There are new questions over the detail of Julia Gillard's $16.4 billion health reform package. According to West Australian Premier Colin Barnett the introduction of an activity based funding system through a national pool by mid next year was achievable, but stressed it needed to be “well understood and easy to administer”.
He added that the state and federal responsibilities under the plan and the details of the pooled funding arrangement needed to be finalized. Unless the structure of the pool was right, positive health reform could not be delivered, he said adding, “We agreed on the broad principles… The detail will not be an easy task, but I’ve got confidence that some of the best brains in health administration at a commonwealth and state level will be able to solve that problem…The absolutely critical thing will be the arrangements for management, who has responsibility for what, how the money flows. And if we don’t get that right, then the system won’t work.”
Prime Minister Julia Gillard also spoke on this declaring the blame game was over. She said the deal would provide greater transparency but conceded the “fine details need to be nutted out”. She said, “The funding blame game is over and we can get on with the job of providing better health services to Australians.” Ms Gillard said an independent body would work out the “efficient price” of hospital services to govern the flow of funding, an innovation she claimed would bolster transparency.
However Dr John Deeble the founder of the Medicare system had doubts about how the efficient price could reasonably be set. He said, “I think that will have to be significantly modified. You can do some sums on what looks to be an efficient cost, but the people who make the decisions are the doctors who treat people… I'm a bit concerned that the determination of the efficient price will end with great deal of squabbling.”
According to Federal opposition health spokesman Peter Dutton removing the levels of bureaucracy from the previous Rudd reform plan was a positive. But he said the new agreement made no mention of mental health or aged care. He added, “Let’s call for what it was: Julia Gillard desperately needed a political win and that’s what she got… She didn’t get real health reform.”
Rural Doctors Association of Queensland president Dr Dan Halliday also added that the new reforms did not think of services in the bush, because it did not address the issues of minimum standards to ensure adequate services in country areas, or new measures to improve staff recruitment and retention. He said, “It doesn’t have a significant shift in terms of the funding models that we can see immediately… There is potential for the blame game to continue and that is another big concern.”
Victoria’s premier Ted Baillieu welcomed the reforms saying, “This is a much better deal than the deal that was in place which Victoria had signed up to.” It means more money upfront for Victoria and better protection of Victoria’s local health networks and of home and community care he said.
Prominent health reform advocate John Dwyer has also welcomed as a positive the 50-50 funding arrangement. He said, “It’s an improvement, in the sense that it’s achievable…But clinicians are concerned we are putting more and more resources into the same old hospital-centric system.” He also said that the “real rescue” for hospitals should come from reducing demand by changing the models of care, such as minimizing the development of chronic disease through prevention strategies. “They’re not on the table,” Professor Dwyer said, adding that the deal was not a health system reform but a hospital funding reform package.
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