The broadcaster, headlining day one of the AIDH’s HIC2025 conference next month, says we’re not at the top of the mountain, but we can see how to get there.
Physician, journalist and broadcaster Dr Norman Swan believes the Australian healthcare system has a mountain to climb in order to be fit for purpose, but the goals are known, attainable and don’t require radical change.
Dr Swan will deliver the keynote address on day one of the upcoming Health Innovation Community 2025 conference, hosted by the Australasian Institute of Digital Health.
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“We know the system that we want to have, and I think we’ve defined what’s at the top of the mountain,” Dr Swan told HSD in an exclusive interview.
Primary care that actually provides the care that its workforce is trained to provide, “which is more than they currently provide”, is the basis of that mountaintop healthcare system, he said.
“It would be founded on the premise that a happy workforce also means a higher quality of care.”
At the heart of Dr Swan’s vision for primary care is the idea of giving responsibility for it back to the states and have the commonwealth act as a “protector and standard setter”.
“We probably do, in the end, need to shed the commonwealth as the provider of primary care in this country, and turn it over to the states with the commonwealth being the standard setter and the ultimate funder,” he said.
“Why would you want to wake up every morning as the [federal] health minister having to deal with the problems of primary care?
“There is very little economic incentive for the commonwealth in providing better primary care, whereas there are huge incentives for the state systems to provide better primary care.”
With the states bearing the brunt of the responsibility for running the hospital system, improving primary care would help keep people out of hospitals, reducing costs and reducing the need to spend billions of dollars on building new facilities in a bid to keep up with demand.
“The role of the federal government could be to protect primary care to make sure it isn’t raided, but nonetheless the people who’ve got a horse in the race are the state governments,” said Dr Swan.
“We don’t necessarily need one system for the country. We need one system for each state and territory.”
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Dr Swan would also like to see one seemingly minor but important tweak to MyMedicare which would, he said, encourage group practices and team-based care.
“MyMedicare is a great innovation,” he said.
“It’s about more integrated primary care, more team-based care, and it’s about more money coming into primary care, and includes patient registration – which is a good thing, because we know you get higher quality care when you have your own GP and continuity of care.
“But at the moment, with MyMedicare, you register with a GP rather than with a practice.
“So, if that GP is away, the other GPs in the practice are not necessarily sharing in the income and the [other benefits of MyMedicare].
“Why not tweak the system so a patient registers with a practice, rather than an individual GP? That would mean there are shared records, more opportunity for integration and a larger population of patients.”
It’s all a symptom of a commonwealth department of health that is “defensive and narrow and risk-averse”, said Dr Swan.
“Why don’t we just get brave and encourage different models of care in general practice?” he asked.
“Why can’t we have a system where we pay GPs a salary? Instead of working an afternoon session, when you don’t have any patients, and therefore you don’t get paid – why not salary that GP? That way you incentivise [practices and GPs] to manage patients as efficiently as possible.
“We are not loose enough in terms of the way we think about ways to get to the top of that mountain.”
For a while it seemed that the covid pandemic had lit a fire under the healthcare system, forcing reforms and fast-moving system changes that had long been bottlenecks.
“During covid we shared data and we had a lot of cooperation,” said Dr Swan.
“We were moving at speed. But we seem to have regressed back. We are not learning from each other.”
Change in the healthcare system, he said, takes forever.
“We’ve said for the last 20 years that it’s going to take 20 years, but we haven’t started yet. People have tried to start, but it’s glacial.
“Whenever we start, it’s going to take 20 years, so we might as well start now.
“Starting now means there will be a proportion of older GPs who don’t like the idea of moving away from the way they’ve always done things, and nobody should force them to move away.
“But there will also be a cohort of younger GPs coming through who think ‘I’d quite like to earn a salary that I can predict, that’s similar to a staff specialist, and I’ll get a satisfying practice with team-based care, and I’ll get feedback from data and data analytics’.
“They might quite like that, and over 20 years the system moves in that direction.
“We’re not going to get to the top of that mountain tomorrow, but we must get started.”
Another reform Dr Swan would like to see is involvement of private health insurers in primary care.
“That might mean we get rid of Medicare, or privatise Medicare, in the Dutch sense, which means you have an entirely private system, but highly regulated,” he said.
“The health insurers have to be careful what they wish for in this because if you do go to that sort of system there will be a lot of regulation to make sure the parameters are right.
“But why wouldn’t you allow some sort of health insurance involvement in primary care?” he asked.
“Yes, you’ve got an equity issue, but we’ve already got an equity issue in the system, in that if you live [in richer suburbs] you’ve already got access to far more GPs and potentially a higher quality of care, just because of where you live.”
Allowing private health insurance funds to operate in primary care could incentivise them to serve previously underserved populations, he suggested.
And where does digital health sit in Dr Swan’s vision for healthcare reform?
“I’m not one of those people who is worried about AI replacing doctors,” he told HSD.
“We’ve got more demand than we can serve at the moment, and AI scribes have got the potential to enhance the diagnostic accuracy of general practice.
“It’s already happening in radiology and pathology, and demand for radiologists has gone up, despite the fact they are probably the highest users of AI and machine learning in healthcare.
“What does ‘digital health’ actually mean? Interoperability, certainly. It’s using digital tools to improve the standards of healthcare and individual health,” he said.
“The general public are already using it – home testing, DNA testing, home diagnostics. But they’re still going to need their GP.
“And GPs need digital tools to maximise their time with the patient and minimise the time that’s wasted.”
After his keynote speech on Monday 18 August, Dr Swan will facilitate a session featuring productivity commissioner Dr Catherine De Fontenay, Daniel McCabe, the first assistant secretary for Medicare and digital health at the DoHDA, Dr Simon Kos, the chief medical officer ANZ for Microsoft, Bettina McMahon, CEO of Healthdirect Australia, and Dr Danielle McMullen, president of the federal AMA.
HIC2025 will be held from 18-20 August at the Melbourne Convention and Exhibition Centre. Visit the HIC2025 website here. Register here.
