Opinion & Commentary
Bleed bureaucracy to restore hospital health
On top the serious problem of longer and longer waiting lists for elective surgery, public hospitals throughout Australia are increasingly unable to provide safe and timely emergency treatment. More than one-third of patients requiring unplanned admission now wait longer than eight hours for a hospital bed. Delayed admission has been linked with 1,500 avoidable deaths per year—more than the national road toll.
The reason public hospitals are in crisis is that the total number of acute public hospital beds in Australia has been cut by one-third to a level far below the OECD average since Medicare was established in 1984. Taking population growth into account, the real fall in bed numbers is even larger—a 60% fall from 4.8 public acute beds per 1,000 population to around 2.5 per 1,000 population today.
Overcrowding occurs when hospitals operate beyond a safe level of 85% bed occupancy and more patients require unplanned admission than there are beds available. When emergency doctors and nurses have to care for the overflow of patients queued up on trolleys in emergency department corridors waiting times for new patients inevitably blow out.
While bed numbers have been cut to the bone, the size and cost of the State area health services that administer public hospitals have continued to blowout. Growth in the bureaucracy has crowded out frontline services while beds have been closed in favour of opening offices.
The new report by the National Health and Hospitals Reform Commission claims that boosting primary care services and spending billions of taxpayer’s on a national network of GP Super Clinics will take the pressure off hospitals.
This approach has been tried and has failed in New Zealand. Public hospitals in New Zealand suffer the same if not more serious problems than their Australian counterparts—the unacceptable clogging up of emergency departments due to a critical shortage of beds.
Public hospitals are also under pressure because an increasing number of elderly patients are requiring admission to a hospital bed. In the last five years, separations in public hospitals by patients aged 75–84 and 85 and over have increased by 25%. A decade ago, the 85 plus demographic was not even separately distinguished in the statistics.
As more Australians live to older ages, increasing numbers of older and sicker patients will inevitably get ill and require emergency and bed-based hospital care. Unless we get the policy settings right, a lot of grandparents and great-grandparents are going to languish on trolleys in hospital corridors while waiting for a bed.
The NHHRC has recommended the federal government boost funding to public hospitals to increase bed numbers by 15%. A one-off and expensive bed increase is neither a long-term nor sustainable solution.
The last thing we should do is throw more money at public hospitals. Real public hospital funding has increased by 64%over the last decade and the problems have just grown worse.
A 50% increase in patients presenting at emergency aged over 85 is predicted over the next five years. Policymakers must ensure flexible funding and responsive administration arrangements are in place to ensure bed numbers can increase to cope with rising demand.
To prevent the hospital crisis becoming a catastrophe, we must address the wasteful way the State’s run public hospitals. The federal government can led the way by taking full responsibility for funding hospitals, on the condition it also establish a voucher system to pay for treatment in either public or private hospitals.
A voucher system will increase patient choice, competition, and efficiency. The federal government should also require the states to re-establish the community boards which used to run public hospitals. The area health services can then be closed down and the money saved redirected to pay for vouchers and fund frontline services.
Genuine reform is required to rebuild the hospital system and reverse the process of the last twenty five years. By closing offices and ending the waste of taxpayer dollars on bureaucracy, a voucher system and community boards will enable hospitals to open the beds that are desperately needed to care for an ageing population.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies. His report ‘Why Public Hospitals are Overcrowded: Ten Points for Policy Makers’ was released by the CIS in July.
