Ideas@TheCentre
There is a Jekyll and Hyde quality to the Bennett Report released by the National Health and Hospital Reform Commission this week
The problem with the Bennett report is that the left hand wants to plan the future of Australian health care from the top-down and give people the services the government thinks they should have, while the right hand is trying to free up the system and allow resources to follow patients based on clinical need. As a result, the report is a mix of sound policy and questionable proposals, and is confused about the direction in which health reform should be heading.
The National Health and Hospital Reform Commission (NHHRC) recommends:
- Scrapping the centralised bed allocation process in the ‘high care’ aged care industry in favour of providers offering as many places as demand dictates.
- Allowing providers to charge accommodation bonds to secure much needed capital for renewal and expansion, and the removal of caps on fees for residents to permit price competition.
- Activity-based payment (including the cost of capital) is endorsed as the principle method of funding public hospitals.
- Possibly replacing Medicare with health plans provided by private health funds, which would purchase services on their member’s behalf.
The golden thread running through these proposals is a shift away from ‘command and control’ approaches and a move in the direction of ‘consumer-directed’ health care, with the aim of making services more responsive to patient demand, and promoting allocative and technical efficiency. This is market-based reform, though the NHHRC avoids frightening the horses and does not use that label.
It’s a different story in the sections of the Bennett report dealing with primary care which revert to ‘central planning’ mode. The NHHCR recommends that Medicare should fund a wider range of primary care and allied health services which should be accessed in the federal government’s network of ‘Mega Clinics’.
The report justifies this massive investment on the grounds that Mega Clinics will keep the elderly healthy and relieve pressure on overcrowded hospitals. Here, the commission is betting it knows the health services an ageing Australia is going need and the circumstances in which government should deliver them.
Much like the government who commissioned the inquiry, the Bennett report is a tug-of-war between the invisible hand and central planning.
Dr Jeremy Sammut
Research Fellow (This e-mail address is being protected from spambots. You need JavaScript enabled to view it)
