Health care reform remains a prisoner of Federalism. Guest blogger: John Dwyer

The intractable problem that sees a very wealthy country unable to provide cost effective and equitable health care is a political one. We are the only OECD country in which the provision of health care is illogically and inefficiently divided between two levels of Government. The Federal government is charged with funding, but not providing, Primary and Community care. The State governments are both funders and providers of our public hospital system and endless arguments (“the blame game”) revolve around the adequacy or otherwise of the contribution to hospital care from the Commonwealth. So 22 million people are served by nine departments of health with duplication costing us about $4 billion a year!

Our Health system is sickness and hospital centric and unlike much of the rest of the world we have not changed our Primary care system to provide Australians with a care model that focuses on prevention. Such a system provides the “Win Win” situation where Australians would be healthier and the demand for hospital services would be reduced. The Productivity Commission reports that each year 700.000 admissions to public hospitals could be avoided by an appropriate community intervention! The States cannot pull the leavers to improve Primary Care and so relieve pressures on their hospitals and the Commonwealth seemingly does not know how to do it. The Federal government has no experience in delivering health care.  At this time when health care should be patient focussed with the spectrum of care from the doctor’s office to the hospital totally integrated (seamless) how frustrating is it that COAG has actually enshrined the separation of Primary and Community care from Hospital care?

It’s an election year and we should again be pressuring our politicians to embrace the only solution to all this inefficiency and inequity. The Commonwealth should be the single funder of health, providing our health dollars to a single agency with appropriate expertise that would contract with various providers to deliver the required integrated system characterised by the features described above. John Menadue’s suggestion for a trial of a similar approach at State level where an agency with pooled Commonwealth and State money delivers integrated cost effective health care makes sense but even this, perhaps less difficult option politically, currently has no traction around the COAG table. The Australian public would have applauded Kevin Rudd proceeding along these lines. That same Australian public must keep such health reform strategies on the election year agenda.

John Dwyer

 

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