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    Doctor Whom

    Casemix in Victoria has been a true success story. It has driven costs down and promoted true efficiencies. Despite the fears of clinical workers it has also driven safety and quality improvements as new, leaner ways of working are introduced the pressure to ensure that safety and quality are improved has been greater on the newer way than the old tried and true methods.

    However Harry Hemley is right. The casemix has morphed into a narrow procedure focused unit cost funding that doesn’t pay fro anything done outside hospital walls.

    Casemix initially was designed to include capital costs, teaching costs and even some research costs. But it has been eroded over the years to the point where even the DoH and Treasury acknowledge that it now doesn’t include capital costs.

    This means the new or improved buildings and patient flow improvements depending on architecture, are now part of a political lottery instead of a health/safety/efficiency business decision.

    Teaching and research have always been problematic due to the octopus like occupation of teaching hospitals by universities.

    The sponging of universities off the hospital funding is to some extent being unraveled successfully in Victoria and the relationship of hospitals to teaching and research is almost fully transparent in many places.

    This does raise the embarrassing issue of who should and will fund research, teaching and capital.

    The simplest one to solve is the capital issue. A great deal of the infrastructure is inadequate and obviously so even to a 12 year old schoolboy dragged in off the street.

    This ripe for federal funding. It is national infrastructure after all. It will supply building industry jobs. It is to some extent discreet one off funding. Very little recurrent funding is involved. It would stop a churning of staff from run down hospitals to newer infrastructure if workers had a clear commitment to decent building at some time. It would be easy for the Feds and states to combine to allocate priorities. It would disentangle essential infrastructure from state elections and politics. It can be entirely bi-partisan (and is almost that now) There is no reason not to have a clear 20 year plan.

    Victorian hospitals get something like 80% of funding from casemix – other funding is a mix of grants for various purposes.


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