By: George R. Palmer, Stephanie D. Short , Published by Palgrave MacMillan Australia , Paperback , 400 pages , ISBN-13: 9781420256147 , RRP $79.95 .
Reviewed by Ian Ring
Centre for Health Service Development, University of Wollongong, New South Wales
This book is a classic in the field of Australian health policy. First published in 1989, this 4th edition updates policy analysis across the board, including the elements of the health care system and their organisation, health insurance, workforce, medical services, medical technology, public health, health services for disadvantaged groups, and has final chapters on reforming the making of health policy (including a small section on the NHHRC), with an eye to the future. The authors, George Palmer, emeritus professor in the Faculty of Medicine at UNSW and Stephanie Short, associate dean, postgraduate in the Faculty of Health Sciences, University of Sydney, are well known and eminently qualified.
The strength of the book lies in the breadth of its coverage and in its historical depth. The latter however, arises from the earlier editions of the book, and is not an unmixed blessing as the coverage of issues for the 1980s and 1990s sometimes seems to be at the expense of a fuller discussion of contemporary issues.
A book such as this inevitably displays the attitudes and biases of the authors. You are left with an unmistakeable feeling that in the strife of interests, the chief villain appears to be the (male dominated) medical profession. Undoubtedly, the medical profession has not always covered itself with glory, and the doctors’ strike in NSW was an absolute low point. However, doctors have advocated positively on other key issues such as Aboriginal health and, in any case, are not the only health profession to pursue industrial aims by denying services to sick people. Besides, it could be argued that the consequences on the health system of doctors looking after their own interests have not been as bad as those flowing from bureaucratic ineptitude and political shenanigans, characterised in more recent times by an obsession with populist policies aimed at the marginals rather than for the benefit of the country. These issues have received sketchy coverage at best and a future edition of the book might, with advantage, also give more consideration to the selection, background, training and preparation of senior managers for the large and complex health system – perhaps the largest in the country.
A critical analysis of health policy can easily support the notion, so common in the media, that the Australian health system is something of a basket case, when – while it is undoubtedly under pressure, and could and should be better – this rather odd patchwork system is probably better than most others and the health of the Australian public is certainly internationally competitive. From a policy perspective, it could be held that it would not be unreasonable for Australia to aim to have the healthiest population in the world and the best health system. Perhaps some analysis of health systems of other countries could help to provide an added sense of perspective and some useful policy directions for the future to make such an aim a reality.
In such a wide-ranging book there is the inevitable odd glitch. An important one is that the Constitution actually gives the Commonwealth power to legislate about sickness and hospital benefits, medical and dental services (but not so as to constitute civil conscription), rather than as the book says medical benefits and hospital services. The precise meaning of ‘benefits’ is a matter of some controversy and has a significant bearing on the current issue of the respective roles of the Commonwealth and the States in the provision of hospital services. The book also perpetuates the misconception that the 1967 Referendum gave Aboriginal people the right to vote (this right had been given by the Commonwealth in 1962 and Queensland, the last State to provide enfranchisement in 1965). The 1967 Referendum allowed the Commonwealth to make laws for Aboriginal people and for Aboriginal people to be included rather than excluded, in population counts.
In terms of future directions, the publication of the book may have been overtaken by recent developments but the following issues of a successful national scheme have been obvious for some time and might have been given more consideration: Commonwealth and state funds pooling; regional agencies for integrated service delivery with responsibility for all forms of care – hospital, primary health care including GPs and community health, aged care, and mental health; funding for regional agencies on a weighted per-capita basis where the weights adjust for higher service delivery costs due to remoteness, disadvantage or other factors, as well as patient flows between regions.
But these are relatively small glitches in a comprehensive, perhaps unique book which can be highly recommended for students and practitioners of Australian health care policy.