Common health for the Commonwealth?

23 02 2009

6 minutes’ Michael Woodward summarises some of the NHHRC’s suggestions that have been made to improve Australia’s healthcare system.

1. More Super Clinics.
2. Voluntary enrolment with a single practice.
3. Fundholding to supplement fee-for-service.
4. Performance payments.
5. Super divisions of primary care to replace division of general practice.
6. Extending Medicare and PBS rights to nurse practitioners.
7. Procedural work to be done by physicians’ assistants.
8. Shared care arrangement s and care co-ordinators.
9. Electronic health records for all.
10. A National Aboriginal and Torres Strait Islander health Authority.

Crikey‘s health blog, Croakey, believes in only one solution to reform of Australia’s broken health system.

Let the Commonwealth take right over everything. Sure delivery will be local, but no authority will rest in local hands.

Now, while I agree that a state-based model is next to useless. There’s no sudden shift in medical needs as you cross the border from New South Wales into Queensland, so really hospital standards, doctor qualifications and diagnostic testing shouldn’t differ either.

But this solution sounds typical of urban-based Australian politics.Local regions still need to retain authority over service delivery in there area.

Australia is huge. Massive. But unlike other massive countries like Canada, USA or China, Australia’s population is concentrated in very few population centres. Because of this high concentration of voter power, it means that funding and services will prefentially favour these gravity wells.

Now you might say, this makes sense, as surely Brisbane will have higher demand for health services, than say Mt Isa. But the quality and standard of care shouldn’t.

Not only is it important that regional areas have their own voice to ensure appropriate distribution and accessibility of health care. As the above example illustrates – health care demand does differ across Australia – but on a regional level (as opposed to a state one). Health risks and priorities in southern Victoria differ from those in tropical Queensland, to those in Western Australian Aboriginal communities.

Yes, management will be required, to ensure that relationships are smooth. But establishing these relationships will be essential for any sort of effective delivery of health care. Plus those little managers = JOBS! (Local JOBS!) And Australia needs jobs (especially if we suddenly make all state health care personel redundant).

Local delivery without local authority would be a shambles. Regional complaints, authorisations, decisions would go through Canberra-based committees, who would have little care or interest in local communities. Transferring power (and of course funding) into regional health services would stimulate growth and improvement, rather than the stagnation and disarray we are seeing right now.

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