While the political debate revolves around the GST carve-up between the commonwealth and the states, the germ of a seismic reform with the power to transform the nation’s health system was quietly uploaded online in the form of the mid-term review of the National Health Reform Agreement.
The document compiled by Rosemary Huxtable has an overriding theme: health funding arrangements as they stand drive the dollars towards treating inpatients in acute settings rather than keeping them out of hospital in the first place.
The report calls for a shift towards a more flexible system that integrates out-of-hospital care at the primary care, local hospital network and Aboriginal Community Controlled health organisation within a truly national healthcare system.
It hints at rewards for performance rather than activity driving funding.
This must happen. If not, the funding of acute care will drive the nation almost broke.
The sense in funding systems to keep people well, prevent development of advanced disease and keep people out of hospital is beyond obvious. Reforming the system to do so will be another matter. It’s highly complex, and as the horsetrading on the NDIS showed this week, the states can sometimes not be trusted to do their bit when the commonwealth increases its share. Having agreed to an as-yet unspecified “cumulative” increase in growth funding for public hospitals, the commonwealth has bound itself to pour billions more into state-run hospitals. The states must now do their bit.
The commonwealth must make sure to ink their commitment to do so in black and white in the next National Health Reform Agreement.
The commitment from the commonwealth to offer increasing primary care support to elderly Australians in order to avoid unnecessary hospital admission, and support earlier discharge, is the first significant shift towards Huxtable’s vision.
Primary care in nursing homes is an unforgivably dysfunctional area of policy that should be fairly easy to fix. The reality now is it’s uneconomic for GPs to provide primary care in a nursing home. So when aged-care residents get sick, an ambulance is often the first port of call. They too often then get trapped in hospital, deteriorating rapidly, with no primary care available to look after them.
Fix this appalling situation, and hundreds upon hundreds of beds will be freed up in wards.
This is but one example of the disconnect between primary care and hospital funding and policy that slips through the gaps of our federated system, driving costs upwards and ultimately causing human misery.
Expect more discussions and agreements of this kind over the next year leading to signing of the health reform agreement – and not a moment too soon.
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It’s a truism to say politics often generates more heat than light, but it certainly was the case this week when it came to the wash-up for health funding of national cabinet.