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…

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.

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.

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?

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.

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

As for the argument against Federalisation – many many services are delivered by the Federal Government across Autralia.

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.

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?

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.