If every system is perfectly designed to produce the outcomes it gets, then it’s clear that our “health system” (of course there’s no such thing) does an excellent job at producing a perpetual blame game.
National health reform has failed to stop the unending fights between federal and state/territory governments – and patients are paying the price, according to many submissions to the Senate committee inquiry into implementation of national health reform.
At least two submissions (from the Australian Health Care Reform Alliance and Catholic Health Australia) suggest that the time may be right to revisit having a single funder for health.
“The continual abrogation of responsibility for hospital services by both the Federal and State governments does not serve the interests of consumers or help build a sustainable health system over the long term. AHCRA believes that the most appropriate funding system is one where there is a single point of accountability to maximise transparency and efficiency.
“This would reduce the potential for disputes over funding levels and responsibilities to occur and give the Australian public some certainty about the future of their hospital system. Given the difficulties the States and the Commonwealth are having in agreeing on funding formulas and processes for revising funding levels within the current system, AHCRA suggests that it may be timely to re-visit the debate over a single funder for all health services.”
The submission from Health Workforce Queensland says “the blame game is negatively impacting health service delivery in remote and rural communities as the divide of services and funding responsibilities become the focus rather than improved patient care with systematic improvement and integration between the local hospital and health services and the Medicare Local organisations”.
Medicare Locals have been left in the unenviable situation, the submission says, of having to pick up the pieces of cutbacks in state government funded services, without being adequately resourced to do so.
Don’t expect the blame game to end any time soon, reports Andrew McAuliffe, Senior Director, Policy & Networks at the Australian Healthcare & Hospitals Association.
Many questions about the future for national health reform
The hearing was dominated by debate over who was to blame for service reductions following the funding reductions announced by the Treasurer in the October MYEFO.
The hearing coincided with the announcement that the Commonwealth would bail-out the Victorian health services that had been hit by the funding cuts, a move which comes after a concerted campaign in Victoria and more recently Queensland to highlight the impact on services and patients.
As has been discussed elsewhere (see this articleby Professor Stephen Duckett, as well as his submission to the inquiry and the ones from the AHHA and Professor John Deeble), the debate of the appropriateness of the cuts relates to the application of updated quality control techniques by the Australian Bureau of Statistics following the last Census which resulted in the largest ever retrospective adjustment of population figures.
As always there were winners and losers under the adjustments with Victoria, New South Wales and Queensland hardest hit.
While was no suggestion that the ABS has done anything inappropriate with its calculations, the Treasury and DoHA officials came under significant pressure from the Coalition and Greens Committee members to explain why population figures had been used in a way that appeared to ignore the ABS recommendations as to how to manage the large technical adjustment that was required.
Treasury and DoHA responded that the various legislation and agreements that cover the health funding arrangements require payments to be made in set ways at set times. This requires the use of the best estimates of population available at that time and those were the numbers that were used.
So in general terms it can be said that the letter of the Agreements has been followed, but it is clear that the Government’s now defunct commitment to a budget surplus benefited from the strict application of the terms of the NHRA. Conspiracy theorist can form a queue to the right.
It is equally clear that the confidence of States and Territories and, more importantly, that of health service providers, in the National Health Reform process has been shaken.
Among the intentions of the NHR was the aim to achieve a transparent funding system and devolve management and responsibility of health services to a more local level.
The Victorian health system has been ahead of the game in this respect to governance with its system of local health service providers and local management Boards. It was apparent at the hearings that this maturity of the reform agenda in Victoria was directly reflected in the speed and transparency with which the funding cuts were passed on to the individual health services.
It could be argued that this is a demonstration of a successful reform rather than the cynical political ploy that the Commonwealth is painting it as, although it would be naive to think that the Victorian Government didn’t welcome the subsequent outrage from service providers and communities.
The Commonwealth’s stated intent to pay its bail-out money directly to hospitals is contrary to another component of the NHR, the establishment of the National Health Funding Pool into which the Commonwealth and State’s pay their funding shares.
The DoHA and Treasury officials defended this approach, saying it was appropriate as it was a one-off payment, where as the Prime Minister stated it was because she didn’t trust the Victorian Government with the money.
So while Victoria has had a temporary reprieve, there has been no resolution as to how the funding methodology will be applied in future years, what bail-outs will be on offer to other jurisdictions or what, if any hope, there is for any resolution to the ongoing blame game.
• Andrew McAuliffe is Senior Director, Policy & Networks at the Australian Healthcare & Hospitals Association