Still looking for a more equitable deal for patients
Tuesday February 15, 2011
The proposed health reform will do little to address the most pressing needs of our most needy patients. THE federal government's recent rhetoric has been that hospital funding formulas are of little interest to patients looking for care. Yet the emphasis in the new reform plan is about hospital funding.The federal government has agreed to match new state funding 50/50, but that won't happen until 2017. Also, no extra funds will be made available until 2014, so the current 39/62 split will continue for another three years. And because the new arrangements only apply to new funding, it will be 2030 before the split is 44/56. Therefore patients must wait.Tough national standards are proposed, one of which is waiting times for surgery. But the plan ignores waiting times to actually get to see the surgeon and be put on a waiting list. One of my patients who needs spinal surgery has already waited a year just for an outpatient appointment. That time is ignored when measuring waiting times for surgery. Once seen she may only wait six months for surgery, but her real waiting time will be ignored because the Commonwealth government refuses to acknowledge the reality. Waiting times are a joke.Another proposed standard is to reduce the time patients wait to be treated by emergency departments. But for years hospitals have been cheating to meet such standards for state governments and will continue to do so when faced with unrealistic targets and inadequate resources.While the Prime Minister may believe that the biggest challenge facing our health system is that it is running out of money, the truth is that the biggest challenge is that there is no system.Patients are faced with the nightmare of negotiating the public hospital system, the publicly subsidised private hospital system, the general practitioner system, the community care system, the publicly funded private allied health system, the mental health system, the publicly subsidised private dental system, the public dental system, the aged care system, the private specialist system, the public specialist outpatient system, and a myriad of other poorly connected pieces.Structural reform to integrate these systems is required, but is not suggested in this plan. Instead, relatively powerless regional organisations called Medicare Locals will be charged with co-ordinating this maze of primary care services. The new plan abandons proposals for the Commonwealth to take over all primary care funding so the added barrier to co-ordination will be a continuation of different sources of funding.Hospital-centric Local Hospital Networks will address just the public hospital side of hospital care. The two entities are then to be expected to work together to integrate services despite their completely different interests and funding streams.The funding silos for all those systems will remain intact and ignored by a government intent on avoiding any significant structural reform of the primary care sector (GPs, nurses, allied health, dental), the dental sector, or the private hospital sector.Ensuring equity or a fair go hardly gets a mention. Instead, the approach is to address gaps in services. Under the new plan the Medicare Locals will more quickly address the issue of after-hours access than was previously planned. They are charged with filling the gaps that a flawed system reveals.But nothing is done to address the reasons why such gaps exist. More important, little is suggested for the 32 per cent of sick Australians who, according to the Commonwealth Fund, fail to see a GP or get tests or fill out prescriptions because of costs. This is despite the fact those facing financial barriers tend also to be those with the worst health outcomes.Financial barriers to access are almost totally ignored by these proposals. Indeed, the Commonwealth government imposes such barriers for prescriptions.Despite the rhetoric, a better deal for our most needy patients does not appear to be the priority under this new plan. Financial and geographical barriers will remain, perhaps increase, and there is no vision for an integrated health system.The obsession remains efficiency, an important principle if it is about health outcomes, but one from which patients will not benefit if it is about throughput or how much is done. The most needy will continue to get the least care.