a system could be put in place, it would soon be ruined by the ad hoc compromises needed to keep it going.

Health “systems” are recalcitrant because they comprise hundreds of thousands of quirky individuals and innumerable competing vested interests trying to serve very large populations with every single individual a potential expert in his or her own case.

The benchmark for success should be: does the “system” or system of systems deliver high and rising life expectancies and low and falling morbidity rates at a cost commensurate with comparable systems around the world. On this score, Australia does pretty well. Health costs are about 10 per cent of GDP here compared to 8 per cent in the UK and 15 per cent in the US. We have more choice than the UK and more fairness than the US.

Of course, we can always do better. Health is always a work in progress. Often, however, the best is the enemy of the good. We should be striving for improvement, recognizing that our structures, diagnoses and treatments are essentially provisional until something better emerges. Still, if the question is posed: “do the health services government funds or provides nearly always meet or surpass reasonable expectations?” I think the answer is: “yes they do”.


OF: People rate health as one of the most important issues influencing their vote.  A 2007 national poll (http://www.newspoll.com.au/) showed that a well-functioning health system was important to more voters (79%) than industrial relations (48%), national security (60%) or the environment (70%). What should the nation’s health priorities be? Might higher health spending simply increase public expectations and lead to an endless spiral of increasing costs?

TA: As an individual, my health priority should be to eat well and exercise regularly so that, as a consequence, I maximize my chance of preserving good health. For a government, the priority should be delivering the right public health messages and procuring the most effective health services.

Higher health spending is almost inevitable and should not be seen as necessarily a problem. There’s been much talk, for instance, of “unsustainable” growth in health spending which the intergenerational report projected at 15 per cent plus of GDP by 2040. In fact, health spending has already doubled as a percentage of GDP with no obvious ill effects on the economy. Since 1960, health spending has increased from 5 per cent to 10 per cent of GDP. That hasn’t been unsustainable because it helped to generate increased life expectancy from 71 to 81 years at birth. Indeed, this doubling of health spending as a percentage on GDP has coincided with a four-fold increase in real wealth per head. Higher health spending makes people much more productive, in part, because far fewer die in middle age from cancer and heart disease, so can be seen as an investment rather than just a cost.

As long as new health spending is justified against rigorous cost effectiveness tests, it should not be seen as a drag on the economy.



OF: People do not always act ‘rationally’ in safeguarding their own health. It has been argued that education which encourages individuals to value and look after themselves can be more effective than punitive measures and the ‘medicalisation’ of risk factors. Are such ‘harm reduction’ and public education approaches effective or an unwarranted intrusion into personal lives by the ‘nanny state’? What incentives can be created to encourage healthy lifestyles? Should those who refuse to stop smoking/lose weight/exercise be penalised?


TA: In health, public education campaigns can have massive benefits. A 1 per cent reduction in smoking rates, for instance, saves tens of millions in health costs. Although it’s not always possible directly to link better outcomes with specific campaigns, it seems that many campaigns promoting specific behaviour change to prevent a clear harm can be worthwhile.

Still, the trouble with penalizing smokers, over-eaters, non-exercisers etc is the footballers, skiers, runners etc who also can have higher health costs because of voluntary behaviour. Can we legitimately distinguish between “acceptable” and “unacceptable” behaviours with adverse health consequences? Then there’s the problem of fibbing about smoking and drinking if these are penalized. All things considered, I would prefer persuasion to coercion in this area.


OF:   Greater community participation in developing policy options and setting priorities is often seen as a promising way forward. Are internet forums, such as Open Forum, an effective way to generate discussion and engage citizens in the debate? To what extent should health policy be dictated by the public though such forums?

TA: Consultation is important but shouldn’t be allowed to paralyze decision-making. After all, if the politicians won’t make the decisions that the public can’t make either individually or collectively what’s the point of electing them? In my own area, the state government has effectively stalled the building of a new hospital by asking locals to decide the right site. Through a combination of localism and nimbyism, no agreement has ever been reached. It’s vital to know what people think as long as lack of consensus doesn’t mean that governments shirk unpopular but unavoidable decisions. Often, it takes a decision to produce a consensus.


OF: The implementation of an electronic health record system is slower than originally hoped.  Why, when so many other aspects of life are fully computerized, is progress so slow in this area? Should a comprehensive Federal or State based E.H.R. system be a spending priority in the future?

TA: Progress has been embarrassingly slow because it’s in no one’s obvious interest to make it happen. Why should one doctor or one hospital make it easier for another to treat the patient next time? Why should health institutions empower patients to be more discriminating consumers? Privacy and professional ownership concerns are not insignificant but, in my view, are often excuses to avoid what obviously needs to be done. Then there is the tendency of policy-makers to want the “best” system rather than the system that is readily achievable.

In my view, the federal Government’s best contribution to an ehealth system would be to make securely available through the internet patients’ Medicare, PBS and immunization data. This has been regularly promised but never delivered, mostly because Medicare Australia is no longer part of the Department of Health and thus not amenable to health ministers’ directions. The need for the data to be “translated” does not mean it should not be available.

I doubt that government could build a functioning ehealth system, any more than government could have built the internet. Still, government should do what it reasonably can to make information available in this way. Eventually, once people discover how useful it can be, an integrated ehealth record will start to evolve.


OF: Staff shortages have dominated recent front pages.  Is this a real and systemic problem or a passing media scare?  What are the major obstacles to improving the standards of hospital care?

TA: There are serious problems in public hospitals but most patients are still well treated most of the time. Standards of care would be improved by: a more experienced and more stable professional workforce; higher staff and management morale; comparatively more funding for actual service delivery; and much better data on the quality of individual hospitals.

Hospitals need to be accountable to people with real authority in the communities that particular hospitals serve. That’s why the establishment of local hospital boards to appoint the CEO and set budget priorities is a key element in any meaningful health reform.


Open Forum would welcome your thoughts on these issues. You can use the link below to post your comments to Tony or participate in our health related discussion forums: