The federal government's key economic adviser is tackling one of society's last remaining taboos – the business of dying.
The Productivity Commission has identified palliative care as one of the six priority human services areas – along with public hospitals, social housing, public dentists, remote Indigenous services and family and community services – that are ripe for more competition from the private sector.
Government and consumer expenditure on human services is worth about $300 billion a year and the Commission found that if consumers were given more information and better choice between public and private service providers it could lower costs, improve service and promote consumers' wellbeing.
But any move from a government-dominated sector to one in which the for-profit sector plays a greater role would have to include safeguards to protect the vulnerable, the Commission said, noting the damaging 2009 reforms of the vocational education sector which saw an influx of unscrupulous training providers and an explosion in student debts that some individuals are unlikely to ever repay.
In the case of public hospitals, the Commission cited the British system in which patients referred to specialists by their GP have a legal right to choose their own hospitals and specialists, with the use of a government website which compares the costs, mortality rates, complications and waiting times of the alternative choices.
The Commission's report, arising from the Harper competition review, recommended state and territory governments explore more "contestable" approaches to hospital services – allowing new players to compete to provide public hospital services – when they renegotiate arrangements with local health networks.
It also urged more transparent arrangements to replace underperforming senior managers at government-operated hospitals.
But in the case of palliative care, the distress of patients, loved ones and family makes it difficult to have a well-informed discussion about the final days of the terminally ill.
Inadequate training
"Taboos about discussing death can prevent this from happening," the report said.
"Patients often rely on medical professionals to initiate conversations about palliative care, many of whom are inadequately trained about, and intimidated by, holding such conversations."
Despite the reluctance to talk about death, the demand for palliative care is soaring.
Over the past decade, the number of palliative care-related hospitalisations has grown by 4.4 per cent a year, which is twice the rate of all hospitalisations.
In 2015, 40,000 Australians used palliative care but the Commission found there was very little data on carers' and families' experience in the standard of care.
Even though Australia rates well internationally for palliative care, the commission said there was wide variation in the quality of care.
"There is little evidence that service providers are being held to account for relatively low service quality," the report said.
Spurring innovation
One remedy would be encourage more players to compete to provide services, which would make providers more accountable for their performance and spur innovation to make patients' final days more comfortable.
A practical measure suggested by the Commission would be to encourage private health insurers to fund community-based palliative care organisations which are often charities relying on donations but almost never funded by the health insurance industry.
The Commission's final report is due in late November, with the federal government to consider possible policy changes next year.
