Ideas@TheCentre brings you ammunition for conversations around the table. 3 short articles from CIS researchers emailed every Friday on the issues of the week.
Nothing better illustrates ‘being in love with the problem’ than the familiar tale told at most health conferences in Australia.
One inevitably hears that to address the well-known problem of healthcare financial unsustainability, we must address the equally well-known structural problems in the health system that mean we spend too much on expensive hospital-based care — and not enough on non-hospital services that would prevent unnecessary hospitalisations.
The real problem, we are also told, is that the rigid Medicare and regimented private insurance systems mainly pay doctors for one-off appointments, tests, and procedures; there is no scope or flexibility to develop alternative, cost-effective models of integrated healthcare — especially for chronically ill patients — that could lower costs and improve patient outcomes.
Yet despite all the talk about the problems, no one ever comes up with real solutions: a politically-feasible — and potentially bi-partisan — reform strategy to generate much-needed innovation in the health sector, and deliver better value for money and more sustainable healthcare.
The new report published this week by the CIS Health Innovations Program argues that the way to overcome the toxic, ‘Mediscare’-style politics of health is to establish ‘Health Innovation Communities’ (HICs).
Within certain geographic regions declared to be HICs, healthcare providers could apply for exemptions from existing Medicare and private health legislation, and be allowed to create and use alternative payment and service delivery models that are currently banned. Exempt providers could then recruit individuals who wish to voluntarily opt-in to receive integrated care.
Importantly, the current Medicare and private health insurance arrangements of the vast majority of the population will stay the same. But at the same time, HICs will operate as ‘Silicon Valleys’ catalysing the development of novel healthcare products.
Once we discover what works to make healthcare more cost-effective, we can then start loving the real solutions for the problems with Australian healthcare — and start talking about rolling these solutions out across the whole of the health system.
Education is high stakes. It’s not good enough to throw ideas about teaching methods at a wall and see which one sticks. Classroom practice has to be guided by the best research, to give children the best chance of strong learning gains.
One teaching method in particular has been consistently shown to be effective on a variety of measures — direct and explicit instruction. These terms are generally used interchangeably to refer to a set of instructional practices characterised by highly structured and carefully sequenced lessons in which it is made clear to students what they need to learn and how to go about it. Student progress is checked frequently and they are expected to master each step before moving to the next.
This teaching method has been shown to be effective not just for fundamental skills like literacy and numeracy, but also higher level conceptual understanding and creativity.
A specific form of this method is Direct Instruction — a comprehensive teaching program that includes both direct instruction pedagogy and curriculum content. DI programs have been the subject of dozens of studies, which have been overwhelmingly positive.
At a forum co-hosted by CIS and Good to Great Schools Australia this week, several outstanding school leaders explained how DI and direct instruction led to success in their schools.
The Cape York Academies use DI — adapted to align with the Australian Curriculum — achieving substantial gains for students in remote communities where such outcomes had previously been thought impossible. Good to Great Schools co-founder and chair Noel Pearson and community leaders Dion Creek and Phyllis Yunkaporta explained the careful process by which DI had been chosen, and spoke passionately about the changes they had seen in the children attending Cape York Academies.
Despite the fact that policies and programs put in place by schools systems still fail to embrace evidence, increasing number of schools are adopting these methods and Direct Instruction programs. Hopefully this small groundswell will turn into a tidal wave.
Now we are a week on from the fallout over paid parental leave, and the government is consumed by other disasters, we can put the issue in its proper context.
First, almost no-one — either on the left or right — supported Tony Abbott’s plan to massively increase paid parental leave, so we can stop the comparisons between Australia and the apparent maternal paradise in eastern Europe. It’s a bit late to pretend it’s a core issue of fairness now.
Second in the grand scheme of gender inequality, a couple months of paid parental leave pales in comparison with the societal expectation that mothers — not fathers — will sublimate their career to caring responsibilities for decades with a resultant gap in pay, promotion and prestige. Paid Parental Leave doesn’t address this underlying issue at all.
This is not the only concern, a deeper problem stems from government ham-fistedly using welfare to engineer social outcomes like getting women back to work, or gender equity and fairness. With minimal means testing, PPL is structured as a welfare ‘entitlement’ not a safety net. For people who believe in small government, rejecting this broader welfare agenda is a key battle.
Where welfare once attracted stigma because it was seen as being exclusively for the poor, now some payments are seen as entitlements or return for taxes paid. These payments (especially family payments, age pensions and childcare) represent some of the fastest growing areas of government spending over time.
Targeting dole bludgers and refugees, not to mention the perennial favourite — politicians’ entitlements — will never generate sufficient savings to close the budget gap or substantially shrink government. Moreover, history suggests that over time, entitlement payments will expand to overwhelm any short term savings found.
If the welfare state is to be kept in check, then welfare must return to being solely targeted at those who are too poor to look after themselves. Using it to create de facto equivalence between single and dual income households, or families and singles, or as a reward in retirement, is a mistake that legitimises big government redistribution schemes.
By accepting the premise that social engineering is a valid purpose for welfare, not only are we effectively left arguing a supposed moral case — that ‘women of calibre’ are deserving, but Duncan Storrar’s kids are not — but we have no defence to the line from the little girl in the Old El Paso ad: why not both?