The National Health and Hospitals Reform Commission report is a policy response to a political issue — and not too bad a response at that.
The political issue is not the one that the media finds most interesting — Kevin Rudd’s promise to call a referendum if the states don’t fall into line on health, or even the Opposition’s attempts to claim Rudd has broken his promise (give up guys — after 18 months, Rudd is perceived, as much as any politician can be, as keeping his promises, in the same way Howard was perceived as breaking them).
The political issue is that our health systems — plural — are perceived as broken when in fact they’re not. Australia — as Rudd acknowledged yesterday — obtains pretty good health outcomes from its healthcare system despite ploughing less as a proportion of GDP into health than most OECD countries.
Part of that is because of extraneous factors — we’re a peaceful country with few guns, well-enforced road rules, an educated popualtion and a climate that’s normally not too hostile. There’d be something wrong if we weren’t one of the world’s healthier peoples.
The media, however, enthusiastically promote the idea that if you have to wait in an emergency department for treatment, or because there are queues for elective surgery, or adverse events in hospitals, that’s evidence of fundamental dysfunction. Urban Australians seem to have bought into this idea, unwilling to accept that, in the absence of a pricing mechanism, queuing is the market’s way of rationing goods and services, or that, no matter how good the system, mistakes will always happen.
Kevin Rudd happily endorsed this approach when he promised to fix health before the election. As with fuel prices and groceries, doing it is proving much harder than saying it.
There are plenty in the health sector who are also happy to play along. The health sector is chockers with groups, companies and academics who either want to protect their stake in the current system or change the current system so they can get a bigger stake. There are few disinterested views on offer from health professionals.
Despite all that, there is some very good work in the report.
There are some glaring problems in our health system: if you’re indigenous, or live in rural or regional Australia, or have mental health issues, you’re comparatively poorly served and that’s reflected in health outcomes for those groups. To its credit, the Commission has tackled these problems as the first of its three priorities, urging greater resources and better coordination of services in those areas.
It also recognises that basic dental care has become a problem for lower-income Australians, although whether a tax hike to extend Medicare to a $3.6b a year “Denticare” program is the best way to address it might be an issue voters will want to think about.
It would be a pity if, in going to high-visibility “coalface” health industry sites like Royal North Shore Hospital, the Prime Minister mistook the whingeing of mostly well-off urban Australians and the media that serves them for the real priority of improving health outcomes for Australians in indigenous communities, and country towns, and those with mental illness. That’s where precious extra resources should be directed, not at reducing waiting times in urban emergency wards or cutting queues for non-urgent surgery, and MPs from all parties who represent rural and remote areas should be making that point loud and clear in the coming months.
The report then addresses both emerging challenges and the changes necessary for long-term sustainability. In those sections, the report frequently offers only current healthcare fashions. More funding for prevention. The wonders of e-health — something that has been promised for years and never materialised; the astonishing bureaucratic wrangling and industry resistance on electronic health records that has gone on for years suggests the report’s timeframe of 2012 for a personal electronic health record is rather optimistic. Greater use of ICT and broadband. More coordinated primary care, with greater continuity of care. All of these are well-established approaches, mirroring existing documents like the National Service Improvement Frameworks for chronic disease developed much earlier in the decade.
Where the report is stronger, though, is in arguing the case for more efficient funding and more unified funding. It recommends activity-based funding for hospitals, Commonwealth responsibility for out-patient services, and different Medicare funding models than the standard consultation-based approach, as well as consideration of, in essence, a contestable version of Medicare, “Medicare Select”. But the move to a single funder is the key point, one recognised by former Health Secretary Andrew Podger today in the AFR, where he notes that, whatever Rudd might say, the issue is not the competence or otherwise of State governments managing health. It is “the structural impediments of multiple government funders”.
Podger’s point is critical because, in the absence of a magic pudding, the cost of health care reform — on top of the burgeoning cost of the sector as the population ages and advanced treatments proliferate — have to come from somewhere. Yesterday Rudd lamely offered Budget changes to the Medicare safety net and the haircut he had given the private health insurance rebate as evidence there were significant savings to be obtained that could fund big reform. And while it’s true that the appalling rort of the private health insurance rebate should be ended forthwith, the inefficiencies that accrue from having multiple funders, often funding the treatment of the same patient with the same condition through multiple stages of their treatment, are the biggest potential gain.
Rudd repeatedly says that he — like all Australians — “just wants it fixed”. But what precisely Rudd — and the rest of us — want fixed is less clear. The issue of whether “faceless bureaucrats in Canberra” or “incompetent State Governments” run healthcare is less important than the need to address the health funding equivalent of the old rail break-of-gauge that splits healthcare into multiple and sometimes conflicting fiefdoms.
Well Bernard, I like the sound of the content of this report. However, I have to admit that as yet I haven’t read it! Having said that, I think there are real problems with the health system. I live in NSW, and while this State Government has a lot to answer for, the fact remains, that I sympathize with the at least $1 billion dollars denied to this State each years since the GST was introduced. It could be $3 billion per yr or more. That’s an awful lot of money – in nine years, between $9 billion-$27billion!
The ‘elective surgery’ term is a nonsense. I think of this when the topic of cosmetic surgery is used in the same sentence. I don’t include reconstructive surgery after a mastectomy caused by breast cancer, or skin grafts/surgical procedures following burns or vicious attacks. I certainly don’t include surgery for any cancer anywhere in or on the body as ‘elective’ – that was what my family member was told in the last few years! What do you ‘elect’ to have? Life or possible death? That is a disgrace!Simple!
There have been some pretty horrific stories of peoples’ experiences at major hospitals, usually caused by shortages of beds, staff or both. It’s ridiculous to assert, that the health system is usually OK for most people. That’s clearly not so! Added to this are the assaults, both physical & verbal against hospital staff by disgruntled out patients etc. This is a growing problem. Only a couple of weeks ago, our local newspaper (Fairfax) had a photo on its front page or at least 6 ambulances waiting for their patients to be seen in our largest hospital – Wollongong! If this is the product of an OK hospital/health system, than I don’t know what constitutes one! Apart from those patients in need of a doctor, the ambulance vehicles and the paramedics were tied up for several hours, and people could’ve died from lack of a paramedic after or during a heart attack or stroke, when we’re told for example, that it’s the first 15 minutes after a stroke that is imperative for a good outcome!
We also suffer from a huge lack of GP’s. In my local area(also classified as a city), about 5 doctors left the area in a couple of weeks. I was at my doctors surgery, when a woman was sadly turned away – not taking any more patients – 2 doctors stretched to breaking point. This woman had been to 3 other surgeries – same response? I don’t call that OK, do you? The receptionist was placed in a bad position; I could tell that she was most upset to have to turn this woman away – she’s a good person with a big heart!
Successive federal governments, including Howard’s, cut the numbers of people who could do medicine – now we’re paying the price! Those wealthy doctors who didn’t want competition(and a cut in their healthy incomes) had too much power with the then Minister, Michael Wooldridge. They won – we lost! Hospitals, maternity sections, outpatients etc have been closed then opened, then partly-closed or???Psychiatric nurses are advocating 12 hour shifts as preferable to what’s happening at present??
What??Not good enough!
Then there’s the awful state of the nation’s teeth. It’s at crisis point! Too many people without enough money are suffering badly-some are horrific. I recall the story of the aged pensioners – one in particular – in a nursing home with several abscesses in her mouth! Imagine how this would drag down her general health. People could die from having such infections. It’s a disgrace – she certainly wasn’t in a minority!
On the question of going back to local boards? I recall that was changed due to inadequate and in many cases, improper decisions being made. Too much money wasted and a decline in services and service quality! It seems to me, that one of the largest wastes of money is having duplication of state and federal monies and responsibilities. I’d like to see a breakdown of what individual responsibilities each Minister has, how many administrative positions, and if there’s overlap and why?
Correct me if I’m wrong, but didn’t Rudd promise to have a Referendum re taking over health care if there was no improvement in ’09? Isn’t it true, that he doesn’t have the authority to arbitarily take over responsibility from the States in the area of health? That if the States don’t agree, the only answer for a national government is to have a Referendum? Isn’t it true, that the only reason the hospital in Tasmania is in Federal hands is because that state wanted it to be, and Howard had to pay the token amount of $1 to make it ‘legal’ – he had to ‘buy’ it? If this is true, isn’t the Opposition carrying on over broken promised just political BS? Then, why hasn’t a journalist told Peter Dutton that it is thus! Why is Turnbull allowed to carry on with this BS too?
Good points Liz. Your mention of a referendum echoes what the PM said yesterday. He intimated if there was no agreement with the States and Territories when they meet in the new year, it would probably be a referendem assoc with next years General Election.
I share your concern over Duttons ‘BS’.
He is carrying on like a pork chop and the more he moans and complains like a spoilt brat the more stupid and inconsequential he appears. Ever since he was made to sit on the Opposition side he has moaned and grizzled and whined incessantly. Very little alternative policy just whinge in a boring monotone that would do justice to a robot. Someone should grab him by the ear, and tell him to start sounding like a grownup. If that was the way he gave evidence in court as a former police office, he would have bored the daylight out of Judge, jury, Magistrate,lawyers, public gallery the whole show.Dreary doesnt do him justice. With a bit of luck he will lose his seat with boundary changes next year and that will be that. Dreary person he is.
Yep – another review – this time a good one well done by well-intended experts – and yet again a bunch of words from Rudd and his spin-men, looking for all the reasons to defer any response or action until – well who knows when?
The problem is clear – just like the water problems – poor old Kev just cannot control his State Premiers, and so he will cast about for every reason in the book to again sit on his already very flat hands until the time comes for another election.
What has he done – apart from sending out cheques. B….r all!!!! Oh he apologised!! That’s one. Signed Kyoto! that’s two. Both of those actually changed nothing. Meantime the poor aborigines out in the bush still ain’t got a single house built, but the fatcats just get fatter in their ivory palaces.
A thousand or so houses rolled out fast like Whitlam did in 1973 would do far more for health reform across Australia than any of the 123 recommendations.
Well said, Liz and David. On the subject of emergency ward delays and ambulance ramping at Woollongong. The same situation applies throughout Australia. Accident and Emergency wards have been under funded because of the caving in by governments to media campaigns on waiting lists for elective surgery. Accident and Emergency wards are full partly because every Labor Government, especially ours in Queensland have happily taken bribes from the hotel industry to extend trading hours and numbers of poker machines, all major contributors, to increased stress in the home and community. With regard to ambulance ramping, in the UK the Ambulance Service comes under the local National Health District budget, there is no reason to have paramedics minding patients in the back of ambulances and corridors, whereas in Queensland, the Health Department dont pay for the paramedics (different department) so they use them as temporary nurses being paid out of someone elses budget.
Well said Liz. A good reply to the smug, who look at the figures on a piece of paper and think things are getting better, but not having had actual experience of working in the system, don’t understand how the system is broken, and inefficient, and sometimes just plain dangerous.
There is no salvation in the Liberals. Going back to hospital boards is a ridiculous and simplistic idea that will solve nothing. I am old enough to remember hospital boards and hospital board members. Usually they were trusties appointed by the political party in power at the time of their appointment. In the country it was often the butcher, the baker and the candlestick maker, who had less experience and less understanding of running a health service than the least experienced nurse on staff.
There is merit in some of the Commission proposals but it does depend on how it is done. I am left wondering how much of what is to be done will be done by governments contracting out to the private sector? Denticare needs to be a publicly funded and publicly provided program in the city and rural areas. Talking with a friend who is a community nurse this morning, she was telling me about some dentists who get mental health patients in, who are paid for by the existing dental provisions under Medicare for the initial work, but then these dentists tell them that they need all this expensive work done, which can be done if these pensioners pay them $300 per month. Is this a foretaste of Denticare?