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

2. 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

3. 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

4. Health Experts and Health Politics
Bridge The Gap
Between
Health Experts and Health Politics

5. 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

6. Core Beliefs of Healthcare Experts
(Continued)
Government Should Do More, Not Less
Taxes Must be Raised to Meet Key Health Needs
Prevention is important

7. 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

8. 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
SENIORS COME FIRST
16% of the Population
22% of Voters
Most Likely to Vote on Health Care Issues
Twice as Politically Active as Low Income Families
Well Organized and Informed

9. 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

10. Most important issues in 2004
Which Party is Better For
Issues
Three most important issues
L-NP
ALP
Improving health services and hospitals 63 29 57
Improving education 34 30 56
Reducing crime and maintaining law and order 33 42 41
Reducing the taxes you and your family pay 35 50
Open and honest government 28 43
Managing the economy 26
Defence and national security 21 55 31

11. Taxation 32% dominated the list Defence 19% Health issues 16%
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%
Private versus Public Goods

12. 1. Political Cycle Tort Law Reform: Broken System? Compensation
Protect patients, protect patients interests.
Alternatives exist
Politics of reform:
Benefit > Cost to Government
Concentrate interests
Clearly articulated alternative
Window of opportunity

13. Probability of Reform Government If Costs>Benefit
Political, Economic Benefit >Costs
Window of opportunity (media, mass public)
Alternative exists, easily articulated
Personal interest
If Costs>Benefit
Do and inquiry
Symbolic changes
Short term fix
Force for change α
Concentration of interests
(Money, Jobs at stake)
Ability to interest mass publics
Height α
Concentration of interests
(Money, Jobs at stake)
Cost to Government
Tort Law
No Fault

14. 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

15. Indigenous PHC expenditure: in the Australian Context
Commonwealth expenditure on Indigenous specific PHC:
$260 million in
Commonwealth expenditure on 3 drugs for indigestion/peptic ulcer disease:
$314 million in
*(OMEPRAZOLE $187 mil, PANTOPRAZOLE $78 mil, ESOMEPRAZOLE $49 mil)
Source: Department of Health and Ageing, PBS, June 2003

16. 3. Medicare versus PHI E.g. of Exit, voice and loyalty
Expand PHI? (supplement to complement) - see ANU’s 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

17. 4. Medicine and Population Health Symbiotic relationship

18. Relative Risks of Stroke. By Level of Diastolic Blood Pressure.
% Population
Relative Risk of Stoke
Diastolic Blood Pressure (mm Hg)

19. 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

20. 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

21. End