The sick will pay heavy price for Govt cuts

Patients are likely to face blow outs in emergency care and elective surgery waiting times from next year, and may even miss out on care altogether, unless the Federal Government acts immediately to unwind massive Commonwealth public hospital spending cuts.

AMA analysis shows a huge shortfall in Federal funding for hospitals will rapidly open up from mid-2017 as a lower indexation arrangement kicks in, creating a gap in resourcing that State and Territory governments are unlikely to be able to cover.

AMA President Professor Owler said the states and territories were facing an “economic disaster” unless the Federal Government urgently restored its funding, and warned patients would be forced to wait longer for vital health care and may, in some cases, miss out altogether.

“As hospital capacity shrinks, doctors won’t be able to get their patients into hospital or keep them there to receive the critical care they require,” Professor Owler said. “Doctors will always do the best they can by their patients, but these cuts mean the system as a whole simply won’t be able to meet the demand.”

His warnings came amid mounting speculation the Commonwealth will provide emergency funds to avert a pre-election crunch in public hospital finances – though it is expected to make little dent in the long-term shortfall, which is projected to reach $57 billion by the middle of next decade.

Expectations are increasing that Prime Minister Malcolm Turnbull will use a rare joint meeting with the nation’s premiers and treasurers scheduled for 1 April to clear the decks on a range of contentious issues in the lead-up to the Federal election, not least massive cuts to Commonwealth support for public hospitals unveiled in the Government’s disastrous 2014-15 Budget.

The Prime Minister has reportedly already offered New South Wales Premier Mike Baird an emergency $7 billion cash injection to tide the State’s public hospital and education systems through till after the election, which could come as early as July or as late as November, and other premiers are now lining up to demand similar assistance.

Professor Owler said such handouts would help relieve pressure on hard-pressed public hospitals in the short-term, but if a financial crisis for the nation’s public hospitals was to be averted there needed to be an overhaul of Commonwealth-State arrangements to ensure hospitals were supported by a reliable long-term source of funding that grew in step with the increase in demand for their services.

“It is clear there is a crisis in public hospital funding and an immediate commitment is required, but a quick fix will not solve the long-term capacity problems for public hospitals or ease the economic burden on State budgets,” he said.

There is mounting evidence that the performance of hospitals is already being hurt by a squeeze on their finances, even before massive cuts detailed in the controversial 2014-15 Budget come into effect.

The human cost

The AMA’s annual Public Hospital Report Card, released earlier this year, showed that hospital performance is already beginning to suffer as the flow of Commonwealth funds slows.

In emergency departments, the proportion of urgent Category 3 patients seen within the clinically recommended 30 minutes fell back to 68 per cent in 2014-15 – a two percentage point decline from the previous year, ending four years of unbroken improvement.

Meanwhile, improvements in elective surgery waiting times have stalled – the median delay in 2014-15 was 35 days, six days longer than a decade earlier.

Professor Owler said there was a real human cost to be paid for such a deterioration in performance.

“For a patient requiring urgent attention for abdominal pain, this could mean they are seen one to two hours after they present to the ED,” he said. “Their symptoms could be consistent with indigestion, or could be a perforated bowel. The quicker a doctor can see them and make a diagnosis, then the quicker they can receive relief from their pain, and their condition can be prevented from deteriorating, potentially to a very serious situation.”

In the Budget, the Coalition announced it would renege on hospital funding guarantees to the states, saving $1.8 billion over four years, while a further $57 billion would be would be saved by 2024-25 by downgrading the indexation of Commonwealth hospital funding to inflation plus population growth.

Increasing the squeeze, the Independent Hospital Pricing Authority has set the National Efficient Price – which determines how much the Commonwealth pays for hospital services – at 1.8 per cent lower than the amount that was set last year, locking in hospital underfunding.

States under pressure

The massive Commonwealth cuts have outraged the states, which have warned of a significant reduction in hospital services unless another stream of funding is found.

The savings appeared to be part of a broader Commonwealth strategy to dump most of the funding responsibility for health services onto the states and directly on to patients, and occurred in the context of a renewed debate about taxation and the structure of the Federation.

Two premiers, Mr Baird and South Australia’s Jay Weatherill, had championed changes to the GST and income tax arrangements to give states access to a more robust stream of revenue to fund hospitals and schools, but they were undercut when Mr Turnbull dismissed any talk of changing the consumption tax.

The resistance of Canberra to calls for more funds has been stiffened by the fact that all the states are currently in surplus, while the Commonwealth expects a deficit of $37.4 billion this financial year, and no return to surplus over the next four years.

But, while Treasurer Scott Morrison has continued to talk tough, telling the states to sort out their hospital funding problems themselves, behind the scenes Mr Turnbull has reportedly been approaching some premiers to discuss a possible deal.

Professor Owler discussed the looming crisis in a meeting with Mr Weatherill earlier this month, and the SA Premier echoed his concerns.

Any short-term deal offered by Mr Turnbull would only “kick the can down the road”, he told ABC radio.

But he indicated the states were likely to accept any injection of funds offered.

“Mike Baird and I have been pushing for a much bigger solution – a 15-year solution – but we have to be realistic, we’re on the shadows of an election, and it’s an urgent problem,” Mr Weatherill said.

Adrian Rollins

[Comment] Endocrine treatment for ductal carcinoma in situ: balancing risks and benefits

Up to 20% of all newly diagnosed breast cancers are non-invasive carcinomas, known as ductal carcinoma in situ.1 Surgical excision is the mainstay of management, with the addition of breast irradiation after breast-conserving surgery shown to reduce ipsilateral breast cancer recurrence in five randomised controlled trials.1 Because molecular and epigenetic evidence suggests that ductal carcinoma in situ is a precursor for invasive breast cancer, an important question has been whether systemic adjuvant endocrine therapy can affect the natural history of ductal carcinoma in situ, especially given its role in reducing recurrence and preventing contralateral disease and improving overall survival in patients with oestrogen-receptor (ER) positive invasive breast cancer.

Your AMA Federal Council at work

What AMA Federal Councillors and other AMA members have been doing to advance your interests in the past month:

Name	Position on Council	Activity/Meeting	Date
Dr Chris Moy	AMA Federal Councillor	NeHTA (National E-Health Transition Authority) Clinical Usability Program (CUP) Steering Group	18/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Consultation on-screen presentation of discharge summaries	21/1/2016
Dr Chris Moy	AMA Federal Councillor	Consultation on-screen presentation of discharge summaries	/1/2016
Dr Richard Kidd	AMA Federal Councillor & Deputy Chair AMACGP	Consultation on-screen presentation of discharge summaries	19/1/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Practice Incentive Program Advisory Group (PIPAG)	18/2/2016
Dr John Gullotta	AMA Federal Councillor	TGA Medicines Shortages Working Group	12/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	Meeting with expert panel reviewing pharmacy regulation and remuneration	1/2/2016
Dr Richard Kidd	AMA Federal Councillor & Deputy Chair AMACGP	Health Sector Group (HSG)	9/2/2016
Dr Stephen Parnis	AMA Vice President	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Antonio Di Dio	AMA Member	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Roderick McRae	AMA Federal Councillor – Salaried Doctors	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Susan Neuhaus	AMA Federal Councillor – Surgeons	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Johnathon Burden	AMA Member	Meeting with Australian Health Practitioner Regulation Agency (AHPRA) and the Medical Board of Australia (MBA) on improving practitioner experience with notifications	10/2/2016
Dr Brian Morton	AMA Federal Councillor & Chair AMACGP	GP Roundtable	19/1/2016
Dr John Gullotta	AMA Federal Councillor	NeHTA (National E-Health Transition Authority) eReferral Reference Group	25/11/2015
Dr Ian Pryor	AMA Member	MSAC (Medical Services Advisory Committee) Review Working Group for Paediatric Surgery, including Circumcision	8/12/2015
Dr Ian Pryor	AMA Member	MSAC (Medical Services Advisory Committee) Review Working Group for Percutaneous Coronary Artery Interventions	3/12/2015
Dr Brian Morton	AMA Federal Councillor, Chair of AMACGP	Profession Services Review Advisory Committee	2/12/2015
Dr Iain Dunlop	AMA Federal Councillor	Profession Services Review Advisory Committee	2/12/2015
Dr Stephen Parnis	AMA Vice President	National Medical Training Advisory Network (NMTAN)	1/12/2015
Dr Katherine Kearney	AMA Member, DiT proxy	National Medical Training Advisory Network (NMTAN)	1/12/2015

Hospital funding crisis ‘not our problem’, says Commonwealth

The Commonwealth is on a collision course with the states over health spending after Treasurer Scott Morrison declared the second tier of government was on its own despite a looming $35 billion funding gap.

As the nation’s treasurers prepare to meet next month, Mr Morrison has told his State and Territory counterparts that there would be no extra funding from the Commonwealth.

“We all have to manage our budgets,” he told the National Press Club. “Asking for buckets of money doesn’t solve your expenditure problem.”

Several states have been pushing for tax reform, including a bigger slice of the Commonwealth’s tax take, because of a looming shortfall in funding for hospitals and schools.

Changes unveiled in the 2014-15 Budget that are due to come into effect next year are expected to strip $57 billion from public hospital funding revenue over 10 years, creating what AMA President Professor Brian Owler said was “funding black hole” that would have dire consequences for patients.

“Public hospital funding is about to become the single biggest challenge facing State and Territory finances,” Professor Owler said. “Without sufficient funding to increase capacity, public hospitals will never meet the targets set by governments, and patients will wait longer for treatment.”

The AMA’s annual Public Hospital Report Card showed that performance improvements have stalled and, in some instances, are going into reverse, as hospitals struggle with inadequate funding.

Almost a third of Emergency Department patients categorised as urgent are waiting more than 30 minutes for treatment, and elective surgery patients are, on average, waiting six days longer than they were a decade ago.

There had been hopes that Federal, State and Territory leaders would agree on tax changes at a meeting to discuss reform of the Federation next month that would put health funding on a firmer financial footing.

But the likelihood of the meeting appears to be rapidly receding after Prime Minister Malcolm Turnbull ruled out any changes to the GST, which was at the centre of reform plans advanced by several states, including South Australia and New South Wales.

Instead, the Commonwealth appears determined to divest itself as much as possible of responsibility for health funding.

Mr Turnbull said the Federal Government did not want to increase the total tax take “in net terms”, and challenged the states to find their own sources of extra funds for health.

Papers prepared for the Council of Australian Governments meeting in December indicated that the Commonwealth and the states faced a combined health funding gap of $35 billion by 2030, and suggested closing it would require both spending restraint and an increase in tax revenue.

Gender diversity matters

2015 was perhaps a seminal year for the issue of gender inequity in the medical profession.

The year started with comments about sexual harassment in surgery.

To its credit, the Royal Australasian College of Surgeons resisted the urge to deny there was a problem, and instead commissioned an independent Expert Advisory Group (EAG) to investigate its extent. The Group’s report gave a sobering picture of the high prevalence of bullying, discrimination, and sexual harassment in the surgical workforce. I have no doubt that there are implications for the wider medical profession.

It was pleasing that the EAG responded to a number of points put forward by the AMA in its submission, including recognising that commitment to change needs to come from the top, and the importance of increasing gender diversity in senior roles in the College.

A scan of the leadership across the colleges, societies and employers shows limited gender diversity. My own college, the Australasian College for Emergency Medicine, is a case in point – currently, there are no women on its board. This under-representation exists despite the dramatic increase in female participation in the medical workforce in recent decades, to the extent that women now outnumber men as graduates of Australian medical schools.

To be sure, the medical profession is not alone in having a small number of women in senior leadership and management roles. According to the Australian Government’s Workplace Gender Equality Agency, last year only 9.2 per cent of ASX 500 company directors were women; they comprised 9.2 per cent of ASX 500 executive management personnel; and 23 per cent of Australian university vice-chancellors.

Why does this matter?

A healthier gender balance is essential if the medical profession is to harness the potential of all its members, and reflect the realities of modern medicine in policy and practice.

Like many, I believe that determined leadership is the key to accomplishing lasting change in the culture of our profession. This includes the upper tiers of the colleges and associations, the employers of doctors and, indeed, the AMA itself.

At times the pace of change may seem slow, and the task too difficult; however, the changes that have been demonstrated recently within the culture of the Australian Army show what can be achieved with a determined effort.

There has been considerable debate, and no consensus, as to whether an increase in gender diversity is best accomplished by using mandated targets or quotas. In our submission to the EAG, the AMA expressed support for a voluntary code of practice or a similar document, that includes voluntary targets and timeframes.

I believe this approach is worthy of consideration.

Our goal is clear – to achieve timely and substantial progress towards a leadership of the medical profession that reflects its composition. In turn, we are then more likely to realise the full potential of our abilities as doctors, and to promote a healthier professional culture.

Cheaper hips path to lower premiums

Private health funds are under pressure to pass any savings from reform of prosthetic pricing on to consumers through more modest premium increases.

As part of her push to improve the value of private health cover, Health Minister Sussan Ley has appointed experienced health administrator Professor Lloyd Samson to lead a working group examining the way medical implants and devices are priced.

The Industry Working Group on Prostheses, which includes a representative from the AMA, will look at current arrangements under which the cost of around 9000 prostheses and implants used in the private health system is set, resulting in prices that are often double or more of those paid in the public sector.

Ms Ley said the pricing process meant the same pacemaker delivered through the private system cost $26,000 – twice as much as if it was provided through a public hospital.

“It doesn’t matter whether it’s the hospital or the insurer purchasing these devices, the cost will always ultimately fall to the consumer, and I want to take unnecessary pressure off premiums,” the Minister said.

Under the current system, the price of a prosthesis is set and can only be under-cut if a rival device has more than 25 per cent of the market.

The focus on prosthesis pricing has come amid insistent warnings form the AMA about the quality of insurance policies on offer.

AMA President Professor Brian Owler has raised the alarm on the proliferation of policies with multiple exclusions and high excesses that often leave patients stranded without cover virtually at the surgery theatre door.

Professor Owler said it was particularly concerning that patients were often unaware that their cover had been downgraded, while others were being lured into buying “junk” policies that only provide cover in public hospitals.

The prostheses working group has been asked to look at ways to make the purchase of devices more competitive and efficient, and to ensure that the benefits of this are passed on to consumers.

Private health funds have long complained about the prices they are required to pay for prostheses, and estimate that up to $800 million a year could be saved by bringing prices more in to line with those paid in the public system.

The industry’s peak group, Private Healthcare Australia, said insurers spent $1.9 billion on prostheses last financial year – 14 per cent of total payouts.

The group said private patients in Australia paid far more for medical devices than those in comparable countries such as France, Japan and Italy, and much more than it cost the public sector.

“This is an unfair cost burden on private patients which the Government can address immediately,” PHA Chief Executive Dr Rachel David said, arguing for a system of reference pricing benchmarked against local and international charges.

But the Medical Technology Association of Australia said the price of medical devices had not changed in five years, and the growing payout reflected increased use of prostheses rather than cost.

The Association argued axing the current arrangement would cause chaos and take the power to decide what device a patient had from doctors and hand it to the health funds.

The Government’s review has also come under fire from smaller device manufacturers concerned that it will increase the market dominance of the big firms by allowing them to bundle overpriced routine products with devices only they can supply.

Changes to the pricing arrangement may also be resisted by some private hospital groups, which earn significant revenue from the supply and use of prosthetics.

The prosthesis review is taking place amid a broader assessment of the private health insurance system initiated by Ms Ley because of mounting consumer dissatisfaction with the value of private cover.

Ms Ley has asked health funds to resubmit plans for premium increases this year, based on their full financial position, rather than simply a tally of claims and benefits paid.

“Consumers have made it clear they don’t believe they’re getting value for money,” the Minister said.

Ms Ley said that claims and benefits constituted only part of the picture, “when we know insurers are holding an additional $5.1 billion capital in their pockets. The question I am asking insurers is: do they have some capacity to use this excess capital to deliver premium relief for their customers this year?”

The Samson review has been directed to report to the Minister in August.

Adrian Rollins

[Perspectives] The body politic

Last year the retired neurosurgeon Ben Carson announced his intention to seek the Republican nomination for this year’s US Presidential election. “I am not a politician”, he told supporters in Baltimore, “I don’t want to be a politician. Politicians do what is politically expedient and I am going to do what is right.” For several months Carson seemed to be the main threat to the ambitions of another Republican anti-politician, the businessman Donald Trump, though his challenge has since faded. Carson’s qualifications for the presidency have been called into question, but his pedigree as a clinician is not in doubt: appointed Director of Pediatric Neurosurgery at the Johns Hopkins Children’s Center in 1984 at the age of 33, he achieved prominence some 3 years later for the first successful separation (with survival) of occipital craniopagus twins, and retired in 2013 as a respected member of his profession.

AMA in the News – 2 February 2016

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Timing of Medicare cuts announcement criticised, The Age, 29 December 2015
Doctors have criticised the Turnbull government for using the Christmas-New Year holiday period to reveal the first tranche of items to be dropped from the government-subsidised Medicare Benefits Schedule. AMA President Professor Brian Owler said the proposed cuts would make the common tonsillectomy procedure marginally more expensive due to fewer individual parts of the operation being funded by Medicare.

Take care morning after the big night, Adelaide Advertiser, 1 January 2016
Health and safety experts are urging people to be careful embracing life the morning after a big night. AMA President Professor Brian Owler urged people to take it easy with water sports and even sunbaking over summer if they have consumed alcohol.

Anti-vax nuts try to cheat jab laws, The Sunday Telegraph, 3 January 2016
Anti-vaxers are trying to manipulate the new “no jab no pay” laws in a bid to gain taxpayer-funded rebates available only to those who vaccinate their children. AMA President Professor Brian Owler said the attempt is hurting only the child involved.

Threats to handouts prompts jab boosts, The Sunday Telegraph, 17 January 2016
Doctors have noticed a significant boost in the number of parents bringing their children in for vaccinations as the new “No Jab, No Play” laws start to bite. AMA President Professor Brian Owler said the laws were already having a beneficial effect on immunisation numbers.

Warning over autism doctor shopping, The Australian, 19 January 2016
GPs should be given stronger guidance about how to diagnose autism. AMA President Brian Owler said that having consistent guidelines would make things easier for doctors during diagnosis, but added that the emphasis should remain on assessing children early.

Doctors warn of busy emergency facilities, Australian Financial Review, 28 January 2016
The AMA Public Hospital Report Card found the performance of the public hospital system has stagnated, and even declined in some areas. AMA President Professor Brian Owler placed the blame for the declining public hospital performance firmly on the Federal Government’s reduced rate of health funding which would lead to a funding “black hole” in 2017.

Hospitals faced with funding ‘black hole’, Sydney Morning Herald, 28 January 2016
The Federal Government is under pressure to reform taxes following a report card on public hospitals that shows the most urgent patients are waiting longer at emergency departments. AMA President Professor Brian Owler said hospitals would be insufficiently funded to meet the rising demands from 2017, when the states and territories were facing a “black hole”.

State looks sick, Herald Sun, 29 January 2016
Victorian emergency patients are paying the price for a “funding crisis” in the nation’s public hospitals, and doctors warn the worst is yet to come. The AMA warned that a further $57 billion of Commonwealth funding was expected to be lost from hospital coffers over seven years starting next year, by indexing funding growth to CPI and population expansion.

Radio

Professor Brian Owler, 774 ABC Melbourne, 29 December 2015
AMA President Professor Brian Owler discussed recent cuts to the Medicare Benefits Scheme. Professor Owler said it was clearly a cost saving exercise by the Federal Government.

Professor Brian Owler, Radio National, 29 December 2015
AMA President Professor Brian Owler talked about new cuts to the MBS. Professor Owler said the AMA has supported the Medicare Benefits Schedule review from the outset, on the basis there were no cuts to access to patient services.

Dr Stephen Parnis, 4BC Brisbane, 7 January 2016
AMA Vice President Dr Stephen Parnis dismissed claims that pap smears would cost women $30. Dr Parnis said cuts to Medicare have resulted in reports of overpriced pap smears.

Dr Stephen Parnis, Tipple J Sydney, 25 January 2016
AMA Vice President Dr Stephen Parnis discussed the use of so-called “hangover clinics”. Dr Parnis said the treatments they offered were a placebo, and he questioned whether their operations were ethical.

Professor Brian Owler, Radio National, 28 January 2016
AMA President Professor Brian Owler discussed the latest AMA Public Hospital Report Card which revealed a public hospital funding ‘black hole’ as Commonwealth funding cuts hit the States and Territories.

Professor Brian Owler, 2GB Sydney, 28 January 2016
AMA President Professor Brian Owler talked about a report from the AMA showing emergency department waiting times has worsened for the first time in seven years.

Professor Brian Owler, 774 ABC Melbourne, 28 January 2016
AMA President Professor Brian Owler talked about the AMA Public Hospital Report Card and said longer waits for elective surgery and emergency rooms often resulted in more health problems.

Television

Professor Brian Owler, ABC News 24, 28 December 2015
AMA President Professor Brian Owler talked about Health Minister Sussan Ley’s proposed removal of 23 items from the Medicare Benefits Schedule.

Dr Stephen Parnis, ABC News 24, 1 January 2016
AMA Vice President Dr Stephen Parnis talked about how parents who refused to vaccinate their children would be stripped of childcare benefits by the Federal Government under new laws. Dr Parnis said public health was a major government responsibility, and vaccination rates were not as high as health experts would like them to be.

Professor Brian Owler, The Today Show, 14 January 2016
AMA President Professor Brian Owler discussed the importance of safe work environments for emergency workers after a police officer was allegedly shot by a patient with a history of ice addiction at a Sydney hospital.

Professor Brian Owler, Channel 7 Melbourne, 26 January 2016
Medibank says it is passing savings onto its members, but there are concerns more affordable premiums might mean cuts in benefits. AMA President Professor Brian Owler said doctors did not want to see people taking out cheaper premiums and policies and then realising that their private health insurance was not worth it.

Professor Brian Owler, The Today Show, 28 January 2016
The AMA Public Hospital Report Card 2016 showed that, against key measures, the performance of public hospitals is virtually stagnant, and even declining in key areas. AMA President Brian Owler said unless the Government looked at the way it funded public hospitals, people were likely to wait longer in emergency departments and for elective surgery.

Professor Brian Owler and Dr Stephen Parnis, Channel 9, 28 January 2016
The AMA released its new Public Hospital Report Card and the figures revealed that scores of patients were not being treated within recommended times. Doctors fear the situation is only going to get worse.

Professor Brian Owler, ABC News 24, 28 January 2016
The AMA has warned that public hospitals are facing a funding crisis. AMA President Professor Brian Owler said hospitals faced a crisis due to the funding fight between Federal and State governments.

Hospitals face funding ‘black hole’

Almost a third of Emergency Department patients in need of urgent treatment are being forced to wait more than 30 minutes to be seen, while thousands of others face months-long delays for elective surgery as under-resourced public hospitals struggle to cope with increasing demand.

The AMA’s latest snapshot of the health of the nation’s public hospital system shows that improvements in performance have stalled following a sharp slowdown in Federal Government funding, underlining doctor concerns that patients are paying a high price for Budget austerity.

“By any measure, we have reached a crisis point in public hospital funding,” AMA President Professor Brian Owler said. “The states and territories are facing public hospital funding black hole from 2017 when growth in Federal funding slows to a trickle.”

The Federal Government will have slashed $454 million from hospital funding by 2017-18, and a downshift in the indexation of spending from mid-2018 will reduce its contribution by a further $57 billion by 2024-25.

Professor Owler said the consequences of Commonwealth cutbacks were already showing up in hospital performance, and the steep slowdown in funding growth in coming years will further exacerbate the situation.

“Public hospital funding is about to become the single biggest challenge facing State and Territory finances, and the dire consequences are already starting to show,” the AMA President said. “Without sufficient funding to increase capacity, public hospitals will never meet the targets set by governments, and patients will wait longer for treatment.”

The AMA’s Report Card, drawing on information from the Australian Institute of Health and Welfare, the Council of Australian Governments Reform Council and Treasury, shows the performance of public hospitals against several key indicators has plateaued and, by some measures, is declining.

In terms of hospital capacity, the long-term trend toward fewer beds per capita is continuing. The decline is even more marked when measured in terms of the number of beds for every 1000 people aged 65 years of older – a fast growing age group with the highest demand for hospital services.

In 1993 there were almost 30 beds for every 1000 older people, but by 2013-14 that had virtually halved to around 17 beds.

Alongside a relative decline in capacity, there are signs the hospitals are struggling under the pressure of growing demand.

Emergency departments, often seen as the coal face of hospital care, the proportion of urgent Category 3 patients seen within the clinically recommended 30 minutes fell back to 68 per cent in 2014-15 – a two percentage point decline from the previous year, and a result that ended four years of unbroken improvement.

The national goal that 80 per cent of all ED patients are seen within clinically recommended times appears increasingly unlikely, as does the COAG target that 90 per cent of all ED patients be admitted, referred or discharged within four hours. For the last two years, the ratio has been stuck at 73 per cent.

The outlook for patients needing elective surgery is similarly discouraging.

The AMA report found that although there was slight reduction in waiting times for elective surgery in 2014-15, patients still faced a median delay of 35 days, compared with 29 days a decade earlier.

It appears very unlikely the goal that by 2016 all elective surgery patients be treated within clinically recommended times will be achieved. Less than 80 per cent of Category 2 elective surgery patients were admitted within 90 days in 2014-15 – a figure that has barely budged in 12 years.

The Commonwealth argues it has had to wind back hospital spending because of unsustainable growth in the health budget.

But Professor Owler said the evidence showed the opposite was the case.

The Government’s own Budget Papers show total health expenditure grew 1.1 per cent in 2012-13 and 3.1 per cent the following year – well below long-term average annual growth of 5 per cent.

Furthermore, health is claiming a shrinking share of the total Budget. In 2015-16, it accounted for less than 16 per cent of the Budget, down from more than 18 per cent a decade ago.

“Clearly, total health spending is not out of control,” Professor Owler said, and criticised what he described as a retreat by the Commonwealth Government from its responsibility for public hospital funding.

“There is no greater role for governments than protecting the health of the population,” he said. “Public hospitals are the foundation of our health care system. Public hospital funding and improving hospital performance must be a priority for all governments.”

In a statement to Fairfax Media, Health Minister Sussan Ley declined to specifically address the issues raised in the AMA Report Card.

Instead, the Minister pointed out that Commonwealth funding for hospitals was increasing on an annual basis, and there had been no policy anouncements in last year’s Budget or MYEFO affecting that. While technically correct, the Minister’s comments brush over the big changes announced in the first Hockey BUdget in 2014-15, including a massvie slowdown in the growth of Federal funding for hospitals.

The issue of hospital funding is set to loom large when the nation’s leaders meet in March to discuss reform of the Federation.

Already, several premiers are pushing for an overhaul of taxation arrangements to provide the states with a better growth revenue stream than the Goods and Services Tax.

South Australian Premier Jay Weatherill has proposed that the Commonwealth hold on to GST revenue and, in return, give the states and territories a slice of income tax receipts.

Adrian Rollins

[Comment] Surgery—a call for papers

The Review on periprosthetic joint infection by Bhaveen Kapadia and colleagues in this issue shows just how many unknowns haunt modern surgery, and the importance of research for better understanding of biomechanics, anticoagulation, perioperative care, biofilms, and patient reported outcomes to improve surgical care. With this in mind, The Lancet invites submissions of surgical research for our annual surgery-themed issue to coincide with the American College of Surgeons’ Clinical Congress in Washington, DC, USA, on Oct 16–20, 2016.

Name

Position on Council

Activity/Meeting

Date