 Good evening and welcome to vote 2016 federal election series. They've been going for many weeks. I'm sure some of you have been every single week. This is my second appearance. I came to the first one, which I really enjoyed, and have come back tonight where our topic is healthcare. You know, in ongoing surveys from the federal government towards voters in Australia, it is found consistently that healthcare and economic issues rate as two of the most important issues Australians consider when placing their vote. And there's been a lot spoken about healthcare in this election, and our three experts from the university today are going to talk about that, but also their own particular ideas, policy ideas, responses in the areas of healthcare. The ANU election series is presented in partnership with PolicyForum.net, which is based here at the Crawford School of Public Policy at the ANU. PolicyForum.net is the Crawford School's platform for analysis and discussion about the region's public policy challenges. So if you haven't been on PolicyForum.net yet, I do encourage you. There's a lot of information there. The podcast of tonight's panel will be available to listen to shortly. And to find that, visit the website of ANU at ANU.edu.au and click the 2016 federal election series, and that will take you to the podcasts. And I invite you tonight to join the Twitter conversation using the hashtag AusVotes and our ANU. Health policy, as we said, is a key election issue, and tonight we're going to hear from our experts. Sharon Freel joined Regnet, which I had to look up because I didn't know what it was. Sharon, but I discovered it's the School of Regulation and Global Governance here at the ANU. And Sharon joined that in May 2014 and became the school's director in July 2014. She also serves as a director of the Menzies Centre for Health and Policy at the ANU. And in our discussions, it was very clear that one of Sharon's great interests is in primary healthcare and how policy towards primary healthcare affects actually the health of people and therefore the economy and its broader implications. She's also the co-founder of the Global Action for Health Equity Network and Global Alliance, concerned with research, training, policy and advocacy related to action in the social and environmental determinants of health equity. Associate Professor Adrian Kaye in the middle here is director of the Policy and Governance Program at the Crawford School of Public Policy. His major research interests lie in the intersection of international and comparative public policy with a particular focus on transnational health policy and the social determinants of health policy. Art Sardrikyan is the professor and foundation chair of the Department of Health Services Research and Policy at the Research School of Population Health and has joined the ANU for this role and has brought his international expertise with him to Australia. He holds a professorial chair at Weill Cornell Medical College. He's a trained cardiothoracic surgeon and a graduate of the John Hopkins University with a PhD in health policy and management. Please welcome our panel and we're going to start this evening. We'll hear from each speaker briefly and we will have time for questions. So please think about your questions while they're speaking and we will come to you as soon as we can. Sharon, thank you. Thank you. So I'm not really going to speak about health care as such. I want to make the point that every public policy affects people's health and the inequalities that we experience in health in Australia can be remedied if we think about a whole range of public policies. But I want to start by saying we've had such significant improvements in health in Australia and that really has been a testament to very good public policy. We had a fall of about 10% in fatal and non-fatal diseases within less than 10 years, which is no mean feat at all and that was largely cardiovascular disease. But we do still have quite a significant burden of disease. If you look at recent data from the AIHW where the analysis looks at the burden of disease for Australia, so we've still got 4.5 million years lost due to premature death or people living with illness, so we can still do an awful lot. And there's five diseases that dominates our disease burden in Australia, not a surprise probably for people in the room. Cardiovascular disease, mental substance, misuse problems and musculoskeletal, a word that I can never say, so I'm not going to say it again in discussions. These are really quite, many of them are very preventable. In fact, the estimates from AIHW is that we can prevent more than a third of the burden of disease addressing these factors. And the risk factors, so the sort of the behavioural risk factors associated with these diseases are things like poor diet, physical inactivity, smoking, alcohol. So the sort of the behavioural risk factors. We've had some attention to those within the discussions, the policy discussions in the election campaign, not an awful lot. But I'd like to discuss this evening that actually pay attention to the causes of the causes. So the social and the economic factors that affect what it is people eat, what it is people drink, how it is we live our lives, our daily living conditions. We'll actually see quite a significant and very cost effective approach to health in the country. And the point of the distribution of health, we experience health inequalities in Australia in a way that really is quite disgraceful. Why is it that the poorest 20% of the population can expect to live six years less than the richest 20% of the country? Why is it that Indigenous Australians can expect to die almost 11 years earlier compared to non-Indigenous Australians? That is not a biological thing. There's no reason, no biological reason for these differences. It's preventable. And in discussions around our quality of employment, our access to health care, which we will speak about in terms of the way we design our cities that make some people centred, that would go a very, very large way to address these health inequities that we have in Australia. So when we have a discussion about health policy, we've got to have a discussion about the broad range of public policies as they affect our health. Because actually it's a very cost effective thing to do. Thank you. I'm going to make three points. The first is that system-wide health care reform in Australia is very difficult. Politicians know this. It's difficult for a number of reasons. We have obviously a federal health care system in which roles and responsibilities, finances, delivery are split between governments between the federal state and other governments. Further, it's a hybrid mixture of public and private sectors. Australia unusually in comparative terms for a country with a universal health insurance system also has a subsidized and heavily regulated private health insurance system. For all these sorts of reasons, there's no real command and control base for the entire Australian health care system. Therefore it's very difficult for whichever Australian government comes in to actually reform and control and direct the system. And this means that, for example, things like controlling costs, managing and assessing the use of new technologies in the system. Very difficult. Australia is a very well-regarded and well-established process for new medicines for considering new pharmaceutical products. But for other bits of technology in the system, it's much less comprehensive, much less transparent and rational in what it's doing. That's one example of where, although we talk about the Australian health care system, it's not really a well-integrated system and therefore it's difficult to make policy about it. As I said, politicians know this. Most election campaigns, even though it's very important and voters put a great deal of priority onto health care, you don't see a lot of detailed discussion of health care reform. I think the last election where that happened was in 2007 where Kevin Rudd had a clear plan in which he linked together his views for reforming federalism in Australia with his ideas of reforming health care in Australia, and perhaps the lessons from that period that was ushered in by Rudd's election in November 2007. Perhaps they'd been learnt by politicians in the negative in the sense you try and stay clear of big promises on health care and stay clear of commitments on health care reform because they're difficult to implement from just the Commonwealth government basis. The final point I'd like to make is that the real questions of what the health care system is for really aren't spoken about and this really follows on from Sharon's point that the health care system really isn't that much about health. It's really about diseases. The major determinants of health are all things that exist in public policy areas outside of the health care system. So the determinants of health in terms of tobacco consumption, alcohol consumption, diet, exercise, all these things are really things that have conventionally sat outside that Australian health care system and there seems to be no platform or at least discussion at the moment about how to make sure that prevention is actually a central part of health policies, much more about health care as disease management rather than health promotion. I have the advantage of talking last, so you remember what I said best. So I'll build on what Sharon and Adrian were talking about, preventive care, advancing preventive care or better organizational aspects of care. I'm a surgeon by training interventionist, so I will hit on the issue that is relatively under-recognized, which is efficiency of the health care, particularly the hospital care. So there are a number of studies and these are multinational studies that show that health care can be at least 30% more efficient. If we target surgical interventional complications, adverse event of drugs and medical devices and advance the quality of interventional care. So when we talk about cutting costs and how much we invest in the health care, I'm less worried about how much money we spend on a health care. I'm more worried about if we're getting value for money we spend. So ultimate value for humans and us is the health care and long life and better quality of life. Maybe we don't have to spend that much money on defense and we can spend a lot more on a health care as soon as we're getting good value for money with a good lean health care system where the dollars yield the value that we're expecting it to yield. So in that context I have three points to make. The three policy issues that I think we should target in a health care and these are international issues, not necessarily unique for Australia. So a variation in care, variation in offering technologies and outcomes on a regional level. If people in Sydney will get better care, better outcomes than in northern territories and if you're dating 10 times more money spent per capita then we need to learn about it and do something about it because that's about inefficiency of the health care. Either in some places there is lower access to care and health burden is not being addressed or in other places there's more spend and overuse happens. So we need to learn about this and address it in a policy level, research level. Second issue is I think these technologies that are offered within health care, primary care, interventional care if there are a lot of these that are low value, non-evidence based. And we know from the birth of evidence based medicine a lot of things we do in a health care might not have a good evidence basis. We need to learn about it and target and cut back on that waste. Low value care I think is something we need to, we need to definitely target. Third issue is better choices. Informing hospitals and clinicians. These reference pricing issues but evidence based reference pricing for technology purchases so that we can level and address private health care and non-private health care differences in terms of premiums and issues related to purchasing and the costs. I think those are the issues that are important and also about inefficiency of the health care system. So I think evidence based reference pricing so that purchasing happens in a way that can provide better value is a third issue that I would put in this context. Thank you. We'll be going to your questions in a minute. So please if you've got a question, we've got some microphones around. So please be ready and before we do that I should say my name's Catherine McGrath and I normally work up in the Parliamentary Press Gallery so I've been covering the campaign for the several weeks that it has been going on and if it was a normal campaign it would be over already but it's not over already and I've said to a number of people I think if you're a member of the public it would be a pretty hard campaign to be engaged in or excited about and I think a lot of Australians feel that way. Health is a very, very big issue. The politicians are going to hospitals all the time and they're not going to hospitals, they're visiting GP clinics because there are a number of issues in play and I'll get you each just to comment briefly if you could because I think voters would like to hear from you on these issues. Now one of the, going back to the 2014 budget when the then Abbott government ripped up the agreement with the states and effectively 57 billion dollars in forward estimates funding was no longer. The government says they didn't pull it out because it wasn't there in the first place. Labor says they did pull it out but it's been an argument over that funding ever since so that's at play in this election. Labor announced on the weekend that it would recommit to that agreement between the federal government and the states and would pay 50% of agreed efficient hospital costs and it also said it would put $100 million into primary healthcare. The government has its new healthcare homes program that it's building on and has also been looking at health insurance. Now if we can start with Sharon. Health insurance and GP services. How do you think the government, how do you think they currently are for people and what have you seen on offer that you think is worth considering? I won't comment on the health insurance. It's not something and I'll pass that over to the colleagues who know much more about it. But in terms of the GP, so the idea of, so the homes idea is actually a really sensible one in terms of having the services easily accessible, easily referable, having the allied health services there connected makes an awful lot of sense for people particularly with multiple chronic conditions. So that's a sensible policy idea and there's a lot of experience of that internationally and how that can be done well. In terms of the, I suppose I would comment on the fairness, so having a fair go for health and one of the big concerns from the GP perspective and certainly the continued, if it does continue the freezing around the rebate for GPs the ability to bulk bill and what that might mean for GP prices and what that will, if that then flows into basically equitable access. You might just bring everyone up to a date. You're probably familiar with it. You've probably heard it being talked about. But there's a freeze on the GP rebate in 2020. So there is debate around that. The ALP has said it will unfreeze it. So that's not a direct sort of additional payment for users as the people going along to the GPs but the argument might be that somebody will have to pay for that rebate freeze and will it then get pushed through from the GPs onto the patients and ultimately will affect socioeconomic groups, people with multiple morbidities having to go and see the GPs. So that's in terms of an equity question within the health care system that's a real, I think a real question and I haven't seen a real very strong response to that saying we think from a fairness a fair go in the Australian context a fair go for health that's something that we really need to think about. And then of course the insurance question comes into play. I'll let Adrian answer that. There's a question up here I think was there a microphone. Sorry, just up the back there. For the last 35 years or so we've been living in this era of neoliberalism where there's been a push toward privatization of many, many things including health care in Australia among other countries but other than privatized health care benefiting the more affluent sectors is that really consistent with the idea of a fair go? Can you have health equity, social equity when you have a system which is being privatized and when I think of a privatized health care system the United States of developed countries has the most privatized system in the world. 18% of the US GDP now goes to health care but the health statistics don't bear that out because there's this huge medical industrial complex which is a big profit making machine. So do we need to start talking about reversing the trend toward privatization of health care? Adrian? I'm not sure in Australia there is such a pronounced trend towards a privatization of health care certainly private health insurance in Australia pre-exists, long pre-exists the neoliberal era I mean I think your equity point is well made that if you use public funds to subsidize private health insurance your favoring the 40% of Australians who have private health insurance and that costs a lot of money as well the Greens have done the most work on this, they commissioned the Parliamentary Budget Office to cost the value of the private health insurance rebates and the PBO came up with a figure of $5 billion per annum $50 billion over 10 years that's a substantial amount of money using just 40% of the Australian population and we assume the richest 40% of the Australian population so I think your point about supporting private health insurance is well made whether this, I'm not quite convinced this represents a wider privatization or Americanization of the Australian health care system. What is an efficient system? I think it's not very efficient system fee for service and privatization to the extreme I agree with you in the United States and I will be guilty found guilty of criticizing the system that I've been working in for almost 20 years and I'll tell you that it does lead to inefficiencies and it does encourage interventional care rather than primary care so every general practice practitioner or any specialist is looking for intervention to do to build more and I think that's not a good incentive fee for service and particularly encouraging interventions that often have little value or low value care so I think that's a major issue we're facing in the United States and it's possible we'll be facing also in Australia if that's the direction this will be going so I agree with Sharon in fact primary care and often those interventions in primary care healthy living that are not necessarily possible to privatize in a way that are incentivized in a private healthcare system. I'll just keep that microphone for a minute and I'm going to ask you a question but we'll get the next question already with the microphone is there a question up here? And we'll come to that in a minute while we're getting the microphone over there you spoke earlier about big data being available in medical decision making in Australia what is the problem at the moment in that area? So I mean I have like only seven months experience I'm new here so these are early observations but I have to admit that I was expecting that Australia would have all the resources all the data is there and yet access is quite limited I was expecting it would be much easier for scientists to be able to access national data MBS, PBS link it up with the state data and create really wonderful repository of data sources with primary care and hospital care interconnected longitudinal tracking of patients over time so all data exists but unfortunately little efforts are made to connect link all that and made available for qualified scientists and I'm not saying it has to everyone has to have access on their iPhones to start playing with this or their iPads but for qualified scientists access is quite limited again I don't want to have a comparison with the United States where I work and worked and I had since 1995 to 2014 20 years of longitudinal records of 27 million people who live in New York and I could track every hospitalization on individual patient level de-identified I don't need to know who these people are but I could track their hospitalizations outcomes of those hospitalizations as part of the routine care data collection and I could also look at the link it to mortality data I could potentially get physician unique identification their license numbers so I could look at the study on a physician individual physician outcomes in addition to that unfortunately all that data exists here but it's not made available and interconnected what's the benefit for Australian citizens if that was available I think scientists like people A and U having access to that data could definitely look for this unwarranted variation document in efficiencies in a healthcare look at the real world outcomes of all those 40, 50, 400 items that Medicare is paying for understand what's low value care and inform the policy better so I think those issues certainly scientists could do well work with that big data look at the comparative safety effectiveness of many things that are paid for and also link it up with clinician databases say Australian orthopedic association has a wonderful registry of all heap and knee replacements done in this country an internationally well-known excellent resource and we could also understand not only just orthopedic aspects but the disease aspects of care for patients struggling with osteoarthritis and arthritis which affects 20% of the population and highly prevalent in elderly so I think this data access certainly is critical from my perspective and ability for us also to compare the outcomes of care longitudinally with other countries outcomes of care could help us also inform how well we're doing and what are the policy interventions we need to implement to do better. Again, there's this issue about protecting patients' confidentiality of privacy we don't need to know who people are it needs to be de-identified but made available to scientists. Thank you very much I'm afraid I'm a journalist and so I only engage peripherally in the medical issues but I thought having listened to the politicians that waiting lists was what it was all about and yet I've come here I've heard three brilliant dissections of what needs to be done. Why isn't this being debated why aren't we talking about it these are so important and as you've said Sharon made the point to begin with that it doesn't cost a lot primary healthcare right but I think it's important to refer to your point that really we need to be doing operations better. Where are we falling down and why? I think because the system's fragmented and within this fragmentation the acute sector the hospital sector dominates so as Sharon outlined the rising burden of chronic illness is associated with increasing life efficiency. He's been dealt with too much in an acute sector and not in primary community healthcare this is because the system is fragmented and not joined up and part of the question is a big data as it allows us to examine those unwarranted variations that occur because of those system boundaries yet the politics of it gets stuck in terms of the amount of money which is going into hospitals on a ten year basis and the fiscal relationship between the two states on that basis but the real system problems aren't being, I think you're quite right aren't being discussed. I suppose as well the idea of having an announcement around a waiting list is an easier thing to say than we're going to address in terms of prevention the sorts of issues that we've been speaking about tackling some of these underlying systemic factors we'll see the benefits in 10, 20, 30 years time isn't quite as sexy in terms of as an announceable it would be fantastic within the media to I suppose work with this to really help communicate the really profound importance and significance and the really very good things that our politicians could be achieving with their mandate of looking out for the Australian population by addressing some of these things but how we as scientists I mean we're academics we don't say all of that in a very easy way sometimes but so the communication of these issues through the media I think would be something that would be very welcomed but also for our politicians the announcements particularly in an election campaign are so short term I agree and the weighting list issue and offering care say it's much clear to a politician when a kid with leukemia was denied care because was not eligible for particular technology use or expensive drugs right I'm just giving you example from the states it's probably similar to here it's also very clear someone with arthritis unable to pay for joint replacement and it's only private insurance system that you will those are kind of more striking and patients get agitated and reach out to their politicians so it becomes higher on their agenda and yet I think we have done not as good of a job identifying the harms and showcasing how we can address the harms and medical errors that lead to consequences for health a well-known device failures or pharmaceutical failures that are harm people I think they're getting somehow less attention than is that the medical profession you think academics I mean is it the medical there's been a big case here in the last few years hip replacements that's a worldwide problem absolutely and it's wonderful government supports that registry but constantly ask the question do we need to keep funding it instead I think we need to ask how do we fund those more of this and high quality and because they will both improve the quality and efficiency of the health doctors don't want those things I mean it's not their natural position to encourage people to discuss different procedures different technologies available so the lack of information certainly a big hindrance if physicians are trained to use a particular type of implant or a device or they're familiar with the particular pharmaceutical and prefer these type of medications I think the information available for patients consumers to make decisions is very limited and it's one way communication from physicians often and having scientists be able to recognize these data and prepare information for patients having access to these data and link data I'm going back to my point I think would certainly help educate patients more and help them to make more informed decisions not just go and ask for a particular thing they heard on a TV that works best or agree whatever physician necessarily is telling is the best but we have like dialogue with a physician be able to pick and choose of course the surgery is a bit more complicated because docs are trained to use a particular implant and to change that decision with technology we need to have incentives in place so that reference pricing and also incentives for physicians to change are really important for a from policy perspective. Thanks Patrick Tobin and I work for Catholic Health Australia which represents Catholic hospitals like Calvary and Vincent's and so I just thought I'd declare interest. Congratulations on having this forum it's obviously one which the press club which many of us would normally expect to go to it doesn't look like it's going to happen this time round because at least one political party doesn't want health talked about as much. The other thing I was going to say too is in terms of Labor's commitment to hospital funding what they've committed to is 50% of the growth in funding not 50% of funding so at the moment Commonwealth pays about 37% of public hospital funds so Labor's not going to suddenly jump that up to 50% but I think that's a common misperception. The question I was going to ask is in terms of health reform obviously governments are important actors but in this country they're fragmented we also have private health insurers as well and against that you've got very powerful provider interests in terms of what you might do with reform so things like fee for service to actually address that you actually will come against the interests of very strong provider groups data so for consumers there's no comparative data about what fees are from one provider to another you can't get data easily on the actual outcomes of particular procedures as a consumer unless you know somebody in the system you're making choices very much based in the dark so I guess my question is to what extent can we expect significant reform when you have very strong provider interests whose interest often is not to promote reform. I don't think we should be expecting major reform soon for all the good reasons you've outlined I mean fee for service is a really good case of where when health reforms in the 70s were being first considered it survived and at the behest of the medical profession and has become installed and institutionalised as something that is really difficult to shift within the Australian system however I think over time I think changing demography changing social attitudes I think a more enlightened way of using COAG as the way national health performance agreements there may be some glimmers for real reform in that sort of area and I point to something like mental health as an example of where new ideas can get into the system new money can get into the system and maybe looking there is where we'll see the best opportunities reform and where politicians sticking together can confront some of these provider interests The only other comment as I would add is the power of some of the other the NGOs they're not for profit particularly NGOs and if you think of the the power of a collective voice from the various disease health alliances the public health associations the health and hospital reform association the Australian medical association having a a collective voice from those groups one would be fantastic but some way of bringing those voices together into this debate around the private or some other vested interests I think so using those other mechanisms to enable those government politicians and colleagues within the bureaucracy to really take on some of the issues that you're speaking about Not directly relevant to your comment but I found talking to my colleagues in multiple I mean many universities in the country they're having way harder time in fact accessing private health insurance data and they're much more paranoid about making that data available for research and I think subsidizing a lot of this has to be a bit more transparency and also it will help us understand if private health insurance is offering better value and you know compare to public system it's extremely important in my opinion to understand if it really improves the quality of care and that will inform the debate how much privatization we should accept and what's acceptable and this is not again only a Australian problem when we let's say you would like to look at the United States Medicare data which is only over 65 population but it's a wonderful resource again interconnected data throughout their life after 65 and yet with introduction of managed care which is private health plans that are managing these Medicare patients we keep losing data it's now reaching 30% of Medicare data is lost because the private health insurance is not sharing that information and in 10 years it might be 80% managed by private health plans and even that resource will disappear so I really my play is really from scientific side let's make sure data is not lost and is available for us yep they get commercially handled and they internally might not be very interested to collaborate and cooperate so they're not sharing unless there is a way either with carrots and sticks to incentivize that to happen it would be horrible for scientists to not have that information also voters probably didn't know it was a thing until just now so people can now they can write to their MPs they can ask they can see why that's not happening now going back to that earlier issue about the GP rebates and the advertising campaign are people aware of the advertising campaign that the Royal Australasian College of General Practitioners are running on television with basically that campaign with heart rendering stories of people saying no I didn't go to the doctor because I couldn't afford it basically and they've got big campaigns in GP offices around Australia run by the college the first time they've done it now can each of you what do you think of that kind of campaign they're out there telling their patients to speak to their MP and to activate on this it's a good thing we also we know the power of those types of campaigns we've certainly seen it internationally we've seen it around things like tobacco some of the approaches that we're taking in the tobacco campaigns with AIDS campaign so quite powerful and I think I suppose what that type of campaign raises is two things one is you as a human being and as a voter you have agency you have control and the way you can use that is you go and you speak to your politicians so it's really quite empowering for as listening to those campaigns to be enabled to do that and the second is and again I come back to the fairness argument it really hits home fairness and if Australia is really concerned about a fair go then it speaks to those values whether that speaks to there has been some work done I think it was by the Australia Institute which looked at how that the fairness values actually was positioned across different generations it certainly is there among older generations if I remember it correctly not so much in some of the younger generations so whether that works for that target group maybe that's not the target group I'm not sure so you've got an empowering come and be part of making this for you and it's identifying and tapping into some of the fairness values that are strong within Australia Adrian on a straight forward political analysis point of view it's interesting this is obviously a coalition government traditionally strongly supported by doctors the very fact that they have to be so public and noisy about their opposition to a government policy is unusual and really shows maybe they've lost a little bit of insider status and maybe the medical dominance of some of the health policy politics in Australia as we can slightly so it's interesting both in its noise in us but also what it might tell you about insider power of the general practitioners question over here thank you very much for speaking tonight my name is Trish Carl I'm one of the greens candidates for the federal election just being up front there and I think we're not actually having candidates speeches so I think I'm not giving a speech I'm just saying who I am because I'm going to comment on a really good question about why we're not talking about health issues more I think that was great because I can tell you out there in the community health is really the number one issue that people are coming up to me about and they are saying how wonderful the doctors are at Canva hospital and the health professionals in general but they actually do see that we need to discuss resourcing and revenue for health services so I guess that is my question are you able to comment further on how we actually actually say we need to fund these essential services and we don't say screw all over here or something that it is about funding these services and having that discussion thank you I suppose I could say we have an election coming up so the opportunity for voters to use this last few weeks to try and provoke the politicians into being transparent and clear about those funding commitments and about the differences and I'm even as someone who follows health policy confused by what is happening beyond the forward estimates and how much both major parties are committed to funding the growth in hospital costs and that uncertainty feeds through to important effects about decisions planning decisions, the building of hospitals the planning of health care services because these operate on much longer lead times than just the four years of the forward estimates we might just get a couple of questions in a row so people are there and then here and then at the back and see how we go this is very quickly one after the other and then over here Hi there, Liz Allen from the Centre for Aboriginal Economic Policy Research here at the ANU my question relates to I guess the policy landscape with reference to Indigenous health it's been increasingly suggested that addressing Indigenous the gap in Indigenous life expectancy by doing so we should actually just look at it's an issue of disadvantage and that we can make cost savings by looking at the issue of disadvantage and so called mainstreaming health care Indigenous people through mainstream health care so I guess I'm wanting to hear your opinion on that but also your thoughts on what a successful policy landscape would look like which seeks to close the gap in Indigenous health care we'll get you to come but we'll get the next question which was over here and then we'll get the third one and then we'll get everyone to comment on so thank you Hi Fiona Brook I'm from the National Rural Health Alliance the last big reforms in health have come out of reports on the back of the Productivity Commission which has done a significant analysis including economic analysis so I'm thinking mental health, NDIS, aged care they've all gone through that process how do we engage better with the economics side to really make our point that particularly addressing the social determinants of health has major cost and savings and benefits for governments given it's well out into the 10 to 20 year cycle not in the 3 year cycle that politicians think in if they think that far ahead Thanks for that question we'll get the mic up there we'll deal with those too briefly if we can only so we can get to the last question Indigenous health closing the gap and the social benefits the economic side so I suppose what would the policy landscape look like that is focused on closing the gap well it's a policy landscape that thinks about issues of racism it's a policy landscape that thinks about violence it's a policy landscape that names all of that as something that we would have to actually address it would be a policy landscape that says when we think about education we can think about education who benefits and who loses when we think about urban planning who benefits who loses I could run through all of the different policy domains but it's just constantly thinking across these policy areas who benefits who loses and how does this improve the health particularly of Indigenous Australians and then if we do that the thinking about the costing and the sort of the cost effectiveness of that sort of policy landscape more broadly I mean there's some lovely analysis that was done actually through Catholic Health Australia with colleagues in Natsim that said if you reduce health inequalities in Australia it will save and of course I can't remember all the numbers but it will save this, this, this and this I highly recommend to have a look at it on the website of Catholic Health Australia and Natsim if you haven't seen it at the University of Canberra and colleagues across the country are doing some really really nice economic analysis of if you invest in traditionally non-health sectors what will this save in terms of health costs in particularly in areas like obesity for example there's quite a lot of work that I'm aware of that's happening in Australia around that and that of course can be applied to a whole variety of chronic disease conditions so there's work happening but it's in the in the conversations of the sort that we're having here and in the reporting of this within I come back to our media colleagues in the room making those connections constantly using the demonstration of it's about a fair go and it's about an efficient way forward as well. Thanks Jan now we've got a question there and then a question down here Hello I'm Lauren Peach interested bystander I guess we've talked a bit about how difficult widespread reform will be and how important it is to make sure we're getting value from money from our system investing in the right places we've seen in the last 12 months introduction of primary health networks I'm still sort of grappling with what it is that they're going to be doing according to the health website their key objectives are to increase the efficiency and is this working? Oh good sorry it's very loud isn't it the efficiency and effectiveness of medical services and improving coordination of care I guess I'm interested to know your thoughts on whether primary health networks will continue should labour be our new government and also maybe your thoughts on how effectively the PHNs will come to achieve their outcomes their objectives sorry So we will address that we'll just have a question So let's just make an assumption for the moment that each of you has the ear of a health spokesperson in a major party what would be the one announceable you would put in the rear that you would want them to make because it's an announceable driven election On both of those we'll start with you Adam I think I focus my comments on access to the data Yeah So give better access let us link it let us create that resource for scientists to hammer that data you'll be amazed what we can do if there is a good I mean data that is out there is made available for us I think we can do a lot To put the coag reform council back in place and to constitutionalise with bipartisan or tripartisan support their role to think long term about the healthcare system And what do you think about the primary healthcare question An interesting one I'm somewhat optimistic that this comes after a long period of Medicare locals and drawing different shapes on the map I think it's important to think about the region as a critical somewhere between very local and the state level as a critical level at which you can deliver an organised healthcare and I think if as long as it doesn't tend isomorphically to one size fits all sort of policy and that's the tendency in these sorts of things if it allows some experimentation it protects politically some different PHNs to do things a bit differently and to learn adaptively from each other over a period of time I think it could be a good thing but if it gets politicised very quickly becomes a very short term and there's just a standard way to deliver things I don't think it will make much difference Sharon what's your announceable Can I have two You're looking at four of them OK well one won't cost anything so one would be we're going to establish an Australian national preventative health agency that focuses on people's daily living conditions we used to have a good one of those and then it was stopped and the second announceable is that we whoever the party is we will make sure that every policy that we introduce will one we know harm we will equity proof it and we will health proof it Fair enough I think that's OK So I think for priority disease and procedure areas those with highest burden the gaps that will identify from that routine collected data that I talked about need to be filled in collaboration with docs creating national data collection systems like registries I think those two things in combination of the data with data collected as part of delivery of care will be a really powerful resource for improvement as we are nearly out of time I'm going to ask each of you this is an election campaign people have come along because they want to really hear your opinions can you in just closing one and a half two minutes each maximum give a report card from your particular areas on how you think the government has done in your particular areas from your view and what things you have seen from the major parties that deal with some of the issues we've talked about and we'll start with you Adrian It doesn't matter that much which parties empower I think they both face and confront similar sorts of challenges within the health care system that's not always obvious during an election campaign where differences are emphasized numbers are picked out and thrown at each other but I think the dilemmas of an aging population rising medical care costs serious continuing illnesses they will affect whoever is the next Australian Government and I think the extent to which we can through elections and democratic participation encourage a degree of bipartisanship on these things I think would be a good thing for health policy I don't think Westminster style government and opposition for health policy actually does health policy much good at all the other point I make is internationally the Australian health care system isn't too bad it's not always apparent during an election as people complain about various things but it actually does a pretty good job and I think the question of what improvements that we've heard tonight that could be made but I think it should be born in mind also that it does a pretty good job the report card just very briefly on the current government on the current government it has been less ambitious on the reform side and has not connected its fiscal decisions and in particular its cuts to a broader story of health system reform and I think that's been a failure I'm not sure that I want to give a report card I'm looking for a government that is actually going to think about really think about fairness I suppose I'm quite disappointed in each of the party's narrow focus on health because it's about treatment it's not about prevention it doesn't really speak at all I don't think about health and I think that says a lot about each of our parties and the state of the psyche at the moment as to how we will be moving forward in the future to address some of the underlying causes of health inequities within the country so my report card for each of them is you can do an awful lot better if you want to think about a fair go for health Have you seen any announcements in the week so far that have pleased you so I don't want to end the night on a negative note at all because Adrian's point of actually in the grand scheme of things globally the Australian health system, health care system actually does a fairly good job but is there anything that makes me feel encouraged that we're going to really address the systemic social inequities that affect the health inequities in Australia I would probably have to put my hand in my heart and say I don't think we're going for the sort of transformative change that I think we would need to address those issues It's a landmine for me I've been here seven months Have you seen, you must have said something I've seen only I like that announcement of reference pricing and cutting back a medical device waste by Minister Lay that February this year has been announced I think it's a good thinking moving in the right direction just making sure we're not hindering innovation and we're encouraging evidence based reference pricing, making sure that they're not different from quality and value for money perspective because often data is lacking we're making assumptions that they're the same they might not be Well thank you very much, I'm sure the audience tonight have really enjoyed hearing from you it's an ongoing debate, health is something that as a society we need to discuss more and certainly I've picked up a whole bunch of ideas that I'm going to be asking politicians about and I'd encourage you to too, feel free to write to your politicians, email ask them, I think the whole idea of more data from private health insurance is a really fascinating new idea that I've taken away and it is just wonderful to hear such experts speak so passionately about their field so thank you so much for joining us tonight on Votes 2016