Many of us have forgotten to do our homework then cobbled a paper together the day before it’s due. It may work occasionally for teenagers and uni students but it isn’t acceptable for a Prime Minister tackling something as important as health reform.
Kevin Rudd had promised to fix Australia’s hospital system last year but got distracted. He then burned through $100 billion worth of stimulus, which completely neglected health care. Now just a few months out from another election it has suddenly become his number one priority. So much so that he pretty much refuses to talk about anything else. Faced with the trifecta of global warming, people smugglers and hospitals which could all derail his prime ministership, the Prime Minister chose the only one which can be fixed with cash; and lots of it.
For a Prime Minister intoxicated with inputs instead of outcomes, money is all that matters. While Australia’s $100 billion health system is in line with those in other rich nations at around $5,000 per person annually, it is without doubt one of the most complex because it involves a precarious balancing act of the private and public sectors.
We have a $30 billion hospital system where the more work they do the faster they go broke. Then there is a $20 billion Medicare service where the faster you work the more you get paid. These two systems actively repel work back at each other - hospitals by understaffing and Medicare because GPs need to sleep at night. A third of our system is private, delivering efficient but selected services for the insured. That leaves 75,000 bureaucrats in eight different public health systems keen to keep their jobs and maintain the status quo.
Rudd’s solution is more a government shake-up than genuine health reform. First there is the pea and thimble trick where the Commonwealth takes 30 per cent of GST then hands it to regional health bureaucracies. Second, there will be some standardisation of processes with incentives for efficient hospital services. Last and most important, money will be targeting the three key fault lines in health; casualty delays, waiting lists and bed block.
However amidst the haste there have been glaring omissions. Rudd’s plan contains no provision for mental health and none for the widely rorted dental items. Furthermore Rudd’s plan makes no provision for independent reporting on the hospital performance. What’s needed is an independent watchdog. Not government appointees and spin doctors paid to hide the truth. Unfortunately Rudd knows states will never agree to independent scrutiny so he hasn’t proposed it.
Clinically, we need to prevent hospitals shifting their costs back onto Medicare. But Rudd provides states with more money to continue the overlap and duplication. Hospitals need incentives to do more of what they do best like specialist outpatient services. Instead those programs are being closed down to save money.
We need to support private health, but Mr Rudd undermines insured Australians by fast-tracking desperate public patients into private hospitals. Australia needs a single funder but Rudd’s scheme keeps two. We need public and private providers competing to deliver services but that won’t happen either. Telecare monitoring of the frail at home could prevent expensive admissions, but Rudd has run out of time. A unique patient identifier could unify health records nationwide and save millions. Same story.
Our hospitals are crying out for some outside governance like local hospital boards. Rudd’s proposal simply splits up the existing bureaucracies and adds a fourth level; regional health boards, so named because Tony Abbott’s local boards plan proved popular. When a region inevitably goes broke, Rudd has created three separate administrations who can blame each other, and more bureaucrats to manage the triple interface. Come election day, voters will have no idea who to blame.
As Queensland’s head bureaucrat, Rudd had little passion for health reform. That’s partly explains Queensland Health now. It also explains the rush. He is talking big health reform yet spent the last three weeks cutting ribbons on cancer machines in marginal seats instead of the harder task of cutting red tape.
Long after the memories of Rudd slaying the Premiers have faded, patients will still languish in casualty departments, seniors will be stuck in hospital beds and waiting lists will remain just that. For sure many of Rudd’s ideas are good, because there are good people giving him the ideas. But the haste for a pre-election solution risks making our already complex system even more bloated and no less wasteful.
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