|
April 19, 2010
Today is crunch time to address the rapidly rising costs and inefficiencies in the fractured healthcare system at CoAG in Canberra. The common ground is that the system does need more money now rather than in 2014, and the commonwealth's contribution has gone down and down and down over the last decade. But extra funding does not necessarily mean higher quality health care.
Will the states accept the Commonwealth's bribes or sweetners and sign up to a limited public hospital program? Or will they---WA, Victoria and possibly NSW --- continue to resist signing over a portion of their GST, even though they tacitly agree that a single funder of health is best? That would begin to end the cost-shifting and finger-pointing that bedevils the current split system.
Or will they refuse to cut a deal and go out on a limb, even though the states have little hope of funding or supplying on their own the 21st-century system that we will need to deal with chronic illnesses and an ageing population over the next decade. And the states know it.
What we have, as Ian Hickie observes in the National Times is that:
The big dollars have been allocated to public hospitals and purchasing of elective surgery from the private sector. The real service commitments, particularly the guarantee that you will be treated within four hours of presenting to an emergency department, are clearly focused on improving the acute care sector only.
Nor are the states pushing for the rapid introduction of e-health despite the cost savings, or addressing the perverse incentives such as fee-for-service associated with bulk-billing in which clinicians are rewarded by the number of transactions rather than health outcomes.
Unsurprisingly, the states have been more interested in extra cash rather than addressing the underinvestment in prevention, early intervention and alternative care settings, particularly for older people. Lowering obesity rates, particularly among young people and those on lower income, or dental care do not seem to be very high on any real health priorities list. Nor is mental health.
Tony Abbott has little to say apart from it being another example of Rudd's smoke and mirrors. Peter Dutton, the Coalition's shadow health spokesperson, has nothing to say, as usual. No doubt they will oppose.
Update
The talks move very slowly---"inch by inch"--- by all accounts. Everybody has stayed on message about CoAG being constructive and everybody being willing to negotiate. NSW Premier Kristina Keneally has agreed to hand back 30 per cent of its GST to Canberra to help fund Kevin Rudd's hospital reforms.The commonwealth's claw back of GST to fund health care is the key sticking point, or bone of contention for Victoria and Western Australia. That issue has yet to be discussed at CoAG. Will it be debated tomorrow?
The Commonwealth continues to throw money around --this time it is $1.2 billion to help meet the emergency department and elective surgery targets set up under the Rudd's reforms. They are not talking about reducing the number of patients coming into hospitals through good primary care as David Burchell observes:
Unravel the righteous words about the importance of primary and community care, and it becomes clear that nothing much is about to change there, either. There are no specific proposals about nurturing "wellness", or better treating the epidemic of breast cancers, or dealing with mental health more effectively. Nor is there any evident revision of the received view that treats old age as if it were a form of illness, so that the elderly are condemned to spending their autumn years under the cold fluorescent lighting of hospital waiting rooms.The federal proposals won't make the business of hospitals easier, by keeping people out of them. They won't make the system fairer in any discernible way; nor, so far we can be told, will they work to restrain overall costs.
CoAG has yet to begin to seriously discuss health reform. What we have on display this time is more political posturing and positioning for upcoming elections.
Update 2
So it cost the Commonwealth $5 billion in incentives (including $1.2 billion to help meet the emergency department and elective surgery; $800 million for improved mental health services and 1300 extra hospital beds) to get the states on board plus a partnership with the states, with each contributing to a joint pool to fund hospital reform.
So the Commonwealth had to back down on directly funding the local hospital networks as the states are still involved in controlling the money. That state involvement through a joint funding arrangement to deliver hospital funding reform does mean the continuation of centralised and bureaucratic approach rather than giving the hospital networks the ability through direct funding to deliver locally crafted services according to the needs of the population.
|
The politics of health is just a squabble for money in the short-term. Despite their rhetoric the states are not really concerned about putting health on a sustainable footing in the long term.