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A tale of two cities

The Coalition is inadvertent to class in formulating its health policy

Where to
begin?

If you drive around Sydney and keep your eyes open, you will notice that suburbs differ. They differ in a variety of ways. Affluence, demography and architecture all vary throughout the city. This variance is of course not something unique to Sydney, rather it is a feature of all urban ecosystems, or as we commonly call them: ‘cities.’

It is not controversial, then, to assume as the basis for this article that suburbs within cities are non-identical. Indeed it may seem that this article is labouring over a non-issue. However, what has just been established is something ostensibly unheard of in the hallowed corridors of Australia’s health bureaucracy.

We move now to the issue at hand — namely, that people are going to start suffering because of the Coalition’s poor policy decisions. Nothing new, yes, but the banality of their ineptitude makes it no less worthy of critique.

The key issue is that the government is using the Modified Monash Model (MMM) to allocate Distribution Priority Areas (DPA’s). To the average person, this sentence may seem nonsensical. However, it refers to something very real that affects numerous lives. And, the fact that it is rather difficult to understand may very well be intentional. It is no new thing for jargon to be used to obfuscate understanding, just ask Joseph K.

The MMM is a model that is supposed to show which regions struggle to attract health workers due to geographical remoteness (this remoteness resulting in health inequality). There are seven MMM categories with MM1 being an area with the lowest need (anywhere within a major city) and MM 7 being an area with the highest need. Basically anywhere above MM2 and even some MM 2 areas will be classed as DPA’s.

But what’s a DPA area? This is an area in which overseas trained doctors (OTD’s) must come and work for a moratorium period of ten years in accordance with the Section 19ABHealth Insurance Act.

The issue is that the MMM is taken as its premise that all areas within a city are the same in terms of their health care needs. This article will focus specifically on Western Sydney — an area that is emblematic of the inadequacies in Australia’s health system. Currently, Western Sydney is experiencing an undersupply of GPs, a higher disease burden than the rest of Sydney and has traditionally relied on OTD’s because it has struggled to attract Australian trained GPs.

Not all suburbs
are identical

As flagged above, this article takes as a premise the idea that not all suburbs within a city are the same — a pretty uncontroversial idea that the Modified Monash Model seems to ignore. According to this model, places such as Mt. Druitt and Doonside are said to be in the same situation in terms of health needs-as places like Vaucluse or Point Piper. This is clearly not the case. There is a great deal of information that shows this, most of it generated by the government.

It is trivially true to say that socioeconomic factors influence an individual’s health outcomes. Using the government’s own SEIFA Index (Socio-Economic Indexes For Areas) IRSD (Index of Relative Socio-economic Disadvantage) Map it is possible to look at the differences between suburbs in Sydney. If one compares the previously mentioned suburbs you will see that both the ones in Western Sydney are in the lowest quintiles on the scale. By comparison,  the two Waverly suburbs are in the highest. That it is a monumental difference, considering that the government is allocating the health workforce.

The second point comes from the Medicare statistics provided by the government’s Health Funding Facts webpage. It was originally set up to combat what was termed the ‘MediScare Campaign’ by Murdoch lackeys but it can now be used to see how the government’s own policy is contradicted by a website it set up to make itself look good. To understand this point, it is useful to consider the electoral divisions of Chifley and Wentworth (alongside the aforementioned suburbs).

As of 2016, the ABS census put Wentworth’s population at 145,949. Those in Wentworth had access to 258 GPs providing Medicare services in the year 2017-18. Of these GP services 72% were bulk billed, totalling 622,939 services altogether. The MBS (Medicare Benefits Schedule) data shows that the government provided $175.5 million in funding during this same year.

Now lets turn to Chifley. Chifley’s population at the time of the 2016 census was 171,249. In the year 2017-18, there were 209 GPs providing Medicare services. In other words, there were 49 less GPs for an area with approximately 25,300 more people. Oh dear, Greg Hunt. Furthermore, 99% of these GP services were bulk-billed, services which totalled 1,522,600. So that’s more than double the number of services than the place with 23% more GPs and a great deal more affluent. Thankfully in the year 2017-18, the government was kind enough to provide $178.0 million in Medicare funding according to MBS data. This is the one metric in which Chifley does better than Wentworth and it is with rapt attention that I await the golden egg to be laid by this paltry $2.5 million bonus.

There was a report done by WSROC called ‘A Comparative Study of Health Services in Western Sydney,’ which outlines the “considerable degree of inequality [that] exists across Sydney.” It is worth reading if you are still looking for a reason why the government’s policy is fundamentally flawed. The report highlights that the health burden “…attributable to socio-economic disadvantage is large and much of this burden is potentially avoidable,” and furthermore that Western Sydney (places like Chifley) are disproportionately affected by adverse health outcomes resulting from socio-economic disadvantage. This report was done in 2012 and even then it was identifying a lack of GPs in Western Sydney. The report shows that the Greater Western Sydney areas is sicker on pretty much every health indicator in comparison with other areas of Sydney.

Classing all areas within major cities as essentially requiring the same level of healthcare is wrong. It will result in people who desperately need care either presenting at ED’s and incurring more cost upon the state or dying preventable deaths.

Ockham’s razor
to the rescue

Should we attribute poor policy-making to a nebulous scheme involving multiple government agencies and spanning successive governments? Is there a plot to kill people in disadvantaged areas?  Most definitely not. The answer proposed here, which is simpler but not necessarily any better is that it is just another case of poor policy-making and political expediency.

It would be nice to hold the Coalition responsible for something requiring a modicum of forethought and intellectual rigour, but this is not the case. Even in their ineptitude, they are incapable of being deliberate or precise. Rather they function with an inadequacy made oblique by meretricious policy programs and sloganising. The hierodules of respective bureaucratic fiefdoms have woven a labyrinthine web, one with a semblance of order when viewed from afar but upon closer inspection really makes little sense. The worst part in all of this is that people will suffer – some of them dying unnecessary deaths.

However, this will all happen in places thought of as ‘other’ within the psyche of our nation. Places that are in between the affluence of the inner city and the ideal of rural Australia. So really the question becomes: will anything happen at all if the people impacted never really existed in the first place?