Australians are a cynical lot. We know when politicians talk about ending the blame game that they just want us to blame somebody else. And we all chuckled last week when the States called Rudd’s bluff on healthcare — saying we’ll fix ours if you fix yours.
Wall-to-wall Labor doesn’t mean the States will quietly allow themselves to be beaten up by a tough-on-waiting-lists government, at least not now the election is over, and good on ‘em.
The truth is the Rudd Government holds most of the health cards. The states could do their hip replacements sooner if the Commonwealth committed an extra $2.26 billion to make good the shortfall on its side of the 50:50 bargain on hospital funding.
We hope the Government insists on measurable outcomes in the hospitals agreement and not use the “it’s-up-to-the-States” alibi of previous Governments. Will some funds be dedicated to prevention, sexual and reproductive health, mental health and Indigenous services, for instance?
Will the Rudd Government seriously deal with the chronic shortage of medical staff that forces the States to poach from developing countries or overlook malpractice as in Doctors Patel and Reeves. The deliberate underspend on medical undergraduate places, the failure to take on the turf wars between professions and our doctor-oriented, fee-for-service Medicare system that rewards expensive diagnostic procedures and interventions over cheaper preventive and early intervention activities, are all there for the fixing.
We apply cost-effectiveness principles in pharmaceuticals, but do not bring the same rigour to new diagnostic technology or surgical and therapeutic procedures, at some cost.
The Government could introduce an independent regulator to clamp down on pharma-funded conferences and the sweeteners drug companies hand to doctors. They could extend the PBS into public hospitals so patients are not sent home with starter medication and told to see a GP post-haste for a script.
Treatments for the same condition vary widely from doctor to doctor, hospital to hospital and town to town. A national push for formal clinical practice guidelines would improve both diagnoses and treatment and help reduce the $1 billion a year cost of preventable errors.
Electronic records that go with the patient would be more efficient and improve clinical decision making, save on basic data collection and mean fewer repetitive tests and better medication disclosure and adherence. Providing capital for the necessary IT infrastructure surely falls under the Rudd Government’s infrastructure umbrella.
And we mustn’t forget the elephant in the room — the private health system — now signed on to by half the population, frightened by much publicised surgery waiting times and ambulance by-passes and sucked in by the idea of choosing their own doctor. Of course most of us are not au fait with who is best at taking out brain tumours or putting in titanium hips so we rely on the old boys’ club to which our particular GP belongs and hope it doesn’t cost an arm and a leg.
Rudd could agree to never run Howard-style frightener ads that say only the private system is good enough for you.
Patients might get in quicker and have nicer rooms but that doesn’t necessarily mean better care. Indeed with most serious illness, a private hospital is definitely not the best place to be. A few GPs will offer to do the surgery themselves and some won’t tell you or won’t know that you have a much better chance of surviving gynaecological cancer, for instance, if you are treated by a specialist in both — a gynaecological oncologist — in a public hospital.
The insurance system that makes private hospital stays affordable sucks up money in administration and is ineffective in containing costs. Doctors are in short supply so they can charge what they like, leaving public hospitals no choice but to up the ante. So the wealth of evidence showing a positive correlation between growth in the private hospital use and growth in overall health costs should surprise no one.
Unfortunately, however logical it would be to remove the $4-6 billion in tax breaks and rebates and give it to public hospitals, there are just too many voters signed on for the Government to take the risk. A safer course might be to bypass the insurers and fund private hospitals directly. This could simplify the tax system, reduce administration costs and give Government some control over taxpayer expenditure which climbs faster than CPI every year, along with the premiums.
Some of this saving could go towards a national no-fault insurance scheme for catastrophic injury, much like Victoria’s TAC. This way someone sustaining a brain injury, for instance, would not be left languishing in a nursing home for want of funds to pay for the long, slow process of rehabilitation.
It’s your choice, Prime Minister. Tackle the reforms we all know are necessary in health or blame the States for an expensive skeleton of a health system that neither provides quality care nor brings down those damned waiting lists.
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