Regional control and centralised funding make a better health system

What would a new health care system look like? Under the umbrella of my new national healthcare system proposal, all of the health and aged care responsibilities that are now shared between various state, territory and federal governments – and the various departments within those governments - would be united. It would see all funding from both levels of government pooled and distributed to regional health authorities on the basis of population and special needs.

The aims, or goals and targets, would be set by the federal government. As we cannot cut the states totally out of the picture, their role would be to monitor quality. Regional Health Boards (RHB) would be responsible for delivering prompt and affordable services in their areas. These RHBs would consist of representatives elected by the community and would include service providers, consumers and health professionals.

Specialist high-intensity services, such as neo-natal beds would still be delivered by specialist teaching hospitals and access to high-care beds would be provided directly by the federal government.

It would be a universal system, based on the need for services and not on the ability to pay.

The question of what specific services would be delivered to meet the needs of the community would be a decision for the individual RHB.

Our health system is under increasing pressure from a range of factors such as an ageing population, higher expectations, and increasingly expensive new technology and medications. Under those circumstances it is clear that we can not afford wastage of any sort.

But there is an enormous level of waste in our existing “dog’s breakfast” of a health system. Often this wastage is a direct result of cost shifting between federal and state/territory governments. It also occurs when the particular services an individual requires is not available and a less effective, or more costly, service is made available instead.

Waste is also occurring because we put so little effort into preventative medicine. In fact, our current funding model works against prevention as it is treatment-focused and funded.

We also waste about $2.5 billion annually by subsidising private health insurance products rather than directly funding health services, or looking at a specific “Gold Card” system for all Australians over 70 years of age.

Money is also wasted because we do not adequately fund or support the medical workforce - particularly our GPs and nurses. There is pressure on emergency departments because many doctors can not afford to bulk-bill and do not practise after hours. Many people simply cannot afford to pay up front for a doctor’s appointment and associated medications, and so when their budget is stressed they head to the nearest hospital emergency department.

Spending valuable dollars training nurses but then not adequately supporting them when they enter the workforce leads to many thousands leaving the profession after negative experiences. This is not just a waste of resources but also a tragedy for those individuals involved.

Again there is waste when allied health professionals, such as physiotherapists, podiatrists or psychologists are excluded from the public system and patients are sent off for expensive surgery instead. When these health professionals can only be seen privately, those on low incomes often can not get the rehabilitation they need. There is waste when dental services are not publicly funded and are therefore unaffordable for many, particularly older, Australians whose diets often deteriorate as a result.