Why reforming health care is integral for our economy

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Healthcare is becoming increasingly important in a services-led economy.

Michael Woods, University of Technology Sydney

Australia’s productivity growth has been stagnant for over a decade and, according to a new report, our health policies and programs could be partly to blame. Released today, the Productivity Commission report also highlights how the health-care sector (among others) could play a starring role in improving productivity.

The commission has offered a short list of thematic directions for reform. In health these include eliminating low-value services that have uncertain clinical impacts, changing the way services are delivered to focus more on the patient, and moving away from a community pharmacy model to more automatic dispensing in a greater range of more convenient locations.

The underlying message is that productivity growth is essential if Australia is to expand its economy, generate opportunities for real income growth and raise community living standards.

But as a Productivity Commission discussion paper released last November noted, there is a justified global anxiety that growth in productivity — and in income and well-being, which are inextricably linked to it over the longer term — has slowed or stopped. Across the OECD, growth in GDP per hour worked was lower in the decade to 2016 than in any decade from 1950.

The commission notes that labour productivity has been rising, but that has more to do with greater capital investment than more efficient workforce practices.

The report also highlights a change in thought about productivity. The emphasis has shifted from the need to produce goods more cheaply to improving our human capital – the knowledge, skills and work practices of our community – and delivering more efficient and effective health, education and related services.

The change recognises that Australia is now predominantly a service economy, that health care is a significant economic service, and that the productivity of our workforce, including its health, needs to underpin our economic growth.

The health sector is big and still growing

The health sector is a big part of our economy and still growing as a proportion of our overall economy. By 2016, according to the OECD, it accounted for 9.6% of our total gross domestic product.

This is similar to that of New Zealand and the United Kingdom, less than Canada and far less than the United States – which is an international outlier at over 17% of its total domestic output. Add aged care and disability services, and the commission puts the figure at 13% of Australia’s GDP.

We continue to spend ever more on health, in real (inflation-adjusted) terms, both as taxpayers and as consumers. But are we getting good value for our money? An inefficient health system, wrongly priced services and poorly designed system incentives all drag on the cost of health care and on the productivity of a very large sector of the economy.

A decade ago, the health-care and social-assistance sector employed nearly 1.07 million people. This was a little less than retailing (1.21 million) and a little more than manufacturing (1.03 million). The health sector employed 10.3% of the Australian workforce.

Fast forward to 2017 and retail employment has stayed relatively stable at 1.26 million and manufacturing has declined to 0.9 million. In contrast, health care and social assistance has risen to 1.64 million – 13.3% of total employment.

Any opportunity to increase the efficiency of the health workforce will translate directly to greater labour productivity for the economy as a whole. And its effectiveness can be improved, in part by education and training, which improves the skills of our doctors, nurses, allied health workers and others to work collaboratively to deliver patient-centred care. This is the subject of an independent review for the COAG Health Council by this article’s author.

The actual productivity of the health workforce, unfortunately, is notoriously hard to measure. This is due in no small part to the lack of market forces and to wage costs that are often negotiated between unions and their employers – the governments.

The Productivity Commission’s forthcoming report on improving markets and competition in health and other human services will hopefully offer useful guidance on what reforms are needed in some of these sectors.

Workforce health is an important part of our human capital

A third role for a more efficient and effective health sector is to contribute to improving the health of the workforce overall. Education and health are recognised as the two most significant building blocks of human capital. Making the most of our human capital is a central message of the OECD’s research on productivity.

There is also ample evidence, including in the new Productivity Commission report, that poor health leads to poor labour market outcomes. A 2013 study into disadvantage in Australia concluded that people with long-term health conditions are likely to experience deep and persistent disadvantage, but, equally, disadvantage can lead to poor health.

Back to the future

The challenge remains to reform the health system, and its workforce in particular, so that practitioners, administrators and others have the skills, knowledge and professional attributes to meet the emerging health-care needs of our community.

As the Australian Institute of Health and Welfare points out in its latest review of Australia’s health, the community’s burden of disease is changing. There is now a greater need for longer-term integrated care to deliver services for those with chronic diseases, the elderly, those with dementia, disability and poor mental health, and to provide services to those in rural areas and remote communities.

The message in this latest report is welcome, but unfortunately it is not entirely new. A Productivity Commission report over a decade ago made the point that Australia’s growth potential will depend increasingly on making the best use of our human capital.

One of the aspirations at that time was for an agreed agenda of integrated health services reform within a national framework. It was seen as a way of adding much-needed impetus to overcoming long-standing structural problems that prevented the health-care system from performing to its potential.

The ConversationLittle progress has been made since then. Hence this report is important in reinforcing the message that the next big gains in productivity will need to come from reforming the delivery of health and education. Let’s hope the call for a shared agenda of reforms is taken up more actively than experience to date might suggest.

Michael Woods, Professor of Health Economics, University of Technology Sydney

This article was originally published on The Conversation. Read the original article.



Assailant influenced by TV series defaming Christian missionaries.

ISTANBUL, January 12 (Compass Direct News) – A judge in Turkey sentenced a 19-year-old Muslim to four-and-a-half years in prison on Jan. 5 for stabbing a Catholic priest in the coastal city of Izmir in December 2007.

Ramazan Bay, then 17, had met with Father Adriano Franchini, a 65-year-old Italian and long-term resident of Turkey, after expressing an interest in Christianity following mass at St. Anthony church. During their conversation, Bay became irritated and pulled out a knife, stabbing the priest in the stomach.

Fr. Franchini was hospitalized but released the next day as his wounds were not critical.

Bay, originally from Balikesir 90 miles north of Izmir, reportedly said he was influenced by an episode of the TV serial drama “Kurtlar Vadisi” (“Valley of the Wolves”). The series caricatures Christian missionaries as political “infiltrators” who pay poor families to convert to Christianity.

“Valley of the Wolves” also played a role in a foiled attack on another Christian leader in December 2007. Murat Tabuk reportedly admitted under police interrogation that the popular ultra-nationalist show had inspired him to plan the murder of Antalya pastor Ramazan Arkan. The plan was thwarted, with the pastor receiving armed police protection and Antalya’s anti-terrorism police bureau ordering plainclothes guards to accompany him.

Together with 20 other Protestant church leaders, Arkan on Dec. 3, 2007 filed a formal complaint with the Istanbul State Prosecutor’s office protesting “Valley of the Wolves” for “presenting them as a terrorist group and broadcasting scenes making them an open target.”

The series has portrayed Christians as selling body parts, being involved in mafia activities and prostitution and working as enemies of society in order to spread the Christian faith.

“The result has been innumerable, direct threats, attacks against places of worship and eventually, the live slaughter of three innocent Christians in Malatya,” the complaint stated.

The Protestant leaders demanded that Show TV and the producers of “Valley of the Wolves” be prosecuted under sections 115, 214, 215, 216 and 288 of the Turkish penal code for spreading false information and inciting violence against Christians.

The past three years saw six separate attacks on priests working across the country, the most serious of which resulted in the death of Father Andreas Santoro in Trabzon. As with Fr. Franchini, many of the attacks were coupled with accusations of subversion and “proselytizing.”

Although a secular republic, Turkey has a strong nationalistic identity of which Islam is an integral part.

Television shows such as “Valley of the Wolves” may not be the norm, but the recent publication of a state high school textbook in which “missionary activity” is also characterized as destructive and dangerous has raised questions about Turkey’s commitment to addressing prejudice and discrimination.

“While there is a general attitude [of antipathy], I think that the state feeds into it and propagates it,” said a spokesperson for the Alliance of Protestant Churches of Turkey (TEK). “If the State took a more accepting and more tolerant attitude I think the general attitude would change too.”

At the end of 2007 TEK issued a summery of the human rights violations that their members had suffered that year. As part of a concluding appeal they urged the state to stop an “indoctrination campaign” aimed at vilifying the Christian community.

TEK will soon release its rights violations summery for 2008, and it is likely that a similar plea will be made.

“There is police protection, and they have caught some people,” the TEK spokesperson said. “There is an active part of the state trying to prevent things, but the way it is done very much depends on the situation and how at that moment the government is feeling as far as putting across a diplomatic and political statement. There is hypocrisy in it.”

A survey carried out in 2005 by the Pew Global Attitudes Project also suggested a distinctly negative attitude towards Christians among Turks, with 63 percent describing their view of Christians as “unfavorable,” the highest rate among countries surveyed.

Niyazi Oktem, professor of law at Bilgi University and president of a prominent inter-faith organization in Turkey called the Intercultural Dialogue Platform, said that while the government could do more to secure religious freedom, he would not characterize Turkish sentiment towards Christians as negative.

“I can say that general Turkish feeling towards the Christian religion is not hostile,” said Oktem. “There could be, of course, some exceptions, but this is also the case in Christian countries towards Islam.”

Report from Compass Direct News


More than 500 senior evangelical leaders gathering in Pattaya, Thailand from October 25-30, 2008, have wrapped up their General Assembly, after five days of intensive discussion to plan the way forward in world evangelization, reports Michael Ireland, chief correspondent, ASSIST News Service.

On Wednesday, delegates agreed upon six major resolutions setting out an evangelical response to religious liberty, HIV and Aids, poverty, peacemaking, creation care and the global financial crisis, according to a media release obtained by ANS.

“The worldwide financial turmoil is, at its root, evidence of what happens when too many are captivated by greed and put their faith in, and entrust their security and future aspirations to, a system animated by the maximization of wealth. Many legitimately feel betrayed,” read the resolution on the global financial crisis.

“While we hope that the painful consequences of the turmoil will be mitigated, our concern is that its impact will continue to permeate into more regions and economies of the world. We recognize that this economic crisis will have the most painful impact on the poor, who are the most vulnerable.

“We reaffirm our faith in God and acknowledge that He is in control. We repent when we have placed our trust in money, institutions and persons, rather than God. Our security is not found in the things of this world.”

The resolution called on Christians to care for the poor during the crisis and live simply and generously.

“The Body of Christ, His Church, is living with HIV,” stated the resolution on HIV, a major focus area for the World Evangelical Alliance (WEA). “With brokenness we admit that as Evangelical Christians we have allowed stigmatization and discrimination to characterize our relationships with people living with HIV. We repent of these sinful attitudes and commit to ensuring that they are changed.”

In the preamble to the resolution on the Millennium Development Goals, evangelical leaders stated, “In coping with the financial crisis of 2008, governments and international institutions have shown how quickly and effectively they can move to mobilize massive resources in the face of serious threats to our global, common economic well being.

“Yet one child dying of preventable causes every three seconds and 2.7 billion people barely sustained on an income of less than two dollars per day has yet to evoke a similar level of urgent response.

“We believe this to be an affront to God, a shame to governments and civil society, and a massive challenge to the witness and mission of the followers of Christ.”

World Evangelical Alliance (WEA) international director Dr Geoff Tunnicliffe told delegates that they faced additional challenges to fulfilling the Great Commission from radical secularism, postmodernism, declining Christianity at the same time as growing interest in spirituality, trafficking and migration.

He insisted, however, that great challenges also brought great opportunities for evangelical engagement.

“We see this tremendous growth and this seismic shift in the church around the world and we are excited to what God is doing as he raises up women and men around the world in so many different places,” he said.

“As we think about the global reality of the world in which we live, [there are] immense challenges but also immense opportunities.”

Dr Tunnicliffe also said that the WEA would remain committed to integral mission “or holistic transformation, a proclamation and demonstration of the Gospel”.

“It is not simply that evangelism and social involvement are done alongside of each other but rather in integral mission proclamation has social consequences. We call people to love and repentance in all areas of life,” he said.

He reaffirmed the WEA’s commitment to world evangelization.

“If anyone tells you that we’ve gone soft on world evangelization you can tell them that we are totally committed to world evangelization because it is only Jesus Christ that changes people’s lives,” he said.

A highlight of the week was an address from the Rev Joel Edwards, who was commissioned during the assembly as the new director of Christian anti-poverty movement Micah Challenge.

In his address, the former head of the UK Evangelical Alliance told delegates that the power to rehabilitate the word ‘evangelical’ lay in their hands.

“Whatever people think of evangelical Christians, if people are going to think differently about evangelicals the only people who can actually change their minds are evangelicals,” he said.

“We must reinvent, rehabilitate and re-inhabit what evangelical means as good news. We must present Christ credibly to our culture and we should seek to be active citizens working for long-term spiritual and social change.

“Words can change their meaning. If 420 million evangelicals in over 130 nations across the world really wanted it to happen, evangelical could mean good news.”

In another key address, the head of the Evangelical Fellowship of India, the Rev Richard Howell said that an identity anchored in Christ and a universal God was an evangelical non-negotiable in an age of pluralism.

“We have but one agenda: obedience to the Triune God revealed in Jesus Christ,” said Dr Howell. “We are evangelical Christians for the sake of God.”

“Our identity has to be related back to God. Unless we do that, we will never know who we are. Our identity comes from God and God alone.”

“The Christian belief in the oneness of God implies God’s universality, and the universality implies transcendence with respect to any given culture.

“Christians can never be first of all Asians, Africans, Europeans, Americans, Australians and then Christians.”

The assembly also heard from the Chair of the Lausanne Committee for World Evangelization (LCWE), Douglas Birdsall.

The WEA is collaborating with the LCWE in its major Cape Town 2010 meeting, which will bring together 4,000 evangelicals to assess the next steps in realizing the movement’s vision of ‘the whole church taking the whole gospel to the whole world’.

“You might ask is there a need for an international congress that deals with world evangelization,” Birdsall told the assembly. “I would say that throughout history, such a gathering is only necessary when the future of the life of the church is threatened by some type of challenge – either internal challenge or external pressure.”

The assembly also saw the launch of the WEA Leadership Institute, a brand new initiative to see the leaders of the WEA’s 128 national alliances trained to serve and proclaim Christ within some challenging contexts.

“Leading an Evangelical Alliance is not easy,” commented Dr Tunnicliffe. “That’s why we want to provide them with the relevant training and resources.”

Also commissioned during the week was the new leader of the WEA’s Religious Liberty Commission, Sri Lankan national Godfrey Yogarajah.

Dr Tunnicliffe rounded up the assembly with a call to evangelicals to keep in step with God’s work on earth.

“It is my prayer that we in our community will be women and men who live with divine purpose within our lives, that we will be good leaders envisioned by God to make a difference in the world,” he said.

“The most important thing that you can do with your [life] is to integrate it into the never ending story of God’s kingdom. God’s already at work in the world. He’s doing things. We just need to align with what He is doing.”

World Evangelical Alliance is made up of 128 national evangelical alliances located in 7 regions and 104 associate member organizations. The vision of WEA is to extend the Kingdom of God by making disciples of all nations and by Christ-centered transformation within society. WEA exists to foster Christian unity, to provide an identity, voice and platform for the 420 million evangelical Christians worldwide.

Report from the Christian Telegraph