Tuesday, November 27, 2007

Fixing Public Hospitals

One of Kevin Rudd’s election platforms was to negotiate better funding for public health with the states. The requirement is better health administration. His Kevin07 wesite says:

“Under Labor's Plan, in order to access funds, the States will be required to sign up to achieving specified health outcomes, such as:· Reducing avoidable hospitalisations and readmissions to hospital;· Reducing non-urgent accident and emergency presentations;· Reducing waiting times for those people who require essential hospital services such as elective surgery; and· Providing more appropriate non-acute care for older Australians.”

There are some specific problems that we, individually, collectively and politically must face. There has developed over some years a culture of division between the states and commonwealth, based largely on political differences and prejudices. This has lead to:

  1. cost-and-blame-shifting, as each tries to limit the $ exposure for “its” responsibilities.
    A reduction in the proportion of GDP provided by the commonwealth for public health care provided by the states. At the same time, the Commonwealth was happy to provide funds to support private health insurance (companies)and private hospitals.
  2. The costs of providing health care have been increasing at a rate faster than inflation and economic growth, and the states have borne the brunt of extra funding required for public hospitals
  3. Increasing “gaps” in health care, resulting from the previous two conditions.

Recent events in NSW at RNS emergency dept and RPA maternity are examples of how health care and its administration has been driven by budget constraints and not health planning and funding.

Kevin Rudd is offering an extra $2 billion over 4 years. Economically he can’t just pump money into the economy – he will need to restrain spending or eliminate unnecessary government spending to maintain an economically neutral position. The Commonwealth and States, and NSW in particular, will need to develop significant restructure plans for health administration, to be implemented over 5 years. Its likely effects will include significant changes in personnel, business process reengineering to change the way and culture of doing things, and higher levels of political accountability and responsibility.

The effects of such changes will take at least ten years to be fully felt. This requires planning well beyond the 4-years of budget forward estimates, but it must be done.