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Smart hospitals need good policy more than clever politics

Smart hospitals The health debate in this year’s federal election will be conducted on two fronts. One is the precinct of the ‘policy wonks’, the other the preoccupation of aspiring parliamentarians. The former muses about structural reforms to the health system, the latter agonises over measures to reduce health costs and broaden service options. The savvy political performers will blend the two and appeal to a vision that alleviates hip-pocket pressures.

Since the last federal poll health has been very much on the back burner at the national level. It has not drawn the same degree of public debate that was the case prior to the 2004 election. Bulk billing by doctors has improved, health insurance membership has stabilised, private hospital revenues have grown and public hospital woes have almost become ‘par for the course’. Sadly, there is a mood of complacency, even resignation, that some issues are becoming too big to solve in a single hit.

Where once shocking front page newspaper stories of public hospital crises would have spun the political class into overdrive, today these same stories draw a considered, almost ‘managerial’, response from political leaders. Both John Howard and Kevin Rudd have deliberately adopted more reflective stances to the recent emergency department horrors besetting major metropolitan hospitals. This is more a product of the sensitivity of the political ownership of the problem than it is an indication of a ‘new politics’ in the health debate. Where hospital crises can be contained to administrative bungles rather than a lack of political oversight or investment, the more political leaders can adopt a statesmen-like persona and keep at bay the rising pent up public frustration.

But despite this political management, the health debate is squarely about the system’s capacity to meet demand.

The ageing of the population has exacerbated the inadequate size and range of the health workforce. There literally are not enough doctors and nurses, let alone dentists, psychologists and attendant carers. Thus the funding squeeze has only got worse. Now the orthodox health management mantra is to ‘do more with less’! As some senior policy makers claim, ‘the health system is now too complex to manage, at best it can only be steered in general directions.’

Into this environment come the major political parties seeking to lure votes without sending alarmist signals on how they will handle this complex issue.

To date the Coalition’s strong suit has been in providing safety nets for out of pocket medical costs. They have introduced subsidies for health insurance and concessions for excessive amounts of medical bills. Labor has adopted the health insurance measures and copied the Medicare safety nets.

However, Australians now pay around 20 per cent of all health funding out of their pockets. This is 4 per cent higher than is the case in the USA. The safety nets are structured so that too few families become eligible for concessions in any given year. The drain on household budgets is not alleviated by any extra public subsidy. As the increase in health costs outstrips the growth in take home wages, both parties need to introduce other measures to provide cash flow relief for average income people.

Smart Hospitals Undoubtedly both sides will consider adjusting the income thresholds at which individuals pay higher tax if they are not privately insured. Currently the levels are too low and in effect penalise people on average incomes whilst the better off receive a handsome tax saving. Labor has raised the issue but is yet to commit to a policy change. Watch this space in the Labor Tax Policy!

A constant irritant since 1996 and now a high profile problem is the availability of public dental care. Labor has made much of the issue for the last 10 years such that the Coalition has introduced new dental measures from the 2007 budget onwards. Both sides have sought to address the issue from different ends. The Coalition will fund care for those with chronic dental problems. Labor will fund general check ups and preventative dental measures across the community. As usual both approaches combined would be the best solution!

Both parties recognise the dysfunction in governance between the Commonwealth and the states. Numerous reports indicate that savings of around $2 billion can be achieved from the eradication of bureaucratic duplication. Only Labor has suggested a potential radical change to the current governance arrangements. Labor will give the Commonwealth full responsibility for public hospitals in three years if the state government performances fail to adequately improve the situation. The Coalition has embarked on a different direct management model with the Mersey hospital in Tasmania. It is billed as a test case and may be the fore runner for other Commonwealth run public hospitals.

Neither party can enter a federal election campaign without offering a way through the public hospital blockade. The usual antidote is money! Historically the Commonwealth provides bonus payments to those hospitals treating increased numbers of public patients. There have even been specific funding programs to have public patients treated in private hospitals. It will be unusual not to see similar schemes rolled out again this time.

One glaring problem for public hospitals is the preponderance of elderly patients needing aftercare. Labor has already announced that it will open 2000 aged care beds to ease the burden on public hospitals. The Coalition has yet to counter, but has the potential to expand the current aged care homes program. However, both sides will miss the point if they restrict changes to the aged care homes scheme. Elderly patients need rehabilitation, sub-acute services for a time-limited, but substantial period. They then require reliable social support and attendant care. The political party that recognises the essence of the problem and responds accordingly will need to match the rhetoric with substantial funding. This may be one area where big spending promises will gain political return.

To date, the major parties are circling each other in an attempt to capture the middle ground of the health debate. Gone are the ideological fronts where Labor championed all things public whilst the Coalition advocated for private sector choice. Gone too is the appeal to public ownership of essential health services. Now the parties have shifted to keep pace with a community sold on pragmatism and impatient with rhetoric.

This does not bode well for the less fortunate and the forgotten.

The underlying inequities in health care particularly for the mentally ill and those with chronic conditions will struggle to gain ‘oxygen’. The Realpolitik of health care will dominate. There are more well than sick voters! Both sides of the political spectrum will seek to appeal to the majority of voters who fortunately don’t struggle to get to work from ill health or face a debilitating disease that changes life’s prospects forever.

Although the pragmatic political aspirant will probably win out, it is incumbent on the rest of us to raise a voice for those who no longer can or are too tired from trying.



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