Australia's next health system

The Howard Government can under-invest in Medicare, and primary care generally, knowing public hospital emergency departments will end up helping patients who could and should have been helped outside the expensive hospital setting.

The Howard Government can also under-invest in health promotion because state-administered public hospitals end up carrying the lion's share of the treatment of those with preventable disease.

Second, the agreements must do more to integrate and utilise the private hospital sector.

We should be looking for ways to better integrate private hospital services into the provision of publicly-funded health care and the training of health professionals. My discussions with the private hospitals leave me in no doubt that they would welcome such an approach and that they will respond positively to these proposals when put to them.

The Commonwealth does not do nearly enough to ensure that private hospitals are effectively used as a national health resource. This is despite the growing role of private hospitals in the delivery of a range of services, and despite the fact the Commonwealth makes substantial contributions to the cost of these services through Medicare, the PBS and the private health insurance rebate.

This is also despite the states’ recognition that the private sector can extend the capacity of the public sector. Indeed there are already arrangements under which the states purchase needed beds and care. The states also work with the private health sector in other ways.

The public and private health systems are also linked through their shared workforce.

The next Health Care Agreements must recognise that all hospitals are in the health business. We will maximise the outcomes for our health system and all patients by working together.

Finally, the next Health Care Agreements should build the kind of co-operation between the Commonwealth and the states which will support a serious discussion, leading to consensus over time, about the future division of health responsibilities between the Commonwealth and the states and territories.

This is a consensus which will not be reached before the next election or before the next Health Care Agreements. But we need to start the discussion now.

Faced with the issues around the current commonwealth-state divide, I know that many players in health even advocate extending a national model to our hospital system.

I also know that those who support the Commonwealth ultimately taking over health would understand that building for that outcome will take years of better and closer co-operation between the states and the Commonwealth. Certainly more years than the term of just one inter-governmental agreement.