It's only fair to share…

Australia recently had a Federal election, where, as usual, health spending featured prominently with both sides promising to spend more. There is little questioning of what it is hoped to achieve or whether proposed spending is based on actual need.

When it came to community care and general practice, neither side has promised anything. The track record of both sides of politics for the last seven years in regards to primary care has been to freeze rebates or increase them at a minimal amount, all the while crowing about what a fantastic job they are doing.

In contrast a proposal in April for patients to have two months of medication dispensed at once was quickly killed off after objections from the Pharmacy Guild. The contrast between the success of the Pharmacists in protecting their interests and the failure of GPs to even hold ground is stark.

The campaign saw the usual promises of more money to be thrown at the pointy end of medicine. Politicians, aside from kissing babies, like to be seen as saving people from cancer. Thus, more scans and subsidising cancer treatments, some of which may only extend life by a few months, sounds compassionate and caring.

This raises the question which rarely gets asked. Is spending ever more money the answer? Sando Galea of Boston University posed this question in a thoughtful piece on Stat. Spending on health care in the US rose from US$74 billion in 1974 to US$1.4 trillion in 2000 and US$3.5 trillion in 2017.

Galea notes that there is much conversation about whether the USA pays too much for health. But observes that asking if we pay too much is the wrong question He adds; “Here’s the right one: Is our spending making us healthier? The answer, sadly, is no”.

The USA spends double the OECD average GDP percentage on health. International figures show no correlation between health spending in different countries and life expectancy or other health indicators. Why is this?

To quote Galea “The  reason is that we aren’t actually spending on health. We are spending on health care. The difference between the two is simple, yet fundamental. Health care – doctors, hospitals, medicines, treatments and the like – takes care of us when we are sick. Health is about not getting sick in the first place”.

Our health system is really a disease system. This is absolutely fine and we need it. However, we need to understand what we have and not fool ourselves. Politicians, usually with support of the AMA equate more hospital beds with better health. A genuinely effective health system would need fewer hospital beds because people would have less need for them, because they were healthier.

An analogy would be defining the success of car maintenance by how much is spent on breakdowns. The more repairs we do the better! Maintaining cars by putting in the right fuel and keeping the tyres correctly inflated and having fewer avoidable trips to the mechanic does not count in such an assessment.

What does this mean for the public and primary care? When we work hard each day to be healthy and keep out of hospital we are invisible. There is no direct link seen between this and the end result. In particular, you cannot measure what does not happen.

Doing exercise, managing stress, not smoking, and eating real food is not perceived as being “of value” by politicians. Primary care advice on these matters is not seen as “heroic” compared to treating cancer. Neither is early detection of disease.

We know that looking after the car is cheaper than fixing a breakdown. This applies even more to the human body. Yet in the auto analogy politicians celebrate breakdowns and ignore the value of keeping cars on the road.

Disease systems will in the next two decades collapse under their own weight unless demand on them is lessened. No amount of spending will avoid this. Primary care is part of the solution. The biggest contributors are the individuals who look after their own health. Politicians don’t seek photo opportunities with those who do this.

A version of this article first appeared here.