As mentioned previously at Croakey, the Productivity Commission is studying the relative performance of public and private hospitals with a draft report scheduled for release in September and a final report due to go to the Government in November.
As part of the study, the Commission has been requested to consider:
- comparative hospital and medical costs for clinically similar procedures performed by public and private hospitals
- the rate of hospital-acquired infections by type, reported by public and private hospitals
- rates of fully-informed financial consent by privately-insured patients, out-of-pocket expenses for patients who do not give such consent, and best-practice examples where fully-informed financial consent is provided for every procedure
- other relevant performance indicators, including the ability of such indicators to inform comparisons of hospital performance and efficiency.
The Commission recently released this issues paper to guide submissions, which are due by 27 July.
It strikes me that the terms of reference are overly narrow, and that it would be far more useful if the Commission was also able to consider some broader issues.
Here are some other issues the Commission might like to consider (or at least to suggest are included in any future such inquiries):
• The inequity of our current system is one of the biggest challenges facing health policy makers – the fact that those who are most likely to have worse health are also least likely to have access to appropriate services. What is the relative contribution of private and public hospitals to reducing the inequities in health and health care?
• As a country we have identified eight national health priorities, including mental health, obesity and cancer. What is the relative contribution of private and public hospitals to achieving improvements in these priority areas?
• Closing the Gap in Indigenous health and disadvantage is another national priority. You could argue, perhaps, that hospital services will have only a minimal impact, relative to all the other forces affecting health. Even so, there’s no doubt that hospitals could do a lot more to provide appropriate, accessible care to Aboriginal and Torres Strait Islander people. What is the relative contribution of public and private hospitals to Closing the Gap?
• Given the widespread concerns about the increasing health spending – with even the editor of the Medical Journal of Australia wondering whether Medicare is sustainable – surely we should be asking much tougher questions than simply how much hospitals spend on particular procedures. Like – what proportion of procedures and treatments in public and private hospitals are backed by reliable evidence? And how do the systems compare when it comes to providing procedures and treatments that are unnecessary, ineffective or potentially even harmful?
• Given the importance of improving the linkages between evidence and practice, perhaps the Commission could also compare how well private and public hospitals do in establishing systems and structures to drive evidence-based care.
• With so much talk about the need to reorient the health system towards primary care, perhaps we should also be asking much tougher questions about what hospitals are doing to support and integrate better with primary care. Are private hospitals more or less likely to link in with primary care?
• Given that our health system has historically done a very poor job of incorporating the values and priorities of the community into how funds are spent or services are provided, perhaps the Commission could also measure how well the two sectors perform in this area. Are public hospitals more or less likely to engage their communities?
• Caring for patients is not the only role of public hospitals. Traditionally, teaching and research have also been an important part of their beat. What is the relative contribution of public and private hospitals to teaching and research?
• With the increasing focus on prevention and health promotion, there is an argument for expecting that health services generally should have a role in public health advocacy, whether at the local community level or more broadly. What is the relative contribution of public and private hospitals to public health advocacy?
I could go on, but it would be nice to hear from some Croakey readers. I will compile a Croakey submission to go to the Commission; if you’d like to contribute, drop me a line.