Just in case the previous two Croakey posts haven’t satiated your appetite for reading about COAG and health reform, below is more commentary and analysis…
Beyond the hyperbole
At Inside Story, Dr James Gillespie, deputy director of the Menzies Centre for Health Policy at the University of Sydney, identifies four issues arising from the new COAG agreements:
1. Federalism has been reasserted. Hospital reform will depend – as in the past – on state and territory governments, not on a magic wand of centralised single-payer Commonwealth funding
2. Questions about whether primary care is more than enhanced general practice? Medicare Locals reflect the limits of a vision focused on expenditure flows from Canberra. Although hailed as the framework for a fundamental reshaping of primary care, much of the system is left out, with these new bodies looking more like revamped divisions of general practice…
3. The reforms recognise but skirt the difficult task of building effective links to coordinate a fractured system.
4. The growth of the private sector remains outside policy.
Whither Medicare Locals?
More questions about the new primary health care organisations are raised At the Parliamentary Library’s blog, FlagPost. Rebecca de Boer concludes: “Much therefore remains to be done before MLs will be able to achieve improved integration of primary care services in a local area and reorient the health system towards primary health care.”
At The Punch, journalist Leo Shanahan says, amongst other things, that Health Minister Nicola Roxon has been the only constant in the Labor Government’s health policy since 2007, and her role in its failures have gone relatively unexamined.
Meanwhile, below are comment pieces from rural GP, Dr Sue Page, and Dr Tim Woodruff of the Doctors Reform Society.
Why we desperately need health reform
Dr Sue Page writes:
According to Douglas Adams’ iconic series, The Hitchhiker’s Guide to the Galaxy, the answer to the Ultimate Question of Life, The Universe, and Everything is 42. Perhaps this is why the NSW government decided on Monday that more than 42,000 couples should have free marriage certificates in a one-off $2 million Valentine’s Day gift from the soon-to-be-ex Premier.
But I can’t help feel pessimistic when such decisions are made, because these are the same decision makers who also adjudicate far more important matters like how our health is funded.
I live in northern NSW where the ABS recorded the largest regional increase in Australia’s population between 2003 and 2008, while Queensland’s Hervey Bay is growing at the fastest rate – exceeding any of the capital cities. It is estimated that by 2025 approximately a quarter of all Australians will be living between Coffs Harbour and Harvey Bay. You might anticipate a responsible approach would be to map government expenditure to population trends, forward planning major infrastructure in health and transport with plenty of lead time.
But remember that Valentine’s Day gift?
The Sydney-Brisbane air transport route is already Australia’s second busiest with 3.9 million passenger movements. 151,000 vehicle movements per day are projected for the Pacific Highway at the NSW/Queensland border by 2026. Yet our region connects to Sydney via a 500km strip of highway that includes a section of the Pacific Highway that last week topped the NRMA list of the 5 worst roads in NSW. And in response to complaints in Sydney that trains were consistently 15 minutes late, our rail infrastructure was degraded and then closed entirely.
It seems that our decision makers are most easily influenced by the news clips they read on their iphones and by the people they share their café lattes with. If it doesn’t rate as conversation in the Sydney social set it doesn’t exist, right?
Across Australia roughly a third of people live in rural and regional areas. We need them to stay there because they are our farmers and miners and industry workers. They produce the foods and the goods we need and they transport them to where it is convenient to buy them. But they can’t, and increasingly won’t, stay where they are treated like second class citizens.
With idiosyncratic decisions like Valentines’ Day, how realistic is it that “Health Reform” will make a difference, regardless of who contributes what percentage to a centralized funding source? Until local people control local health services that are funded per population not per populist headline, what has changed?
According to the 2010 Menzies-Nous Health Survey, while one third of Australians in capital cities think the “system works pretty well”, only one quarter of those living in other areas hold this view. Only 10% of those living in capital cities think health needs a complete overhaul, while 20% of people living in other areas hold this view. People living in capital cities have a higher opinion of public hospitals (42% vs. 34%), Medicare (62% vs. 56%), and specialist doctors (71% vs. 60%) than people living outside our capital cities.
The new people moving to join us are older than the state average and so can be expected to use health services at higher than state average rates, yet budget cuts have seen the loss of 400 jobs in our health service in just the last two years.
Our largest hospital, Lismore, has an emergency department with just 14 beds and sees 31,000 people per year. Simple mathematics says roughly 6 patients per bed per day, every day, all year long. Think of the linen changes, let alone the potential for clinical errors to be made.
Children seen next to trauma patients and cardiac arrests, assaults next to mental health and addiction medicine clients, infections next to the immune-compromised. Do we try to separate them? Of course!
Do we try to give each of them their fair share of time and attention? Of course!
But when it’s busy you have no alternatives – a quarter of our patients arriving by ambulance are still not unloaded half an hour after they arrive because there are no beds to put them on.
Will waiting time targets for emergency departments help here? Not unless the $2 million buys us 25 more nurses for a year and somebody puts down their latte long enough to sign the cheque for Stage 3 of a new hospital.
Now that would be a truly populist* headline!
*supporting the needs and wishes of regular people in their struggle against privileged elite
Still looking for a more equitable deal for patients
Dr Tim Woodruff writes:
Whatever happened to patients? They are faced with increasing out of pocket costs if they are fortunate enough to find a doctor, Then they have to negotiate a maze of systems to get tests, allied health , specialist assessment and surgery if needed, all funded in different ways, all charging differently. These are the problems which the new health deal ignores or to which minimal attention is given. A few bandaids are suggested like better after hours service. In hours service for the most needy in our community is unchanged.
The new funding arrangement for hospitals is a political deal which will not deliver any noticeable benefit to patients. The Commonwealth has refused to return to a real50/50 funding split with the States. Its tough performance markers are a joke with waiting times to just get on waiting lists ignored. It continues to support the growth of private hospitals with yearly increases but tells public hospitals they will have to wait for 3 years before there are extra funds for the majority of Australians who depend on public hospitals.
This is a political fix with some small incremental benefits for patients. It is not reform. The most needy will continue to receive the least care.
• Tim Woodruff is vice-president of the Doctors Reform Society.