Reforms must avoid familiar pitfalls
LESS than three months into its term, the Rudd Labor Government has made its mark on hospital policy in Australia. Soon after the election came the announcement of an additional $600 million to be linked to public hospitals’ performance, including reducing waiting times for treatment. Last week Health Minister Nicola Roxon met state and territory health ministers to discuss performance standards and how these could be linked to hospital funding.
The Government is also progressing its preelection policy to establish a national health and hospitals reform commission to inform and oversee policy changes across the spectrum of the health system.
The Australian Healthcare and Hospitals Association (AHHA) welcomes the additional resources for public hospitals and the Government’s focus on ending the blame game’’ between federal and state/territory governments in health care. This reflects the policy of AHHA, along with other health groups, and should help achieve a more integrated and coordinated approach to health care.
Consumers should also welcome this focused and forward-thinking policy agenda from the federal Government. If successful, it will help deliver the high quality and efficient public hospital system that Australia deserves.
However, translating policies into action will be a challenge. As governments in other countries have found when they have tried to improve hospitals’ performance in areas such as waiting times for treatment, it is easy to make mistakes. Initiatives which look good on paper can backfire when put into practice, leaving people no better off and costing the community significant amounts of money.
Avoiding these mistakes requires a sound understanding of the complexity of the hospital system. This is why it is vital that the federal Government learns from the experience of people who know how the hospital system works, and closely involves the hospital sector in developing strategies to increase community access to care.
AHHA supports increasing accountability and transparency of hospital funding, but the way in which this is achieved is crucial. Some common pitfalls to avoid involve setting crude targets for outcomes, such as waiting list reduction. This could result in gaming’’ (artificial lowering of waiting lists) through, for example, changing the way in which records are kept for people waiting for surgery. This could deliver reductions on paper, without resulting in any additional services to patients.
Reducing waiting times for treatment can also have the unintended consequence of increasing demand as people move from the private back to the public system. This will have the effect of increasing waiting times again, despite the fact that many people previously on the waiting list have received care. It may also result in a less equitable outcome for people who do not have the resources to seek care in the private system, as they may be allocated a lower place on the waiting list due to the increased demand.
Targets for reducing waiting list times also need to take into account that sometimes there are valid reasons for waiting periods. For example, someone who is obese may need to lose weight before surgery can be safely performed. If hospitals are given incentives to reduce average waiting times for treatment, it may create pressure for them to operate on people earlier than is optimum.
Any incentives provided to hospitals to improve performance need to be carefully considered to ensure they do not create a conflict between hospital and patient interests. A simplistic approach to target setting has often delivered good results in the area under scrutiny, but has had unforeseen adverse consequences for other related parts of the health system.
For example, it was reported recently that UK hospitals were responding to incentives for waiting list reduction by focusing on relatively straightforward operations, such as cataract extraction, at the expense of more complex procedures. The result has been that people with very minor cataract problems — including some whose vision reduction is so minor they can still drive — are being offered cataract extractions, while people with significant disabilities (requiring more complicated procedures) remain on the waiting lists.
Ensuring that a focus on quality and safety of patient care is at the centre of any new initiatives is the key to the successful implementation of the Government’s hospital and broader healthcare policy agenda.
Avoiding the mistakes experienced by other countries will require an unprecedented level of collaboration between federal and state/ territory governments as well as the close involvement of the public hospital sector and health professionals.
Establishing close links between the national health and hospitals reform commission and the Australian Council for Safety and Quality in Health Care will be essential, as will be ongoing input from consumers at all levels.
Given the widespread workforce shortages affecting all areas of the health system, it is also important that we do not place undue demands on existing health professionals. Hospitals can only increase their activities to the extent that they have the physical and workforce capacity to do so. Quality of care should not be compromised by placing increased stress and pressure on hospital staff to work at an unrealistic level.
AHHA is confident that if these recommendations are followed, the challenges of implementing health system reform can be met.
We welcome the progress already made by the Rudd Government in driving its health policy agenda and we look forward to working with the minister and her department, along with state and territory governments, to deliver a stronger and safer hospital and health care system for all Australians. Prue Power is executive director of the Australian Healthcare and Hospitals Association