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WHILE participating in the recent launch of the 2015 AMA Public Hospital Report Card, the information in the report made me feel fearful for the future of our hospitals and health system.
Let’s be blunt — the public hospital system is under threat to an extent I have never before witnessed.
I have been a part of the public hospital system since 1989. I count myself fortunate to have trained in it, progressing from medical student to consultant emergency physician. I know that we provide first-class care.
I have seen a multitude of changes in our hospitals over the years. Most changes are for the better with many patients treated faster than ever before, whether for elective surgery or emergency treatment.
Many clinical outcomes are also better, and treatments for some conditions can now be managed from home instead of an inpatient bed.
In my own area of emergency medicine, the changes have been profound. Multidisciplinary team-based care, fast-track clinics, early streaming based on triage findings, the “4-hour rule”, short-stay units, improved computer systems, and new “in-reach” services to aged care facilities are just a few of the measures adopted to improve efficiency and effectiveness, as well as to reduce demand when possible.
But with a growing and ageing population, the demands increase. Every year. Without fail.
While medical care has undergone radical change, changes to the funding systems for hospitals have been even more profound. The move from “block” funding to activity-based funding started in Victoria in the early 1990s.
Shared responsibility between the federal and state governments has been an endless source of angst, as Canberra seeks to reduce its commitments, and the states face an ever-growing proportion of their entire budget going to hospitals.
We have seen the games played with cost-shifting (in so-called “privatised” outpatient clinics and procedures) for too many years.
Hospitals have been asked to do more with less for a long time. Indeed, there were times in the past when it did drive some efficiencies. However, that is no longer the case.
Now, many “reforms” run the risk of compromising care, with attempts to downgrade or close services such as emergency departments or refuse to fund adequate staffing levels in order to reduce expenditure.
Emergency departments hate going on bypass, because it means our resources have been overwhelmed, forcing ambulances to go to other hospitals. This is usually related to capacity constraints, and it puts patients at risk because their treatment is delayed.
The federal government talks about health funding being out of control. But when federal hospital funding has risen by less than 2% per year in recent years, and health spending as a share of gross domestic product has gone from 8.5% to 9.5% in a decade, those claims ring hollow.
The real crisis is flowing from the cuts to health expenditure in the 2014 federal Budget. Tens of billions of dollars will not be forthcoming, while demand continues to rise.
Something has got to give.
The medical profession does not mind a challenge, and we will always look to do things more efficiently and effectively. But we hate injustice, and there can be no doubt that standards will fall if there is no change to the federal government’s intended cuts in the years ahead.
If I cannot justify these cuts to the next patient I care for in my emergency department, then I will actively oppose them when I speak on behalf of the AMA. To do otherwise would be utterly hypocritical.
Dr Stephen Parnis is vice-president of the federal AMA.
1. Here is a revealing graphic that leaves no question about the price the U.S. pays for poor quality care in it’s healthcare ‘marketplace’. http://content.healthaffairs.org/content/early/2010/10/07/hlthaff.2010.0…. It shows a comparison of per capita health spending and 15 yr survival for 45 yr olds in 12 OECD countries from 1975 and 2005. Autralia ranked third lowest for spending (undercut by the public UK system and Japan) and ranks third highest for survival, beaten by Sweden’s public system and Japan. No need to describe the U.S. position, except to emphasize it is over 100% higher than ours. Some individual systems in the US such as Mayo may have great outcomes, but you would be wrong to suggest they are cost effective. There is no doubt that primarily private health systems are more expensive and inefficient.
2. patients are not clients or consumers and it is simply unethical to treat people as such when they are in a vulnerable state.
3. Healthcare costs money; Australians are getting older, but we are one of the richest people on earth. I for one am happy to see more spent on health in accordance with our affluence. But do we want to spend it via a regulated more equitable process of taxation or through a ‘self-regulated’ profit-making marketplace?
I agree with Physician’s comments. Private health is more efficient and cost-effective; otherwise why would Qld Health have outsourced public elective surgery patients to private hospitals via the SurgeryConnect scheme over a period of some years? The Mayo Clinic in the USA showcases the high quality care available in the private sector. In Qld there is Greenslopes Private Hospital, which has over 600 beds and is fully accredited for undergraduate and postgraduate training. The only impediments to private health care are bureaucratic and financial ones imposed by our political masters, usually on idealogical grounds.
Anyone who feels that a greater role for the private sector should be a solution to financing health care in Australia should acquaint themselves with America’s Bitter Pill: Money, Politics, Backroom deals and the fight to fix our broken healthcare system. by Steven Brill (Random House) reviewed in the 23.4.15 issue of The New York Review of Books by Marcia Angell.
I worry about shifting care to private health. The private health care system runs on a profit making business model. Working across both sectors I do cringe at the practices of many in the private sector. On many occasions it seems based more on good business rather than good medicine.
It is right in saying many countries have shifted more focus onto the private sector and, apart from politicians and those managing the finance of private hospitals, the majority wish they had never have taken that step. Once you do it is very difficult to reverse the damage.
Let us concentrate on maintaining a good public system. We have done it before, there is no reason why we cannot maintain it.
Indeed cost shifting is a major issue but the entire health financing system needs review. This should include a greater role for the private sector, financed by private health insurance. This is the approach now being taken by many other countries, and is the only way to increase overall health funding. Simply calling for more government funding from higher taxes is not a viable long term strategy.