There’s been a little bit of Commonwealth-State argy-bargy recently about the possibility of a federal government “takeover” of hospital funding. You might recall that the draft report of the National Health and Hospitals Reform Commission canvassed options for such a takeover. It seems that several of the state premiers, including John Brumby, believe that this is likely enough to be pre-emptorily pushing back:
Mr Brumby said he believed hospitals would be less accountable for their performance if they were funded wholly from Canberra.
“The last thing you would want is a faceless bureaucracy in Canberra running the health system here in Victoria,” he said. “Imagine, five years up the road, you might have a health minister that comes from a safe seat somewhere in Darwin being responsible for the Children’s Hospital, or the Royal Melbourne Hospital or the Comprehensive Cancer Centre.
As far as arguments go against such a takeover, this is one of the lamest, as Nick Miller pointed out in The Age recently. Some of the case for such a takeover can be found by reading between the lines of this fascinating document, a background paper for the reform commission examining potential efficiency gains in the Australian health system. By international standards, the administrative costs of Australia’s health system is actually relatively low, so presumably there aren’t massive savings to be made there. But there are, according to the document, some big gains to be made in “allocative efficiency”, where the funding for different medical treatments is re-prioritized. When the funding comes from a single source (the federal government, presumably), it should theoretically be easier to fund things according to their theraputic value, rather than on the basis of which tier of government puts up the cash.
In any case, it sets up a fascinating debate over the next few months, with health reform potentially dominating politics as a federal election draws nearer. Would federal Labor want any change done and dusted before the election, or is there a possibility of taking a radical reform proposal to the polls?
“a safe seat somewhere in Darwin”
There only one NT seat, and it is extremely marginal.
So much for that argument.
A better argument is that the Commonwealth doesn’t have any experience running anything, except the armed forces, and there’s not a lot of evidence of “allocative efficiency” in defence purchasing and priorities.
How about:
As far as arguments go against such a takeover, this is one of the
lamestmost pathetic,Sam – there are two Federal Seats in the NT – Solomon and Lingiari.
The argument is a crap one – how to the people in Mildura cope with decisions from Melbourne?
The current arrangements for funding and responsibility for Health are a dog’s breakfast. The sooner the Federal Government takes charge, the better.
Much better Deborah – not least because Nick Miller is a Freo fan, who should by now know his pathos inside out.
Razor: I was going to make the same argument in the post, substituting my old stomping grounds for Mildura.
Razor, thanks for pointing out the error. But since the seat of Solomon = Darwin, and it is very marginal, the point is the same.
On the substantive point, yes, there is a case for funding and administrative rationalisation. But it is fanciful to think that it will make a huge difference.
I can’t help thinking back to Howard’s dumb, dumb, dumb idea to take over the Mersey Hospital in Tasmania. The State had finally shown the political balls to cut back on some services from one of two hospitals within 50 km and in come the blundering feds without any due diligence or the slighest hint of a rationale.
More generally, I have far more respect for Tasmania’s service delivery skills than the Commonwealth. All I want is more certainty in funding so the federal pollies can’t reduce funds while at the same time whining about declining hospital performance. It has me baffled that anybody could think that the bloated Canberra bureaucracy could deliver anything efficiently.
Perhaps with Health it’s because people seem perpetually grumpy at any lack of perfection and are ever ready to direct rage at the states over perceived failures. Note that if public hospitals were any better, the private ones would inevitably fold and then we really would have a problem. Fortunately, I’m sure the feds are well aware that if they take over the hospitals, the whining won’t stop; only the target of it.
Either piss or get off the pot. The Feds should either take over hospitals, and health care more broadly, or opt out completely and hand over GPs/Medicare funding/aged care etc to the various states. We’re in this silly, half-pregnant (if you’ll excuse the metaphor) situation here, and no-one really knows who’s at fault. One level of government or other has to unambiguously own health care responsibilities. I don’t particularly care which one.
Jenny, I agree that the Mersey stunt was potentially disastrous, but this is a mile away from that appalling example of pork-barreling.
As noted, the question here isn’t really one of administrative efficiency, more whether the mix of funding across three tiers of government results in the wrong treatments getting the wrong amount of funding.
Whether the feds can administer a hospital system is, as you point out, an open question.
how to the people in Mildura cope with decisions from Melbourne?
Not necessarily well! But I don’t see Brumby arguing to devolve hospital administration to local councils because someone in a safe seat in Melbourne is making the decisions.
cough cough – low blow
No one in Canberra or the states believes for a minute that the Feds will take over the “running” of acute hospitals (or ambulances for that matter). What will happen is that the Feds will attempt to have more say, through tied funding, KPIs, outcomes, national priorities etc in what happens a ta astate level. All the public statements are designed for the great unwashed and the odd passing economist.
What these statements are about is jostling to see just how the Feds might exert influence and not get conned. Lets not forget that Canberra knows 2/5ths of sfa about how acute hospitals are run and are smart enough at officer level to understand they would never “take over”.
The big action in the next 6 to 12 months will be in primary care with the Feds using their $ to boost and tweak existing systems of GPs through Divisions of GPs and to add to chronic care programs.
What’s with the multiple ambulance system operating in Victoria lately. There is
1.Ambulance Victoria
2.Hatzolah
3.Patient Transport Services
4.Specialised Ambulance Services or some such name spotted on a vehicle travelling northbound on the Hume Freeway – presumably the patient had been airlifted to Melbourne and was on the slow trip to Benalla, Wangaratta or Albury to convalesce or die closer to home
Hatzolah is mainly targetted at elderly survivors who might have esl and were reluctant to call for help soon enough for a myriad of (understandable) reasons. It really only operates around St Kilda Caulfield. They are well trained for what they do, which isn’t multi truck pile ups on the Hume Highway.
Patient Transport services or Specialised or whatever name, transport patients! Many people need supported transport betetr thana taxi or relative, but not high level care or speed. The private services free up ambos for emergencies.
The funding versus responsibility is the major problem.
The Federal Government funds GP’s, specialist patholgy, imaging etc through Medicare.
The State Governemnts partially fund hospitals and are totally repsonsible for running them. State Governments want to shift costs to medicare (Gp’s) but can’t influence that except through rationing at Emergency Departments.
The state Governments run the training hospitals but the Federal Governemnt runs the universities providing the places for Doctors. Both the State and Federal Governemnts have to bang heads with the Doctors’ Union and Specialist Colleges to try and lift numbers of Doctors and Specialists.
Federal, State and Local Governemnts fund Aged and Diability Care but the State Governemnt is responsible for runnning and partially funding Hospitals which end up with high care/respite situations – many of which should be in dedicated C-Class (is that terminology still used) hospitals rather than in our acute care teaching and emergency hospitals.
And that is a simple overview – no wonder there are poor outcomes.
That said, Australia is fortunate enough to have one of the best health care systems in the world and if you are critically sick you will generally get world class service.
As for the argument against Federalisation – many many services are delivered by the Federal Government across Autralia.
My question to those against federalisation of health care and funding is – Why should any Australian get a different level of health care from another Australian just because they have different State Governments?
And a generous portion of them are a shambles. At least with decentralisation there’s a chance to isolate profound fuckups in a single state.
And take it from Bligh and Lucas? That wouldn’t be easy.
As an aside for anyone who wants to listen to our Premier and a developer getting into bed…it was vomit inducing live radio.
http://blogs.abc.net.au/queensland/2009/07/talkback-with-premier-anna-bligh.html
Two Major reasons for a federal takeover, to my eye.
Firstly, as Razor has done his best to summarise, the split between inpatient state services and federal outpatient services introduces a bizarre form of cost shifting and bureaucratic dodging to health spending. The current Medicare system is actually a public underwrite of private medicine without basic oversight, even of simply ascertained fraud. Although this does not bode well for the Feds, a large part of the problem is that the system needs to be meaningfully integrated and, dare I say it, centrally planned.
Secondly, it provides an impetus for a wholesale re-evaluation of inpatient service delivery. The Victorian state government, for instance, has never actually admitted running the hospitals. It funds a series of regional boards who then run the hospitals. They even had the gall to claim not to be the employers of hospital employees during the recent allied health pay negotiations.
This is a layer of ablative protection. When any particularly nasty scandal hits (e.g. the TAC debacle) the minister can leave one of the heads of these autonomous organisations to take the heat in clean-handed denial. The down-side is that these then become competing entities. In essence, Hospitals and groups of Hospitals run themselves in their own, institutionally perceived best interest.
Certainly within the metropolitan hospitals, there are almost no regional or service provision obligations. Beyond the smattering of state services (Royal Children’s and the Trauma Centers at the Alfred and the Melbourne) any given hospital provides a service to whoever it can or wishes to. There is no regional responsibility (all stroke patients from here go there) and hence no ability to properly measure and provide for demand. It also means that suburban and regional Emergency Physicians spend half their time on the phone selling patients to tertiary centers. It also means Melbourne has three hyper-specialised epilepsy surgery units while Queensland has none. It means that basic, standard-of-care services are unavailable outside inner metropolitan areas, even though in that area one may have a choice of providers.
Rather than take direct responsibility and the political risk it entails, the Victorian government has introduced a reporting system of KPIs that, as these things usually do, has simply distorted the priorities of the Hospitals (out of ED, I don’t care if this is essentially an ICU and you too sick for the ward, 12 hours is UP!); when they are not systematically defrauding them.
Is the federal government essentially preferable? No, although they can plan care for states which cannot support their own sub-specialty services, particularly Tasmania. Is it likely to reduce overall cost? Marginally, at best. Is it an opportunity to provide the basics to those in the outer suburbs currently completely failed by the state government and remove the preposterous split of inpatient and outpatient services?
I hope so.
Sorry, must go see patients, will re-engage this eve.
“The last thing you would want is a faceless bureaucracy in Canberra running the health system here in Victoria”
Message for John Brumby – I’m worried about the faceless bureacrats in the Melbourne CBD!!
Would improved “allocative efficiency” have helped my 87 year old mother who spent 2 days on trolleys at the Frankston Hospital waiting for a hip replacement after a fall? And then 9 months latter waiting for 3 days on trolleys and various beds at the same hospital to have a simple wrist fracture set?
“The Victorian state government, for instance, has never actually admitted running the hospitals. It funds a series of regional boards who then run the hospitals.”
Dr S makes some good points. Coincidentally, the Victorian system of regional hospital boards came about after an inquiry in the mid 1990s by Ian Harper, of FPC fame.
This coming together of the plots is Seinfeld-esque.
Habby: quite possibly.
For instance, if an increase in aged care funding made more room in hospitals for patients needing acute care, maybe your mother wouldn’t have had to spend two days on trolleys.
So, for the same total health outlay, we get better outcomes for everyone.
Steve @ (16): Government by talkback, it’s obviously the way to get things done in Qld these days: just get on the blower to Anna while she’s on air, and she’ll get Madonna to take your details and someone to sort it out.
Well, maybe you’ll have to get onto her twice, as the traveston dam land reclamation guy shows. But she remembered that he’d called before, and she had got onto it previously, and I wouldn’t like to be whichever bureaucrat it was that neglected to follow it up last time.
Dr S said “This is a layer of ablative protection.”
With all due respect that is what we have now in QLD (most other states if you don;t mind) and we don’t have localised hospital boards. It is the name of the game for health bureaucracy across the board. What does that mean in a commonwealth takeover context Dr S? Amplify that ablative protection by the necessary layers of centralisation to get your answer.
Danny at around 4.30pm – yes I am on the blower to Aunty now. She’ll be right…