The National Health and Hospitals Reform Commission’s final report is a much needed blueprint for health reform in Australia.
But the recommendations of the report should not be confused with actual commitments and that is the real issue now: what recommendations will the Rudd Government actually commit to before the next election so as to actually have affected some change in the health system in its first term.
Before the 2007 election Rudd promised to takeover state hospitals if there was no improvement in services by state run hospitals by June 2009. This was actually crafted in terms of a “commitment by states to reform” but what people gleamed, and what Rudd was happy for them to take away from the promise, was that if there was not improvement by June this year he would hold a referendum for a full takeover.
The report has enabled the Government to dodge a bullet on the issue of a Commonwealth takeover of public hospitals.
The commission has shied away from going that far in its final report. The Government didn’t want it to and NHHRC wasn’t really going to come out and demand it do so straight away.
Today Rudd may has said he stands by the committment to takeover hospitals but the truth is all the pressure for it is now off.
Another deadline, this time a COAG meeting later in the year or next, has been created at which the Government will put its proposal to the states and if not agreed to there will be a referendum.
Still the fact that the commission did not recommend full Commonwealth control means that the Prime Minister can always point out that it’s not the preferred option of the real experts.
It’s worth remembering that whether or not a commission recommended a takeover was never part of their election commitment on the issue (it premised on whether states improved services in hospitals) but none-the-less it will now be easier than ever for the Government to argue that the takeover is unnecessary - thus getting around one of its clumsier and most disingenuous election promises.
Out of the 123 recommendations there is a lot to be excited about (though most of it already appeared in the draft report), from stand alone elective surgery hospitals, increased federal control of out-patient care to free up hospital beds and significant Medicare reform in dental care and new choices in coverage with Medicare “select”.
The changes to Medicare are estimated to increase the cost by 0.75 per cent of incomes.
The merits or otherwise of these recommendations can be debated for another 10 years but the task for the Government now is to answer the question as to what it will actually commit to.
Given that it is almost certainly not going to do anything on a hospital takeover in order to have actually achieved anything substance in its first term on health it must now decide what it actually plans to do to improve things in system that has 4500 avoidable deaths a year and wastes billions of dollars.
The commission represents an intelligent and experienced team of people from across the political minefield which is the health sector. If they can agree to a document like this then it’s fair to say it represents a pretty informed and considered consultation process.
By actually committing to recommendations in their first term the Government will engender trust and support that Rudd and Roxon are actually willing to do something in their second term.
People understand that health reform is not an overnight fix, but they get pretty sick of endless commitments to further consultation and caveat filled half-promises that begin to look like just another long waiting list.
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