PROFESSOR IAN WEBSTER is the director of the Drug and Alcohol Unit at Liverpool Hospital in the heart of Sydney's west, and president of the Drug and Alcohol Council of Australia. He told Green Left Weekly's JENNIFER THOMPSON that budget cuts targeting unemployed and Aboriginal people would increase their health problems, adding to the effects of cuts to the public health system.
High unemployment was already a cause of continuing health problems, said Webster. The government's policies, including harassment of those on unemployment benefits, the imposition of severe job-search activity tests, longer delays for receiving benefits and exclusion of some people from eligibility for benefits, were an attack on the poor and would take a toll on their health.
Aboriginal people had been attacked in the budget also, said Webster, and while the Aboriginal health budget allocation had been preserved, the negative effects on Aboriginal dignity, power and autonomy would affect the already dismal health situation.
The government also intended to cut hospital funding grants to the states by $75 million in the current year, and by $314 million by the end of the following three years, said Webster, supposedly because of "cost shifting" in what was already a "pathetic area of health financing". In Victoria, there was perhaps some systematic cost shifting occurring, but it was "the same health dollars in the end" regardless of their immediate source.
It was completely inappropriate for health financing problems to be blamed on the nurses and doctors in the front line of hospital admittances, who referred people back to general practitioners. They were motivated to give the best service rather than consciously shifting costs. The problem would be compounded by budget cuts to hospital funding, he said.
Although the Commonwealth blames states for cost shifting, the reality was often the other way around, said Webster. Night-time and other after-hours medical services were predominantly supplied by public hospitals, he said, referring to emergency cases, traffic accidents and other times when people who would normally visit doctors came to hospital accident and emergency departments. In his area of drug and alcohol-related health services, "patients come from private practitioners who can't cope with them", including those needing methadone programs.
Increasing the levy for higher income people without private health insurance and promoting private health insurance wouldn't make much difference to the public system, Webster said. Already, the estimated 2% contribution by private patients to the public health system had been undermined by the higher premiums introduced by private health funds. In western Sydney, the average rate of private health insurance was 13% — well below the 33% national average — a reflection of the level of poverty in the area.
Dr Wooldridge wants to be a good health minister, commented Webster, noting the $19 million allocation to preventing youth suicide, an important public health issue. But, he said, continued high unemployment, especially in rural areas, was one of the main factors related to youth suicide.
On the transfer of responsibility for preventive health programs to the states, Professor Webster said he was concerned that the politicians recommit the government to a national drug and alcohol program. While the funding for current programs had been maintained, "the Commonwealth does have an important role in setting the agenda", he said, citing the valuable leadership provided at the outset of the HIV/AIDS epidemic. n