The divide between ‘the haves’ and ‘have nots’
Health and education share some common ground. Both are seen as fundamental ‘rights’, and are highly regulated. The percentage mix of private and public, while not identical, is similar.
Unfortunately, both are also increasingly subject to the obsession of governments with statistics and preferred ‘outcomes’.
The path of NAPLAN (held this month) is illustrative for the health industry in what can go wrong with a good idea once government gets involved.
In particular, I note the latest thought bubble from the RACGP about performance indicators, which is potentially handing another baseball bat to government to beat GPs around the head.
The notion of assessing all children’s capacity to do the three Rs is a good one. If children are not learning them, they are being set up for disadvantage. National testing has the potential to identify which children are struggling and which schools have larger numbers of them.
Logic would dictate that these schools and children would receive assistance to help raise their levels of learning.
Instead, we have a premiership league where the onus is on ‘praising’ the best schools and criticising the worst.
Hence, we have seen emphasis on teaching to the NAPLAN test and time chewed up trying to get the best results for the school.
This goes as far as encouraging kids to stay home, and (like in the US) there have been instances of teachers ‘correcting’ wrong answers to boost scores.
Naturally, wealthier schools in better areas with more children of parents with university education dominate the top positions – big deal.
Teams having the pick of the best players will also dominate any sports competition!
The whole process has been turned upside down. Those who need the support are effectively penalised (in the US, low scoring schools can lose funding), and those who have natural advantages are rewarded. A method to identify problems has been turned into a meaningless competition.
Is this helping those who most need to improve? Of course not!
Hospital leagues tables also reward those who do ‘best’. They encourage hospitals to take on healthier patients so as to have better outcomes.
How does this help anyone with complex needs who might lower the average?
Medicare Locals are to be ranked on 31 indicators, including numbers of patients with asthma action plans and number of potentially avoidable hospitalisations.
A plan is a meaningless piece of paper unless actually understood and acted on. And who will determine ‘avoidable’?
The tables will be meaningless but be seen as rewarding ‘quality’ and end up encouraging ‘practice by numbers’.
So what about GP performance? What can be measured, rather than what actually matters, will be measured.
‘Quality’ markers include rates of statin prescribing, screening for smoking, and selection of broad versus narrow spectrum antibiotics.
All of these are influenced by demographics. Practices in leafy suburbs will get a better ‘report card’ than those in poorer areas.
When (not if) the government gets hold of this, it will be used to castigate GPs. And when (not if) financial incentives are attached, it will further discourage practise in areas that may need it most. And don’t think that, like in education, some doctors won’t seek to ‘game’ the system.
What matters in education is getting children to be the best they can be regardless of whether they are top or bottom of a particular cohort.
In general practice, we are about helping people be as healthy as they can be, given all their circumstances, including those that are NOT amenable to medical treatments.You cannot measure this by arbitrary statistics.
In the words of Groucho Marx: “Politics is the art of looking for trouble, finding it, diagnosing it incorrectly and applying the wrong remedies.”