The health system needs a Gonski

Carol Bennett, CEO of the Consumers Health Forum, writes:

From a public health perspective, the Gonski report provides a completely different lens through which to view, measure and fund service systems.

It is a view that is almost completely counter to the way governments and policy makers currently approach health systems.

The most fundamental difference is that Gonski begins with a focus on student achievement or real education outcomes.

In health, we are still stuck trying to look at throughputs and costs – an almost entirely provider focused approach where actual health outcomes are not even measured.

We are trying to run the system more efficiently, but take no real account of health outcomes.

Gonski looks at funding allocation that addresses a wide-range of social determinants and barriers to educational achievement including English language proficiency, indigeneity, location, disability and special needs, and disadvantage such as socioeconomic status.

In health these variables are not even factored into many of the system incentives and payment approaches.

A GP is rewarded for seeing more people – more consultations – rather than seeing those most in need.  Whether a consultation or specialist procedure actually achieves health benefits is not even measured.

Equally Gonski considers the role of support provided by families, parents, communities and other institutions as partners in the education process contributing to real outcomes – i.e. student learning.

In health care we struggle to get the various body part specialist to even establish linkages with community support options, let alone take into account the role of carers, families, employers and others who often determine how our health issues actually impact on our lives.

The Gonski report does something for education that no report into health has done in the last 30 years – it takes an outcomes approach that places students at the centre of the system and considers how best they learn and achieve.  It then talks about how the system can best service the needs of students.

Whether or not you agree with the Gonski recommendations, the approach is to be commended.

In health we spend most of our time tinkering around the edges of a system based on a mixture of crisis intervention and throughput driven incentives with no measures of real health outcomes or patient experience of care.

The unfortunate reality is that those who benefit most from the existing system are the ones who seem to have the loudest voice in health policy making.

Until health adopts a more Gonski like approach, our policy discussion will continue to be dominated by vested interests who have become very effective at resisting any change that might diminish their income or their role.

The hardest policy battles are about trying to work out how to retro fit new parts onto the existing system (like ehealth) and any discussion of improving health outcomes or the needs of health consumers is largely treated as decorative rhetoric.

Taking a Gonski approach would mean we put health and the needs of health consumers at the centre of health system design.  If only!

First published in Crikey March 2012