Australian national health system on the waiting list

Any hope of a truly national health system as promised by Kevin Rudd in the run up to the last election now appears to have stalled, at least for the time being.

Kevin Rudd promised he would seek a mandate to assume financial control of the 750 public hospitals if state and territory governments had not begun implementing an agreed national health reform plan by 2009 but despite implementing a series of scrutinising reviews into the health system, the Prime Minister's credibility on health is becoming increasingly suspect and his threat of a federal takeover of public hospitals, unless they raised their game, now seems to have joined the long line of hospital waiting lists.

The Prime Minister now has in his hands reports from the National Health and Hospitals Reform Commission and two taskforces on primary health care and preventive health which are expected to be released shortly - their wide ranging recommendations which are thought to include options for expanding health services outside hospitals are expected to propose a gradual reformation of health, with a Commonwealth takeover and expansion of funding for all non-hospital health services, the primary care by doctors, nurses and other allied health professionals.

But all the indications are that when it comes to the hospitals themselves, an immediate federal takeover will not be on the cards and that the NHHRC report will propose longer-term options for the more radical developments, where all responsibility for health funding would be transferred to the Commonwealth which would then oversee a network of regional health authorities much the same as Britain's National Health Service.

This would ultimately involve establishing a tax-funded community insurance scheme where super health funds might compete for services and where an individual could choose the cover they need.

But there is resistance by some states to any take-over of their hospital systems and a split between the states over the federal government's health reform agenda is now placing even the most modest options for change under threat - while Western Australia and South Australia have given the idea their provisional support, NSW has flatly opposed a proposed Commonwealth takeover of primary health services and Victoria and Tasmania also have serious concerns.

The NHHRC's least ambitious option would see the federal government expanding the Medicare funding of doctors' visits to assume responsibility for all frontline primary health services, including child clinics, alcohol and drug treatment, mental health, sexual health and school health which are currently run by the states - the most ambitious option would bring the nation's entire system, including state-owned hospitals, under commonwealth control.

Health policy experts say it will be a difficult task for Canberra to take control of even primary healthcare, let alone the entire health system even if all states unanimously supported the move and a number of issues have surfaced - Victoria and NSW, want control over primary health kept in check and have warned that an expansion into child and maternal health clinics could result in a "decline in outcomes and who has responsibility for home and community-care services to the aged and disabled also remains in dispute - electronic health records with their potential to transform health services, is yet another touchy issue."

But federal and state governments already appear to be moving on the sensitive issue of electronic health records with their potential to radically transform health services - an announcement made today of a national consultation on legislation for individual patient ID numbers which will underpin the system, does indicate that federal and state governments are already making progress.

To date the federal government has spent $600 million in an attempt to cut elective surgery waiting lists and a handed out a $20 billion increase over five years in federal money for state health services, mainly for the public hospitals.

The states have agreed on some important changes such as how hospital funding is accounted for and also the publishing of individual hospital figures on performance including hospital-triggered infections and medication mistake rates.

Experts suggest that such accountability procedures mean hospitals and other health services can be subjected to efficiency measures which might influence their funding by exposing their performance and record.