Punch Q & A: What’s all this health stuff?
The Government has sealed the deal on health reforms, declaring them the biggest thing since Medicare - see the story here. But then, they would talk them up, wouldn’t they? The Punch decided to get Australian Medical Association President Dr Steve Hambleton’s verdict.
What’s your overall impression of the deal?
Hospitals definitely needed improved funding and the good signal is that the Prime Minister is actually taking notice of medical experts - so I guess (we should see) improved transparency and meaningful clinical engagement.
Is there still some skepticism?
There is some skepticism because this is billed as the biggest health reform since Medicare. It isn’t. It’s the start of health reform and it’ll only be fulfilled when there’s system redesign led by doctors.
We certainly need decentralised management; the moves to local control but increased clinical engagement is what the hospitals need to reform. Reform is not the money, it’s the rest – the transparency, clinical engagement and redesign.
Are you optimistic those will follow?
The framework is set, now it’s up to the states to deliver and allow those local hospital networks to engage with local doctors to deliver the critical reforms. There challenge is for every state to deliver.
Does it mean the end of the ‘blame game’?
The blame game is never over, it’s just changed. But at least the funding now is clear and will be transparent.
Why don’t the Feds just take over funding and running the whole lot?
The AMA did recommend a single funder, but the states will never allow that. It’s such a significant part of their budget, 25 per cent plus… it could easily be argued that if they didn’t run health then they need to be 25 per cent smaller, the number of politicians, electorates, etc. You’d challenge a core plank of state government.
What do you think about the ‘downgrade’ of standards to targets? Would you call it a downgrade?
I’d call it listening to doctors on the front line. Targets were altered because of the report from the expert panels that said 90 per cent is more clinically appropriate. I think that’s a positive not a negative.
How will the ‘patient journey’ be improved?
Through transparency. The transparency is a key element of reform because we’ll be able to see whether the funding offered is actually delivered to the bedside. In the past millions of extra dollars have gone to states without a single bed (being delivered). So transparency will mean what is promised will have to be delivered. That’s a big change.
That means we progressively move toward better patient services. If it’s not delivered we know who to blame.
What about preventive health?
When you engage clinicians on front line and redesign the system they will take in to consideration teaching, training, research and prevention. It’s the same principles; local control and clinical engagement.
Is there anything else you want to say about the reforms?
The key message is this is the start of health reform not the end. We’ve got a funding deal that stretches out into the future. If it’s business as usual we’ll get the same outcome. We’ve got to remember this is just the beginning.
The medical profession was skeptical about the four hour targets in emergency departments. Then when we got together as the AMA to look at the evidence, Western Australia said ‘we’ve trialled this and while we don’t have publishable evidence yet it’s looking good so far’. The learnings from WA were if you have a whole of hospital reform you can achieve significant change in your waiting times without a lot of extra funding. In WA they made a huge difference just by having a whole of hospital understanding and trying to fix it together.
It’s always better to aim high and miss than to aim low and hit the target.
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