Splintered healthcare, divided responsibilities

We now learn that the Mersey hospital will in future act as a private hospital. The Tasmanian Minister for Health has asked her department to reconfigure her networked services to accommodate the loss of the Mersey to the public system. Individual hospitals must no longer act as islands in an ocean of health care but rather be part of a network of hospital services where the role of each hospital is carefully delineated, safety and quality being major determinants.

These imperatives should have stopped the Howard Government interfering with the master plan for Tasmania’s hospitals, which was derived by experts using the above principles. Mr Abbott’s suggestion, on Channel 9’s Sunday program, that he favours community control of “local” hospitals such as the Mersey is disturbing.

Such interference by the federal government is reprehensible. It may be politically “savvy” but it represents poor policy. The current splintering of responsibilities is a major focus for reform strategies, which concentrate on integration not division. Dividing the responsibility for hospitals between the Australian and state governments is a reformist nightmare. Thus it is all the more distressing to hear rumours that before the election the Howard Government plans to “take over” many country hospitals!

Provide additional dollars to the states to help them run their hospitals by all means Mr Abbott, take over the entire hospital system if you wish, but do not further fracture the health system.

Labor’s approach

What about Labor’s plans for reform? It is not at all surprising that health professionals and consumer organisations, long engaged in promoting significant reforms for our health system, are enthusiastically endorsing Kevin Rudd’s approach to health. The fact is that his plans are “our” plans. There has been a remarkable degree of consensus around the major elements of a reform package for Australia’s health system and Labor has listened, understood and acted.

So what is Mr Rudd proposing to the states and more importantly the electorate in his policy paper? Media reports of the policy have concentrated almost entirely on the “takeover” of public hospitals if the states don’t improve hospital services and thus neglected the commitment of the federal government to improve its performance as well.

I believe his suggestions can be paraphrased as follows:

Let’s be clear, I am not just saying that if in 18 months you are not achieving much better results I will take over the running of your hospitals. I know how hard it is for you to respond to demand with quality service in the present system. The federal government needs to introduce changes to the programs for which it is responsible that will help you achieve what I am asking. Therefore we will resource, nation wide, and a new model of “Integrated Primary Care” that has a good chance of reducing the demand for your services. We will also supply you with many more transition beds to help you discharge, from acute care beds, older patients who no longer need you. We will build these initiatives together with two billion new dollars into the next Australian Health Care Agreement, which traditionally has only dealt with your inpatient services.

To guide us along the journey to health reform, we will establish a commission, strengthened by input from clinicians and consumers that will report to COAG and thus all levels of government. If all co-operate, integrating related programs and pooling our dollar and human resources there is a very good chance we can transform our health system to the one we want.

Now, despite all of these efforts, the cumbersomeness of the basic arrangements now in place may defeat us. If this occurs we will suggest to Australians that we take over the entire health system, administered from Canberra but implemented, of course, by regional authorities. We all agree that if we were starting from scratch we would have only one level of government providing our health system. We must have this ultimate solution available if we are to credibly promise Australians that we can give them the health system they need and can afford.

There have been some disappointments however. Mr Rudd’s decision to “honour” the Australian government’s promise to take over funding of the Mersey hospital in Hobart is particularly regrettable. As Labor seems to understand the importance of networking hospital services this decision smacks of an approach that would be defended by the old “well if we don’t get elected we can’t do anything” logic.

Not good enough Mr Rudd.

The decision to reverse Labor’s opposition to the Medicare “safety net” might be similarly explained. The policy however is indefensible as it is unfair (most of the “safety” dollars go to wealthier Australians), inflationary (no matter how large the doctors fee the government will pay 80 per cent of it) and requires disadvantaged patients to bear the costs of care for many months till they reach an out of pocket threshold. Far better to concentrate on removing the sharp rocks below the safety net so that a net is no longer needed.

Finally the dental scheme Labor proposes is grossly inadequate and suggests that Labor does not appreciate the reality that most people on the waiting list for public dental services need major procedures that will need hospital care.

Despite the above caveats Labor’s master plan represents a major advance towards health system reform. For 20 years the missing but essential ingredient for health system reform has been political leadership. It’s exciting to see signs that it has arrived at last.