Greg Hunt comes to the health portfolio after a long innings on the sticky wicket of climate change and a brief stint in the industry portfolio.
He will need all the nous, cunning and policy heft he has developed over a decade as a shadow minister, and minister, to navigate health's treacherous reefs and murky shoals.
As with environment, health is on the cusp of huge change in technology and economics. Federal and state governments are straining under the $105 billion burden of health expenditure. And consumers and health funds chafe at the 6-7 per cent plus rate of growth in their $50 billion share of the $155 billion spend.
But unlike environment, virtually every Australian feels they have a personal interest in having the health system ask "how high?" the instant they command it to jump.
When it doesn't, which is virtually always, voters and health funds get cranky and take it out on governments.
Hunt will find his inbox groaning with complex challenges and political grenades.
Labor's "Mediscare" nearly did for the Turnbull government at last July's election, so how Hunt fares will largely determine if his star continues to shine or dims.
Health fund premiums
This one is glowing in Hunt's inbox. He will need to decide whether to accept or reject private health funds' premium rate increases in the coming weeks if the funds are to notify their 13.5 million health fund members in time for them to shop around before the new premiums take effect on 1 April.
Last year then minister Sussan Ley told the funds to sharpen their pencils after she saw their opening bids, delaying the process. This year there are signs of pre-emptive restraint.
Medibank Private chief executive Craig Drummond said in October funds had to be conscious that the 5-6 per cent growth in healthcare costs is outstripping household incomes, and NIB Holdings, Mark Fitzgibbon anticipated an average increase below last year's 5.6 per cent. In return, funds want curbs on health costs.
Medicare rebates
GPs' Medicare rebates have been a sore point ever since the Abbott government froze them in the 2014 budget. The freeze was extended for two years to 2020 last year to save another $1 billion and the pips began to squeak in the election last year, with more GPs abandoning bulk billing and raising their gap charges.
Within the next year or so, the pressure will become irresistible. Hunt will need the co-operation of GPs and their union, the Australian Medical Association, to successfully implement a raft of other incomplete reforms begun by Ley.
Yet to deliver he will need to convince the razor gang the expenditure is justified – at the latest by the May 2019 budget, in time for the next election.
Hunt was on the phone to AMA federal president Michael Gannon within ten minutes of being tapped on the shoulder on Wednesday, assuring him the government's commitment to Medicare was "rock solid".
Primary Care and chronic disease
Chronic disease – cardiovascular, respiratory, diabetes, arthritis – take up a large and growing share of health costs. About half of all Australians have a chronic disease, and one in five have at least two. Yet the health system – fragmented, reliant on out-of-date records systems and lacking in financial incentives to be efficient – struggles to cope.
Several of Ley's reviews and proposals – into primary health care and Health Care Homes, Medicare Benefits Schedule review and private health insurance – bear on this problem in some way. Hunt will have to get his head around all of these reviews if he is to have any impact.
In his favour, Ley has broken her reviews up into digestible bundles, unlike the Rudd government's mega-review of healthcare. Against, the government has a poor record of implementing technology-based reform, such as MyHealthRecord.
The good news is the government doesn't have to do it all. Private health funds and clinics are experimenting with better ways to manage chronic diseases, such as Australian Unity's MindStep program for mental health sufferers, or Brisbane North PHN's Team Care Co-ordination. Telstra has invested $240 million on 18 electronic health care businesses and is integrating them into a single unit.
But there is limited evidence on the efficacy of these approaches and they are very difficult to implement. Hunt will have to be at the top of his game.
Pharmacists
Pharmacists claim a review that could expose them to more competition and reduce their incomes is marred by a conflict of interest. Hunt will need to reassure them because they have a formidable record of protecting their patch through decades of efforts to reform anti-competitive location rules.
Prostheses
Ley made a start on reforming the Prostheses List – a price list for implantable medical devices for insurers – but health funds reckon there is a long way to go and $800 million in savings if the job is finished.
Big medical device multinationals dominate the manufacturers lobby, but they are not nearly as frightening as the doctors, pharmacists and patients.
