As a doctor working in the front line of the public hospital system for a decade, I have been watching the debate around health reform with great interest.
The phrase “controlled locally, funded federally” has been repeated ad nauseam by Prime Minister Kevin Rudd. Imagine if we could hear him saying “free universal health care for all ... no more handouts to the private sector ... break the feudal strangle hold of the colleges on the number of specialists being trained ... will include dentistry ... a healthy society ... a shorter working week so we have time to exercise...”.
The need for changes such as an increase in the number of beds seemed to finally be filtering through: even the Liberal opposition health minister in New South Wales, Jillian Skinner, called for a reduction in the bed occupancy rate to 85%, as called for by the Australian Medical Association in the lead-up to the April 19 Council of Australian Governments (COAG) meeting.
The Liberal Party pretending to care about hospitals, given its atrocious record of cuts while in government, defies belief.
The deal worked out at COAG has to be an improvement, doesn't it? At least on the surface there appears to be more doctors, more funding for mental health, aged care, emergency departments, elective surgery, primary health care, beds, and so on.
We need a huge increase in all these areas immediately after decades of deadly under-funding. We used to say the “devil is in the detail”, but so far the detail has been so lacking it’s hard to spot.
Included in the $5.4 billion deal are additional elective surgery places, more GPs, packages for sub-acute care, including mental health and geriatric services, as well as additional funding for emergency department services to implement a new four-hour National Access Target to ensure patients are admitted, referred or discharged within four hours of presentation to an emergency department.
In Western Australia, the “four-hour rule” was introduced a year ago. According to the plan, 85% of emergency department patients would be treated within four hours. Having worked as an emergency department registrar, I was extremely about dubious the plan succeeding without a huge concurrent increase in bed and staff numbers.
On April 17, ABC Online said Perth's Princess Margaret Hospital for Children had reached the target 28 times in the past month. Royal Perth Hospital met the target on two days and Fremantle Hospital reached it on three days.
So, in Western Australia, the four-hour rule has been tried and shown to be a dismal failure, at least for general hospital emergency departments.
Using state GST revenue to fund health care legitimises an unfair tax that ought never to have been introduced and should have been repealed immediately by a Labor government.
The April 24 Sydney Morning Herald said, only Mexico, Poland and South Korea spend less than Australia on health, as a percentage of their total economic output. Professor Jeff Richardson from the Centre for Health Economics at Monash University said: “Australia is the fourth-meanest country in the world in the amount its governments spend on health" among 26 rich countries surveyed by the Organisation for Economic Co-operation and Development.
“Including all levels of government, federal and state, Australian governments spend a total of 6.5 per cent of gross domestic product on health — that's even less than the US with 7.5 per cent”, he said.
Funding the “efficient services provided by hospitals” instead of blanket funding could be an easy way to cut funds in the future. How this translates into paying for behind-the-scenes essential hospital services such as physio, occupational therapy, social work, pharmacy and pathology remains to be seen.
How will we ensure the “efficient price of a hospital service” does not include paying nurses and cleaners say, $4 an hour, and massive under-staffing?
In WA, the public hospital system has been hit with almost 10% cuts, defended with the phrase that they “will not affect front-line services”. Our emergency departments could end up facades, with no actual hospital behind them.
Should West Australians be reassured by the fact that the only premier holding out on the COAG deal, WA Liberal Premier Colin Barnett, is the same person responsible for these most recent cuts?
Federal control and funding of health care makes sense. We should be aiming for a properly resourced version of the British National Health System — similar to the Cuban model — where all aspects of health care are delivered free to all citizens and health professionals see themselves as public servants working in the interests of patients.
Such a system should provide free access to all areas of health care, including mental health, aged care, dental, optometry, and these areas need to be properly resourced.
A society should be judged by the way it treats its most vulnerable citizens. A two-tiered private and public system, where the top tier gets swindled and the bottom left behind, is simply not good enough. Universal health care, which treats patients on the basis of need, not income, is the only way forward.
Whether the COAG deal is a step in the right direction remains to be seen. In the end, Rudd — and opposition leader Tony Abbott — is focused on winning the next election. The health of the people he claims to represent is but one weapon he has selected for his campaign arsenal.