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CoAG agreement must deliver better deal for Victorian patients (op ed)
20 April 2010.
The Premiers are back for another day of negotiations to try to come to an agreement with the Prime Minister on the funding structure of the biggest health reform process of the past two decades.
With the showdown between Premier Brumby and the Prime Minister leading health coverage over the past six weeks it’s not difficult to see why discussions have been sidetracked and patient care has come out second-best. It’s now not time to move beyond politics and spin and focus on the real objective of health reform – better access to quality health care for Australians now and in the future.
The GST arguments may be confusing but one thing remains clear – the Commonwealth’s contribution to public hospital funding must increase in the short term if we are to deliver real health reform to Victorian patients. Our hospitals are struggling to cope with the increased demand for hospital services and patients are left with long waits and increased risk of complications.
Despite substantial injections of funds in recent years by the Bracks and Brumby governments, last financial year 107,000 Victorians waited longer than clinically recommended for emergency care. We failed to provide elective surgery on time to 22,800 patients. And more than a quarter million patients who presented to emergency departments did not get a hospital beds within eight hours, or were not discharged within the recommended four hours.
We have significant capacity problems in Victorian public hospitals. We are short on qualified staff, and morale is low in many areas. In a nutshell: our public hospital system is strained and in desperate need of additional serviced beds.
However, it’s clear that improving health outcomes requires much more than hospital reform. We have a long way to go in primary and community care discussions, with neither the Rudd Plan or the Brumby Plan addressing the complex interaction between the primary care and hospital sectors, but agreement on a solid base for future health funding is a sensible starting point.
We need a funding structure which increases transparency, reduces blame-gaming and does not add extra bureaucracy. A hospital funding pool meets these criteria and should be considered by the Premiers and Prime Minister as a workable alternative to the Commonwealth funding the Local Hospital Networks direct.
A hospital funding pool would achieve more accountability because funding contributions and costs would be transparent, while funding going direct from one or both sources, whether to State Treasury to Local Hospital Networks, allows for gaming.
The other fundamentals of the commonwealth’s health reform proposal - Casemix funding and local hospital boards of governance – could improve efficiencies in other states but have been operating successfully in Victoria for a number of years. Casemix funding has driven efficiencies in our public hospitals but now the system needs more.
I hope an agreement will be reached but taking time to get the right agreement will be worth it. We need to get health reform right. There is no point signing Victoria up to an agreement that won’t provide real reforms in this state.
While we welcome the Prime Minister’s commitment to reform and improve health care across Australia, the offer on the table will not meet the objectives of improving health care in Victoria. The final health reform agreement must deliver extra funds to ease the pressure on our hospitals and improve healthcare access for sick and injured Victorians.
Dr Harry Hemley is president of the Australian Medical Association Victoria
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