The announcement of the establishment of primary health care organisations across Australia does provide a key missing piece of the Rudd Government's health reform jig-saw puzzle. The previous reforms had been been concentrated on hospitals even though good primary care is essential to ensuring people stay healthier and out of hospital.

The proposed primary health care organisations will be built up from the existing Divisions of General Practice networks. Their functions will have a much greater focus on providing or contracting community and allied health services and facilitating care delivery especially for those with chronic disease.

The drawback of the reform to primary care is that the planning and management of an individual patient’s care will remain the responsibility of the GP.

Brumby's health plan does mention primary and aged care:

*Taking action to keep people well and out of hospital - investing in prevention programs such as the successful WorkHealth initiative to help people stay healthy, and avoid chronic illnesses which can result in unnecessary hospitalisation;
*Investing in primary and aged care – for patients who would receive more appropriate care in a non-hospital setting such as a GP clinic or a residential aged care service, reducing pressure on public hospitals;

But there are no details as to how this might be achieved. It's mostly about the need for extra funding. it seems that Victoria's healthcare system is so good that it doesn't need reform --only increased commonwealth funding. Any problems in the Victorian health system are the consequence of insufficient Commonwealth funding according to Brumby.

Hence my claim that Brumby's position is to demand more commonwealth funding with no strings attached.

A parochial Brumby keeps digging a deeper hole for himself these days. He cannot have much credit left in Canberra these days. His is strategy to act as tough guy standing up against Canberra hoping that it will give him a popularity boost as his re-election bid gets closer?

Nan,
There is the theory that Rudds plan isnt going to makes things better and he will be long gone while the states still have the problems.

I guess even you will admit that Rudd has been a bit of a fizzer. You can't blame people for taking everything he says with a pinch of salt now.

Les,
the healthcare system needs fixing--few doubt that--and it needs more commonwealth money and a partnership between the states and the coommonwealth.

There is a problem with co-operative federalism as currently practised---it means the increasing centralisation of power in Canberra and the reduction of the states own power. Along with that increased power comes the strong arm tactics by Canberra.

Brumby may have a case in this instance ----it was well put in his address at the National Press Club---but his track record in putting Victoria first at the expense of the nation undermines that case.

Gary,
Perhaps it would be better just to up the GST and let the states work out where the money is best spent.

Les,
The state budgets for all the states will not cope with the increased demand and rising costs for health over the next couple of decades. Their costs are increasing by 7 to 8 per cent a year while their revenues are growing at 3 per cent. By 2050, health costs would consume every dollar of states' revenues, on current trends.

So they really need the commonwealth to step in to help with the need for increased funding--Rann and Bligh are dead right on this---and they are willing accept the consequences that, in turn, they have to move on health reform. Kristina Keneally in NSW is making an opportunistic grab for money - asking that Rudd pay transition costs of $686 million over four years -

Not Brumb though. Victoria wants more money (more money, more money, more money), and though Brumby and Co talk about being concerned with patient centred care and health reform, they still just talk about more money for hospitals (emergency and elective surgery), without ever mentioning the need to better integrate primary care with hospital care or to provide more access points (allied health) into the health system. They cover the need for reform by saying that Victoria has no need to reform because they've done it all.

Nor do the Victorians talk about increasing the quality of health care or shifting the emphasis away from the system providers (AMA, private insurers, Big Pharma etc) who drive the system at the expense of the needs patients.The system is not a patient centred system.

Brumby is about more money and power not better healthcare for patients. As Lenore Taylor points out in It's politics first, patients second in The Age the power issue is over:

the loss of power over hospital spending and a loss of power over revenue because it replaces GST funds - over which they have complete discretion - with funds that can be spent only on hospitals.

She says that the commonwealth is willing to provide extra money for hospitals---- net new money of $2.9 billion over the next four years for making emergency rooms run faster, for making elective surgery more accessible, for training more GPs--- and every state will benefit. What they lose is power and financial autonomy.

Brumby is trying to push up what the Commonwealth has to pay in additional short-term funding and to retain power and financial autonomy. Brumby wants heaps of money---- he is demanding that Rudd move from paying a 40 per cent share of the hospitals' costs to 50 per cent by coughing up an extra $38 billion over four years--- but he yields nothing in return.

Rudd offers the hope of change to health services without bearing the blame for a decade of decline under Howard's reduced funding. Brumby's boast that Victoria's hospitals are the best doesn't square with patients who have endured long waits for treatment?

He looks aggressive in his attacks on Rudd Labor, and he comes across as a blocker of reform.