Opinion & Commentary
Super Clinics Not So Super
The Rudd government is set to unfurl a whole new series of preventive health policies, the centrepiece of which is a commitment to spend millions of taxpayers’ dollars to boost ‘preventive care’ by establishing a new national network of GP Super Clinics.
Prevention is the new black in health policy, but in reality, there’s not much that’s new about the Rudd government’s agenda. As modern medicine has developed more expensive ways to improve our health, costs have inexorably risen and placed greater pressure on government budgets.
In countries like Australia, which offer citizens ‘free and universal’ taxpayer-funded healthcare, governments of all persuasions have increasingly resented having to fund all the healthcare they promise to deliver. As the bill has mounted, politicians have grown more desperate to find a circuit breaker.
Enter the public health experts, who for the last 30 or 40 years have argued that if governments took their advice and spent more money on public health education campaigns (which tell people to quit smoking, eat less, and exercise more) it would prevent illness and contain health costs in the long run. Governments of all persuasions have understandably been attracted to idea that they can save simply by ‘investing’ more in prevention.
Our course, prevention is better than cure, and if individuals took better care of their own health, governments would have to spend less money treating the sick.
But the point constantly overlooked is that preventive programs targeting diet and exercise lifestyle behaviours continue to consume millions of taxpayers’ dollars each year despite failing to deliver the promised outcomes.
Australia is now experiencing rising levels of obesity, leading to accelerating rates of lifestyle-related chronic disease. This is placing ever greater pressure on our health and hospital systems. On top of the aging of the population and the high cost of new medical technology, it is widely acknowledged that without change, this combination of challenges means Medicare is going to impose unsustainable burdens on future generations of taxpayers.
These challenges have given the push to spend even more on ‘prevention’ a second wind. Public health experts, keen to retain their influence over government policy, keep chanting their mantra about the need to focus more on prevention. Politicians, determined to avoid the difficult political issue of health reform, are even keener to tell us that Medicare will be sustainable so long as the experts’ advice is heeded.
So the merry-go-round continues. Governments readily agree to spend even more on policies that have not improved the overall health of the population, and which have actually coincided with the emergence of the so-called obesity ‘epidemic’.
It’s time, therefore, to look squarely at the evidence, and challenge the assumption that more spending on prevention will reduce illness and health costs.
The evidence shows that preventive policies have not been as successful as hoped because it is simply very difficult to make people change behaviours that are unhealthy but often pleasurable, and get them to sustain a healthier lifestyle in the long term. While many middle-class people have bought into the cult of ‘wellness,’ those in lower-income groups often prefer to continue to live for the day no matter how hard the health promotion message is pushed.
The healthy lifestyle message has been well-publicised, and people now know what they should do to protect and promote their health. But whether people turn that advice into practice depends on personal qualities such self-discipline. This isn’t meant to be nasty; we should just be realistic about the factors that limit the effectiveness of ‘prevention.’
Super Clinics will bring general practice services together with a wide range of allied health providers—physiotherapists, podiatrists, dieticians, and the like. The plan is for Medicare to pay for a whole team of health professionals to ‘facilitate’ lifestyle change.
Unfortunately, studies show that even ‘high intensity’ lifestyle interventions have low impact, especially on long-term diet and exercise habits. Repackaging the healthy lifestyle message in more intensive and costly forms isn’t any better than the old educational strategies at instilling the individual qualities required to modify one’s lifestyle.
Rather than ‘help’ ordinary Australians protect their health as is promised, the evidence therefore suggests that the Rudd government is about to burden ordinary taxpayers with the cost of ineffective ‘preventive care.’ Instead of alleviating the burden rising health costs will impose on future generations, increasing government health spending in this direction is only going to accentuate Medicare’s long-term unsustainability.
Dr Jeremy Sammut’s paper The False Promise of GP Super Clinics, Part 1: Preventive Care was released by the Centre for Independent Studies today.
