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In April 2008, the new Prime Minister, Kevin Rudd, convened a summit to develop long-term policy options across 10 critical areas, including health and health care. The Summit brought together 1000 leading Australians to debate potential responses. The health stream developed over 120 separate ideas across the fields of prevention, workforce, inequalities, future challenges and opportunities and health research. This report will highlight some of the big ideas that arose from the summit.
In the lead-up to the 2007 Federal Election, the then opposition leader, Mr Kevin Rudd, promised to convene a summit to examine the long term challenges facing the nation and develop new options to respond to these.
The so-called 2020 Summit allowed the then opposition to argue that it would listen to the community and offer a new approach to governing, without having to spell out what the policy entailed. This approach provided a contrast to the government who were being accused of running out of ideas and being in office for too long.
The Summit had the following objectives:
The new Government committed itself to producing a public response to these options papers by the end of 2008 with a view to shaping the nation's long-term direction from 2009 and beyond.
The groups charged with outlining a new vision for health and health care came up with over 123 separate ideas, under the five broad topics of prevention, workforce, inequalities, future challenges and opportunities and health research. Whilst it is impossible to report on all of these, a number of the ideas were based around changing the incentive structures to encourage better health.
Of note were the ideas that focused on incorporating health considerations into what are typically regarded as non-health policy areas. For example, the group envisioned better urban environment and planning that encourage individuals and communities to make healthy choices associated with their travel, recreation, food choices and lifestyles. Further, the group put forward the idea of creating incentives for health professionals to be more involved in prevention, promotion and education.
The Health Research Group focused on creating greater rewards for research by providing greater protection over intellectual property and improved commersialisation opportunities.
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It is difficult to comment on each of the ideas listed in the final report. A full rating of the individual policies may become more feasible once the government has indicated which ideas it intends to implement.
Commenting on the 2020 Summit itself, it is fair to say that the high public visibility brought a number of key issues to the forefront of the health care policy debate. For example, the need to develop better outcomes data is not something that normally attracts any media attention. In this way the Summit can be regarded as succesful.
The summit occurred as a direct result of the change in federal government in November 2007. Elected on a platform of new leadership and a promise to fix federal/state relations, the new Prime Minister, Kevin Rudd, convened the 2020 summit to develop a long term strategy for some of the nation's biggest problems.
Health and health care has historically been a shared responsibility between the federal, state and territory governments. Over time this has created a fractured system and has often resulted in different levels of government blaming each other for health care problems. Kevin Rudd and the Labor Party were elected on a mandate to fix the problems arising from such a fragmented system (not just limited to health). The summit was aimed at providing a first step in the development of a long-term national health strategy.
Delegates in each of the groups were challenged to come up with a big idea. The health group came up with five:
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The 100 people in the health group came from a diverse range of backgrounds and included academics, government, politicians, athlets, and patient and provider groups. The ideas contained in the summit report aim to address some of Australia's biggest health challenges including alcohol abuse, obesity, inequality in health outcomes especially amongst people from Aboriginal and Torres Strait backgrounds, lack of routine data collections to make rational resource allocation decisions.
Many of the ideas focused on providing greater information to enable people to make informed choices. For example, improved food labeling to inform consumers about the nutritional content (and even carbon impact) of food. It also proposed the establishment of a national health preventive health agency funded by 'sin' taxes. Such an agency would be charged with developing positive lifestyle initiatives across all levels of governments. Delegates used VicHealth in the state of Victoria and a similar institute in Thailand as good examples of such an initiative.
Delegates who came up with the idea of establishing a Health Equalities Commission thought its first task should be to reduce the 17 year gap in life expectancy between Aboriginal and Torres Strait Islander and non-Indigenous people and initial efforts should focus on improved health outcomes in the early years of life, including providing antenatal care to all Aboriginal mothers starting in their first trimester and continuing through delivery, providing continuity of health care in the early years of childhood, and focusing on preparing children for school.
The final summit report was published on-line and the prime minister has committed the government to responding to its contents. In his opening remarks to the summit, the prime minister stated that he saw the event as a first step in developing a vision for the nation's future as well as a start to building concensus around some of the big ideas that would arise from the summit.
The summitt seemed to create a 'feel good' athmosphere and generally had positive media reviews. There has been remarkably little reaction from stakeholders since the summit. It is likely that public lobbying may intensify in the lead up to government's response.
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Prime Minister Rudd has indicated that the Government will respond to the ideas contained in the 2020 Summit report by the end of 2008. He has also foreshadowed that the government is at liberty to accept, reject and alter any of the ideas arising from the summit.
In interviews immediately following the 2020 Summit, Rudd recognised the need to do more on preventive health stating that spending about 1.7 per cent of the nation's budget on preventative healthcare seemed to be out of balance compared to the explosion in diseases that are affected by unhealthy lifestyles. He also highlighted the idea of Australians having access to their medical records on-line.
No specific details have emerged on how any of these policies will be piloted, monitored or evaluated. However, the new Government has emphasised that it will rely on evidence to formulate new policies.
Not planned. However, establishment of national outcomes data to drive resource allocation would be a major piece of research infrastructure that could aid resource allocation decisions in the future.
Australia has relatively good administrative datasets on health care inputs, and slowly these datasets are being linked to provide a broader picture of a person's health care use. However, in most instances we do not have good outcome data (aside from death).
Improved outcome data would be an important step in enhancing our capacity to evaluate the effectiveness and cost-effectiveness of health care technologies, procedures and services in a real world setting. Access to such data and research would open up policy maker's options on how they negotiate the introduction and price of new technologies.
Over its two days, the summit produced over 120 ideas. On this metric, the summit should at least be described as productive. A number of the ideas have merit and if nothing else it highlighted the need to improve our capacity to undertake research that will underpin the development of future health and health care policies.
There is a danger, as with all summits, that the ideas will get lost in the world of politics and that, in the end, the summit will have been nothing more than a talk fest. However, the prime minister's commitment to respond to these ideas will, at the very least, force the Australian public service have to publicly defend some of its positions and policy recommendations. This will make it harder for the arguments of entrenched interest groups to prevail.
It is too early to rate the likely impact of the multitude of ideas espoused during the summit.
All information obtained from the 2020 Summit website: www.australia2020.gov.au
van Gool, Kees