Thursday, March 4, 2010

The First Piece Of The Puzzle

While there can be no doubt that the need for health and hospital reform is overwhelming, there are some legitimate questions about whether the Rudd Government plan will deliver what is needed. Even if it delivers an improvement, will it deliver the best possible outcome, or merely a step in that direction? And even if it is a good idea, what real chance is there of getting the States and Territories to sign on? Without complete agreement, the whole thing falls over, in which case the Prime Minister has promised the issue will be taken to the people with a referendum. Even then, there is no guarantee of success with only 8 out of 44 referenda having succeeded in the past.

This has led to accusations from the opposition that the plan has been deliberately designed to fail, only to be used as an election tactic. It’s an accusation which might find some resonance among people who distrust the government, but the truth is that it is the opposition who are guilty of trying to turn the issue into an election tactic by making that very allegation. Even they know that the need for health reform is both real and urgent, and the plain fact is that this is the plan which has been put on the table. So it’s important to examine the plan itself, not simply divert attention from it by running political interference.

Genuine questions need to be answered about the funding model which has been outlined, but not yet detailed. First, if the Commonwealth is going to divert 30% of the GST from the States to pay for the Commonwealth contribution of 60% of hospital services, isn’t this just robbing Peter to pay Paul? Does the plan provide additional funding for hospitals, or does it simply redistribute the money that is already in the system? Does the activity based payment system provide sufficient money for remote and regional hospitals where activity is at a lower level? Will the local people who are appointed to local boards, sorry, Local Health And Hospital Networks, actually have real control over their own destiny, or will they still be puppets at the end of the financial strings of a new, even more centralized bureaucracy?

And on the topic of bureaucracy, the Prime Minister has promised that bureaucracy will be reduced and made more efficient by this plan, with duplications and overlaps removed. But the whole plan centres on creating a new bureaucracy to distribute the funding and to set the criteria and benchmarks for the local networks. All this while the States will still have their own bureaucracies in health for as long as they make any direct contribution to health whatsoever. There is a real risk that rather than making the system simpler, it could become more complex. While the Prime Minister is saying all the right things about clinical and administrative decision making being brought closer to the community, it remains to be seen if that actually happens.

There are also concerns about what has been left out of the reform plan. What about improving access to dental health care, boosting resources for mental health, and dealing with the challenges of aged care? What we have seen so far is just one piece of a very large jigsaw puzzle which will take some time to put together. I believe that it is a very good move in the right direction, but there are many more pieces of the puzzle yet to be pulled out of the box.

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