As interest groups jockey for a place in Nicola Roxon’s appointments diary, Crikey offers the new Health Minister some free advice that she’s unlikely to hear from the AMA.

Ian McAuley, lecturer in Public Sector Finance at the University of Canberra and a Centre for Policy Development Fellow, writes: Think of health care as a system, rather than as three programs (medical, pharmaceutical, hospital). Focus on users, not institutions. As a case in point think of the people of northern Tasmania and their needs for clinics, drugs and hospital services, rather than thinking of the problems of Mersey Hospital. Most businesses learned 50 years ago to move from an input focus to a consumer focus; health must catch up.

Get private insurance out of health care. It has all the moral hazard of Medicare and none of its benefits, and is a huge driver of health inflation. If you want price signals, introduce compulsory uninsurable co-payments as the Swedes and Dutch do. If you want community rated health care you can’t do better than the tax/Medicare system – it’s a low-cost insurance system.

De-link private hospitals from private insurance. Get them into the mainstream. Don’t get hung up on the merits or demerits of the “public” or “private” sectors. While the public sector may fund most health care, the private sector will continue to provide most health care.

Bring delivery of public programs under one tier of government – probably state, with the Commonwealth maintaining standards and negotiating power over pharmaceutical firms.

Leave the panics and mishaps to your managers. Keep your eye on the system.

Professor Peter Brooks, Executive Dean, Health Sciences, University of Queensland, writes: Next year you have the opportunity of rewriting the Medicare agreements with the States – what an opportunity to build incentives and disincentives to help drive good “behaviour”.

Perhaps a period of discussion would be worthwhile, involving all the stakeholders – including community and patients – to ensure that the new agreements deliver a patient focussed and health professional friendly health service.

We cannot go on just saying we need more money and more workers – we know health is underfunded and we need to ask ourselves whether it would not be better for Australians to redirect some of the defence budget to health and education. After all one of the “Fathers” of the USA – Thomas Jefferson once said that the best defence of nation was education!

But we have to be smarter in health – we need good business practices within hospitals and we need to look at a fundamental shift from “illth” funding (funding hospitals and acute care) to funding health – health promotion and disease prevention. Australia, like most nations, spends less than 10% of GDP on health promotion, primary care and disease prevention.

We have to develop ways of stopping people “engaging” with the health system – keeping them away from outpatients, emergency departments and hospitals and allowing the scarce resources of those areas to concentrate on those who really require this level of service.

Given that we currently spend 90% on hospitals, why don’t we write into the next Medicare agreement that every year from 2010, 1% will come off the “hospital” budget and be redirected to disease prevention programs?

Professor Tony Adams, formerly Chief Medical Officer, Federal Health Department, and Chief Health Officer, NSW Health Department of Health, writes: Please seek out the best public health minds in the country to provide you with advice before you give in to the squeaky wheels of special interest groups.

On Aboriginal Health consult with the Collaborative Research Centre in Aboriginal Health which has done a remarkable job in identifying success stories.

Dental health is becoming one of the scandals of the Australian health non-system. In July 2004 all state territory and federal health ministers endorsed the “National Oral Health Plan” which, among other things, endorsed the fluoridation of all water supplies provided to all communities of 1,000 or more people. This has still to be implemented across the country despite 50 years of evidence of the public health benefits. Brisbane and most of Queensland (with the one exception of Townsville) plus significant population centres in Victoria and NSW are still suffering high rates of dental decay through lack of fluoride.

Why not make basic dental treatment part of Medicare? The mouth is just as important as any other part of the human body. Of course cosmetic dentistry, like cosmetic surgery, can be excluded from the Medical Benefits Schedule. It’s time this bullet was bitten.

Michael Johnston, Senior Policy Officer – Health, CHOICE, writes: Hospitals in Australia have suffered a beating recently which has dented public trust in the health system. While hospitals are not as bad as they’re often portrayed, they are dangerous places.

It has been estimated that 10% of people admitted to hospital in Australia suffer harm as a direct result of the care they receive. Professor Peter Collignon, from Canberra Hospital, has suggested that up to 4,000 people die each year from infections associated with an intravenous line – a largely preventable problem. This is tragic for the people involved but it also puts additional pressure on the health system through unnecessary admissions and longer stays. Many people receive excellent care in Australia’s hospitals but its clear there’s room for improvement.

Funding is part of the solution. There is no doubt additional resources are needed in many parts of the health system, including hospitals. CHOICE, along with most people, wants the State and Federal Governments to end the blame- and cost-shifting and work together to improve the entire health system.

Better and more transparent performance reporting should be part of any reforms. Current performance reporting focuses largely on waiting times for elective surgery and emergency departments. But people also want to know whether the care they will receive is safe and of high-quality. More funding alone won’t improve bad practices.

Information should be made available on infection rates, adverse events and the outcomes of surgery and other forms of care in all public and private hospitals. Public reporting of this information will empower consumers to make better choices, and assist governments and administrators to identify and address problems before they reach crisis-point.

There is also evidence that public reporting of comparative performance information improves the quality and safety of healthcare. It prompts hospitals and surgeons to examine their practices and make improvements in comparison with reported benchmarks. Better quality and safety results in better outcomes and will reduce the cost of hospital episodes.

Eventually we should move to a system where information is available on individual surgeons. This is being introduced in the UK in response to problems in the NHS and has been available in the US for over 10 years. While there are differences in our health system, there is no reason it can’t be implemented here. We shouldn’t have to wait for someone to blow the whistle on bad practice.