Wednesday, March 03, 2010


Federal takeover of health. Mr Rudd makes a bold announcement - which raises more questions than it answers. The only certainty is continuing federal under funding of hospitals for the next 4 years - or much, much longer if the states do not accept.

By Con Costa, as updated after Mr Rudd's Announcement of the Federal funding of hospitals.

On a weekend when 3 major Sydney hospitals announced downgrading of their ED services and ambulances to divert to other already overcrowded centre, Medibank Private announced its latest gimmick to attract membership – private ED service where for $195 patients could “jump the ED queue”. This comes at a time when federal share of hospital funding now down from the traditional 50/50 split with the states to an official 35%!

The public system is under increasing strain because it is becoming the default of an increasingly dysfunctional health system (including being the default for the private system). There is chronic under funding of hospitals at the federal level and the impact of federal privatisation policies on the community, health and aged care services.

Example 1. They rang me from the nursing home because the elderly woman had returned from the hospital with the intra venous line still in her arm. They had rung me several days earlier because her blood pressure was a bit high and she was complaining of headache, but despite my careful instructions over the phone they could not wait for me to arrive. The staff member on the other end of the phone had no nursing experience, and no other nursing staff available on the shift. So it was much easier to call the ambulance and send the elderly woman to hospital. Clearly both ends of the service equation were not working – and at great cost to the system.

Example 2. Across Australia millions of Australians are too often “treated” by their GP with simply a prescription, blood test or radiological investigation – again at very high cost to the system and sometimes questionable benefit to the patient. Seems its much quicker to order a simple blood test than to spend time with the patient taking a full history, perform an examination and then sit down and talk to the patient.

Thousands of men are now having a simple blood test as the sole means of assessing their prostate – called Prostatic Specific Antigen (PSA). The test is not reliable. Public authorities advise GPs against relying on this blood test as a screening test and that “its more trouble than its worth”. Nevertheless, it is now almost exclusively used by time poor Australian GPs for diagnosing prostate disease.

Patients who end up with a blood test, or some other investigation - in place of quality time spent with their GP, usually leave the doctor unhappy or are put at risk of further and more invasive investigations and treatments including referral to specialist - or they simply take themselves off to the Emergency Room at their local hospital because their problem has not been not properly dealt with or because they just get sicker.

Privatisation and economic rationales policies have strongly impacted on people’s health - to the point where GP consultations are well up. Privatisation of aged care facilities means trained nursing staff are often passed over for cheaper untrained staff. Economic rationalist policies has led to the biggest doctor shortage in Australia’s history - dating since the Productivity Commission advised the incoming Howard government in the early 1990’s along the lines that “if you cannot stop bulk billing, then less GPs would save costs through less bulk billing”.

The acute doctor shortage means that family GPs have an abundance of patients and never have to leave their medical clinic. Many sick or dying people in the community have learned to simply call an ambulance as the best way to receive care. Having a doctor visit at home, or dying peacefully at home is now rarely an option. Perfunctory medical care in the nursing homes means most end up in the hospital ED even for minor complaints. Thus the inevitable call from aged care facilities for the ambulance….

Following PM Rudds recent major statement on health it has been widely admitted that the federal share of hospital funding is now down to 35%. (Traditionally funding of our public hospitals a 50/ 50 split between the federal gvt and the states.) Mal administration of hospitals at the state level is a factor (area health boards in NSW could be somewhat reduced in size and hospital medical staff should have a greater role in regards to the planning and organization of the work they perform) - but even the best administered health board is doomed to fail while federal under funding of hospitals continues at this level – and despite Mr Rudds bold new plan, hospital federal share of hospital funding not set to increase for 3 or 4 years, and only if the states accept his new deal.

The federal government’s shirking of their fair share of public hospital funding is even more puzzling given the massive amounts of taxpayer money that the Rudd gvt has flushed through the system as a response to the GFC – including the notorious insulation program whose failure the PM partly excused based on the urgent need for the government to spend money at the time.

The Rudd government has shown little inclination to redress the real funding problems which beset the public hospital system, and this raises the worry that he is looking to more privatisation, more economc rationalist solutions for our ailing health system. Why else Christine Bennett from the private health insurance sector to lead the NHHRC? Why his quarantining of the failed 30% PHI rebate and the private walk in walk out system under which we pay our private doctors?

Yes, the recent major announcements by the PM on health financing sound bold and statesman- like. But where is the rest of the policy. You get the feeling they may be making up as they go. Or worse still that they may be holding something back which may prove the end game for the public system and introduction of a US style managed care.

The real worry may be that, under Rudd’s new new presidential style power within the Labor Party – the leader now able to hand pick his own cabinet and where Cabinet Ministers watch their own portfolios and are careful “not to tread on someone else’s turf”, there has been a tightening of the PM’s control over policy within his own Party - including greater power to his advisers and the treasury mandarins, together with his Health Minister, and the rest of the parliamentary wing no longer on watch.

The PM could do a lot worse than to immediately restore the 50/50 funding of hospitals with the states. He could set guidelines for privatised Aged Care that make it obligatory to have at least one trained nursing staff on each shift. And as an initial move away from rapid turnstile medicine in primary care, he could put all GP trainees on salaried payments – to encourage them to spend time with their patients and to provide some desperately needed house calls and nursing home care in the community. This would certainly build support for his “health reforms” with the community and the States.

Otherwise, next time you need to wait many hours to see a doctor in the public ED or you have to be transferred through busy city traffic while having your heart attack because your hospital ED has been downgraded, or your GP offers you a simple blood test instead of a quality time, or your elderly relative is yet again admitted to hospital from the nursing home for the third time in as many weeks - remember that you are not alone and it is mainly the federal under funding and economic rationalist policies which are to blame. And without something being done about that, Mr Rudd’s plans to “take over the hospital system” may be doomed from the start.