Ideas@TheCentre
The hard part: an alternative plan for hospitals
Jeremy Sammut |
12 March 2010
Now comes the hard part—coming up with an alternative plan. Here’s mine:
Funding—Public hospitals should be funded on an activity-basis at the efficient casemix price so that each hospital’s budget is principally determined by clinical throughput.
Competition—Vouchers should be issued for procedural care to permit competition between public hospitals and foster higher productivity.
Administration—Area health bureaucracies should be abolished, state health departments should be downsized, and full operational and budgetary control should be restored to pro bono local hospital boards.
Accountability—Politicians must enforce financial discipline, must not raid the Treasury to bail out mismanaged hospitals, and must require boards to make ‘business decisions’ about the services the hospital provides so the income earned covers budgeted costs.
Governance—The federal government should fund public hospitals; state governments should regulate hospitals (according to nationally agreed hospital standards); and local boards, in partnership with the community, should provide hospital services.
The even harder task is the urgent need to politically manage the unrealistic expectations around Medicare:
Debunk the myth of ‘free’ hospital care on-demand—The public should be informed that non-price rationing of services by waiting based on relative need is an unavoidable feature of all government-run, taxpayer-funded health systems. The fact that must be stressed is while reforms might reduce elective waiting lists, waiting will never be eliminated because the health budget is limited and more needy patients are at the front of the queue.
Highlight the immoral ‘hospital crisis’—The public also need to be told that public hospitals are required to treat the sickest, most complex patients and 90% of emergency cases. What should be underlined is how the political pressure to increase elective surgery has contributed to irrational rationing of care via long queues for emergency admission in overcrowded public hospitals.
Promote PHI—Elective waiting times should therefore be advertised to encourage private health fund membership and to praise the private sector for developing a highly-efficient, procedurally-based private hospital system. What should be emphasised is that the more people pay for private insurance, the more affordable the premiums will be, and the better access all Australians will have to essential hospital treatment.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies.
