The Politics of Health Care and Population Health

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The Politics of Health Care and Population Health
Dr Buddhima Lokuge Regulatory Institutions
Network, ANU
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Overview

• Political analysis of health system
• Case studies
• Medical indemnity tort law reform
• Aboriginal health
• Private Health Insurance and Medicare
• Population health and health care

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Relevant concepts and theories

• Discounting
• The statistical life vs identified life
• Public versus private goods
• Concentrated versus diffuse interests
• Exit voice and loyalty
• Politics of mainstream vs minority health

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Bridge The Gap Between
Health Experts and Health Politics
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Core Beliefs of Health Experts
Health is Most Important Goal Children Come
First Decisions Should be Based on Studies of
What Improves Health (EBM, statistics) Reducing
health inequities is a top priority
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Core Beliefs of Healthcare Experts
(Continued) Government Should Do More, Not
Less Taxes Must be Raised to Meet Key Health
Needs Prevention is important
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Goals of Political Experts Win Elections and
Govern Effectively
Means to Goal
Gain Majority Support of Voters and
Favorable Public Opinion Gain Support of Major
Interest Groups Gain Favorable Press Coverage By
the Media Gain Support of Key Political
Institutions and Actors
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Core Beliefs of Political Experts

• Health is a Second Level Goal
• The Needs of The Middle Class Are The Top
  Priority
• The Elderly Come First
• Decisions Should be Based on Studies of
  Preferences of Voters and Key Interest Groups

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Core Beliefs of Political Experts
(Continued) Government Should Do Less, Not
More Taxes Are Too High, And Need to be
Lowered Projects with quick, visible results are
best
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Most important issues in 2004
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However, when electors were asked what the
Federal Government could do that would most
benefit them and their families

• Taxation 32 dominated the list
• Defence 19
• Health issues 16

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1. Political Cycle

• Tort Law Reform Broken System?
• Compensation
• Protect patients, protect patients interests.
• Alternatives exist
• Politics of reform
• Benefit gt Cost to Government
• Concentrate interests
• Clearly articulated alternative
• Window of opportunity

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Probability of Reform
Government Political, Economic Benefit gtCosts
Window of opportunity (media, mass
public) Alternative exists, easily
articulated Personal interest
If CostsgtBenefit Do and inquiry Symbolic
changes Short term fix
Force for change a Concentration of
interests (Money, Jobs at stake) Ability to
interest mass publics
Height a Concentration of interests (Money, Jobs
at stake) Cost to Government
No Fault
Tort Law
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2. Aboriginal and Torres Strait Islander Health

• E.g. of Mainstream versus minority politics
• Health status, expenditure
• Right to healthcare versus charity
• Charity model money for health versus health
  care
• Corruption, waste and political correctness

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Indigenous PHC expenditurein the Australian
Context

• Commonwealth expenditure on Indigenous specific
  PHC
• 260 million in 2002-03
• Commonwealth expenditure on 3 drugs for
  indigestion/peptic ulcer disease
• 314 million in 2002-03

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3. Medicare versus PHI

• E.g. of Exit, voice and loyalty
• Expand PHI? (supplement to complement) - see
  ANUs Gwen Gray)
• Long opposition to UHI by organised medicine
• Governments want to pull out of UHI
• Weak PH system strengthens bargaining power of
  PHI
• For Doctors Fee for service versus capitation,
  managed care
• For Patients costs, selective cover

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4. Medicine and Population Health Symbiotic
relationship
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Relative Risks of Stroke.By Level of Diastolic
Blood Pressure.
Population
Relative Risk of Stoke
Diastolic Blood Pressure (mm Hg)
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The Prevention Paradox
A large number of people at small risk may give
rise to more cases of disease than a small number
of people at big risk
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Political Policy Trade-off

• Population strategy (good policy, bad politics)
• Big population benefit
• Small individual benefit
• Statistical versus identified pt
• Discounting
• High risk (healthcare) approach
• Big individual benefit
• Modest population benefit

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End