Government decision ignores changed role of hospital
GOOD politics and good policies rarely go hand-in-hand during the hothouse of a preelection period. However, the Prime Minister’s announcement, on August 1, of the Commonwealth takeover of Mersey Hospital near Devonport on the north-west coast of Tasmania has left even the most cynical political commentators aghast at its blatant disregard of all the principles of good healthcare planning and policy-making.
Almost everyone who has an understanding of health policy and the realities of providing health care for populations has opposed the plan. One of Australia’s leading health economists, professor Jeff Richardson, speaking on ABC radio, has gone so far as to predict deaths at the hospital as a result of the Prime Minister’s interference.
However, the Australian Healthcare Association (AHA) sees this event as an opportunity to generate discussion of the issues involved in an attempt to bring about a more rational approach to national healthcare planning and funding outside the electioneering hot-bed. The AHA is the national organisation repre- senting the public healthcare sector.
Australia’s dual health funding system has always been a major barrier to an efficient health system. Instead of a system capable of delivering high-quality, cost-effective care, what we get is duplication of bureaucracy and services, reduced quality because patients are not necessarily treated in the setting most appropriate to their needs, and compromised continuity between services (such as hospitals and community or aged care).
Regrettably, the Commonwealth Government’s intervention to maintain the Mersey Hospital as an autonomous institution run by a community-led group operating outside the state system will display all these flaws.
So what is wrong with the Commonwealth Government throwing dollars at an ‘‘ ailing’’ regional hospital?
Well, the fact is that the problem was not only about money. The reason the Tasmanian Government downscaled the hospital was much more about safety of health services than it was about dollars. The state Government has a responsibility to its citizens to ensure high quality clinical services, delivered by an appropriately skilled workforce.
After extensive research backed by health experts and broad community consultation, it became clear that the local community was simply not large enough to provide the patient throughput required to sustain a full-scale hospital. Doctors and other healthcare workers keeping their skills current enough to provide an intensive care service require a population of something like 150,000 to 200,000. Devonport has just 26,000.
The changed role of Devonport hospital was outlined as part of an extensive health plan for Tasmania, which has received bi-partisan support in the state. The plan advocates access to high-technological and complex hospital services for all Tasmanians, in settings where they can be safely provided. Importantly, it focuses on increasing co-ordination between the community and hospital sector. It also supports increased spending in other areas that will help keep people out of hospital, such as primary/general practice care and prevention.
In fact, these important principles of modern healthcare planning are supported across the board — by experts as well as consumer and provider health groups from both the community care and hospital sectors. They all agree that additional funding into the health system should target integration and coordination of health services, rather than funding separate entities, thereby entrenching its current fragmentation.
Often the best strategy for supporting public hospitals and improving co-ordination for people is to also fund community-based services, such as general practice, dental services and aged care.
Putting money into one hospital or health service in isolation will make no difference to overall health system performance and will not achieve the best outcomes for the community. On the north-west coast of Tasmania, this adhoc intervention is more likely to create a situation where nearby hospitals in Burnie and Launceston have to compete for doctors, nurses and other resources, thereby jeopardising the sustainability of clinical services in the entire region.
As the Commonwealth Government already has responsibility for a high level of health services through its aged care and Medicare programs, the AHA suggests that it would make much more sense for both levels of government, federal and state, to agree to pool their health funds through a single authority in order to pay for all health services. Such a mechanism could be piloted in regional areas. In a small state like Tasmania, the authority could well be the state Government.
Benefits in having a single funding body accountable for health outcomes include the alleviation of cost and blame-shifting between governments, plus much better co-ordination between various health programs.
Properly co-ordinated, additional Common- wealth spending could result in integrated services where they are most needed, while taking pressure off public hospitals. This need not be the subject of ‘‘ cloak and dagger’ ’ decision-making and pre-dawn announcements, without consulting either the hospital involved or the state Government. Most health stakeholder groups would support working with the Commonwealth and state Governments on such an approach.
It will be a tragedy for the future of the health system, and will not give the people of the north-west coast of Tasmania the highquality health services they deserve, if the Prime Minister ignores the united voices of the health sector and misses an opportunity to deliver real and lasting benefits through his planned takeover of the Mersey.
Let our leaders take this opportunity to have a serious debate and commit to a plan for change to give Australia a health system which is even better than it currently has. Let’s work towards a health system which has one point of accountability for all Australians. Prue Power is executive director of the Australian Healthcare Association