Is this real health reform or more of the same?
Kevin Rudd’s claim that the re-vamped COAG hospitals agreement constitutes ‘major national health reform’ is dubious at best.
In fact, the ‘in principle’ COAG agreement abandons most of the central reform features of the Rudd blueprint.
A crucial plank of the Rudd reforms was to give the Commonwealth a controlling share in hospital funding and thus majority funding responsibility for the entire health sector.
This was aimed at removing current incentives for buck-passing and cost-shifting between health care sectors. Without a single point of funding and accountability for health care, there will always be the potential for governments to shift costs and responsibility.
As we have seen countless times on our evening news, the health policy debate then turns into a ‘blame game’ where governments focus more on shifting responsibility for services elsewhere than on addressing the problems.
Consumers are left frustrated and confused and the issues that they care about – access, quality, out-of-pocket costs - remain unresolved.
At the COAG negotiating table, the emphasis is on maximising the funds stowed away in their coffers rather than delivering better health care for consumers.
Listening to the rhetoric of the State and Territory Premiers, we could be forgiven for thinking that the dollars used by the states to fund health care are somehow intrinsically different from those used by the Commonwealth.
In reality of course, all health funding ultimately comes from the community. It makes no difference to a consumer accessing a service whether or not it has been funded via the states/territories or by the Commonwealth.
It’s about as important as worrying about whether to pay your credit card bill from your savings or cheque account.
What is important is that – regardless of the source of the dollars – that the funding mechanism is efficient and supports the delivery of high quality and accessible care.
This has not been achieved by the new COAG agreement under which the Commonwealth will remain a minority funder of hospital services, although sharing equally with the states and territories the cost of any growth.
The proposed ‘national funding pool’ of hospital funding may improve transparency of funding arrangements, if nationally agreed criteria for allocating funding can be developed.
However, it still leaves the door wide open for disputes around the margins over how much each state and territory should be contributing to the joint pool. Then there’s the tussle over the definitions of growth funding versus recurrent funding.
It also does nothing to address issues important to consumers, such as the out-of-pocket expenses many face when accessing health care.
Kevin Rudd’s plan for health reform would have delivered some substantial and long-term changes to our health system. The current COAG agreement simply offers consumers more of the same.
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