Health Reform: Where is it heading?

[Whiskers]

No the "main jist (sic)" is about the Commonwealth imposing another layer of bureaucracy on the system. Whoever controls the funding will call the tune.

They may call the tune but as I expect the major changes will be in 'standards' and the funding arrangements probably in the form of a SPP like many other that already exist, what aspect of reform is going to cause another layer of bureaucracy?

Nothing will change. Commonwealth bureaucrats always bungle management, and running a cost effective health system is beyond them. Pouring in more money doesn't help. It just goes down the gurgler as in the BER.

So it's the "Commonwealth bureaucrats" fault, not the politicans eh!

There's a lot of things that Commonwealth bureaucrats and quasis generally manage pretty well, such as Tax collection, Australia Post, Medibank and Medicare.

With regards to health it's arguable that anyone could manage it better than Qld and NSW bureaucrats and politicans for example has done lately.

 

[trainspotter]

Why so?

From the little info available, the main thrust is are not about takeing over the day to day management of health services, but about some sort of standardisation of services, and funding of health services across the country, particularly to attempt to rectify the imbalance in some regional areas, by taking 30% of current state GST and putting into some fund specifically for health delivery services.

The gov may impliment some of the Henry Review recommendations re the spread of wealth in terms of income tax and welfare, but how could the Henry Review adversly affect state budgets, since the GST cannot be changed without the states agreeing?

Do you have a direct line to the document proposal? Still no detail other than the 30% GST to be taken away from the states. "Into some fund" ??? WTF ?? Is this some new Laborite terminology that I don't know about?

"Talk about half-cocked Rabble-Rousers!" Asking questions which you have no answer for makes me a Rabble - Rouser than so be it Whiskers !! LOLOL - Still no detail on the table other than Feds are going to take 30% GST from the states and place it directly to hospital boards. Apparently this will only cover 60% of the running costs and the states STILL have to fund the other 40% or the patient does by paying charges !!!

Don't even know the basics that are enshrined in the system? Then enlighten me with your omniscient wisdom Oh wise one ........ please !

 

[noco]

BUT... the fed gov isn't managing the day to day delivery of health services. That is still in the hands of the States.

Isn't the main jist of these negotiations to secure health funding probably as a larger SPP, that can't be redirected to other areas eg leaving health supplies low because of unpaid suppliers as in NSW, BUT still managed and delivered by the states, but to some sort of national standard?

Surely once agreement on the standards and funding is agreed, it's all up to the states to deliver/manage as usual as per the agreed standards and funding.

The main "jist" of Rudd's pre 2007 election policy was a complete take over of the National Hospital system if the states did not improve by July 2009.

Nine months had elapsed before he decided to do something after he was shamed into it. He watered it down to make it look like he was doing 'something'. All talk and no action again. It was all put in the too hard basket for a complete take over, so he choose to smash and grab 30% of the GST and recycle it as Federal assistance, That's our Prime Minister.

 

[Whiskers]

Do you have a direct line to the document proposal? Still no detail other than the 30% GST to be taken away from the states. "Into some fund" ??? WTF ?? Is this some new Laborite terminology that I don't know about?

Probably, but most of us are aware that it's been mooted for ages in the press and again in this mornings papers.

Also, if you bothered to look at the IGA link you would see that SPP's have been used by fed gov's for ages.

The meeting resumed at 5pm and Mr Rudd added another $316 million - $200 million more for emergency departments and $116 million more for mental health. The states accepted, clearing the decks for the fight today over GST revenue and the states' demand for all revenue to be put into, and administered by, a single funding pool.
.

While Mr Rudd could agree to the latter, he is refusing point-blank to allow the states to keep the GST. He wants to keep the money and spend it directly on local hospital networks.
http://www.brisbanetimes.com.au/national/showdown-over-gst-will-be-like-ok-corral-20100419-spe7.html

"Talk about half-cocked Rabble-Rousers!" Asking questions which you have no answer for makes me a Rabble - Rouser than so be it Whiskers !!

Don't even know the basics that are enshrined in the system? Then enlighten me with your omniscient wisdom Oh wise one ........ please !

I led you to the water, but you have to drink for yourself.

PS: Just now the news is that NSW has agreed to a deal just leaving Brumby and WA on the outer.

 

[Whiskers]

The main "jist" of Rudd's pre 2007 election policy was a complete take over of the National Hospital system if the states did not improve by July 2009.

Nine months had elapsed before he decided to do something after he was shamed into it. He watered it down to make it look like he was doing 'something'. All talk and no action again. It was all put in the too hard basket for a complete take over, so he choose to smash and grab 30% of the GST and recycle it as Federal assistance, That's our Prime Minister.

I suppose the GFC and the states refusing to hand over full control all at once had something to do with that... but at the end of the day I just hope they can all agree on some constructive reform to get the ball rolling now.

 

[trainspotter]

I may need to enlighten you Whiskers !

KEVIN Rudd has made his final offer to the states on his health reform package. What remains between now and the April 19 Council of Australian Governments meeting is a final funding offer from the Prime Minister.

The commonwealth-state divide boils down to money, perhaps a mere billion dollars or so. Victorian Premier John Brumby's claim that the states should retain the 30 per cent of GST revenue Rudd proposes to withhold from them seems to be regarded even by his peers as out there.

A small matter of principle crept in from the premiers' Monday night teleconference: that all the hospital funding should be pooled, presumably to be distributed by some independent authority. It's a silly idea that has been floating around for years and has been vehemently discredited by the states previously. The likely outcome is an agreement broadly in line with the commonwealth's various policy statements.

Funding will switch from states to commonwealth via a withholding of sufficient GST revenue to allow the commonwealth to lift its public hospitals contribution from 35 per cent of total to 60 per cent. The commonwealth will establish 150 local hospital networks to which it will make its hospital payments and which will be accountable for meeting national standards for access and quality.

The commonwealth's payments will be made on an efficient price, or casemix, formula for in-patient episodes, set by an independent statutory commission, with variations for small rural and remote hospitals.

Similar arrangements for hospital emergency attendances and outpatients will be introduced later, with the commonwealth committed to eventually meeting 100 per cent of these costs.

States will meet approximately 40 per cent of public hospital costs and will be responsible for planning and co-ordination within their systems. Significantly, states will meet those costs that are above the efficient price.

Growth in operating costs after 2014 and future capital requirements of public hospitals will be a federal responsibility.

The commonwealth will take full responsibility for primary healthcare funding, with most details yet to be announced.

A network of primary healthcare organisations, separate from the hospital network, is planned. This seems to be a revamp of the network of divisions of general practice that have existed for more than a decade. What, if any, role they'll have in funding and governance of primary health care is unclear, although they'll play a key role in the delivery of new diabetes care arrangements.

A hint of further changes for primary health care lies in the new arrangements announced for managing diabetes patients, including voluntary patient enrolment with a practice for continuing care and payment of a single annual fee to the practice for that care rather than episodic fees.

The commonwealth will take full responsibility for funding aged care, including community, sub-acute and residential care. Details are yet to be announced. But aged-care networks will be set up to better integrate aged care with primary and acute care.

Then there's a list of "next steps" to pick up areas not included in the announcements, including mental health, dental health, obesity, tobacco and alcohol misuse, and e-health. With so much detail yet to be revealed, it's difficult to know if there'll be real and positive reform as distinct from rearranging and churning. Regardless, there are risks for disruption of services even in what's been announced. For example, what games will the various jurisdictions get up to between now and implementation to maximise their benefit?

Assuming the states sign up to the plan in principle, implementation will be fraught. Groups of officials will be established to sort out the detail and will move at a glacial pace. A detailed commonwealth legislative program will be required to make any of it happen and, no doubt, there'll be close Senate scrutiny of the bills. New local governance networks will have to be established to encompass federal and state requirements.

Finally, change on the ground will require significant rearrangement of public service jobs, their locations and working conditions. One estimate suggests 10,000 people could be affected.

Once these preliminary hurdles are overcome, the present working arrangements of healthcare providers will need to change to achieve the desired service improvements and efficiencies.

Reactions of leading medical and nursing professional and industrial groups haven't been promising in this regard.

The progress in e-health is instructive. After more than a decade of joint commonwealth-state "strategies" and "action plans", and government investments worth more than $1 billion, e-health has produced little more than a piece of legislation that's languishing in parliament after intense criticism from industry and privacy advocates.

The Rudd plan, while exciting and visionary, is full of blank spaces. Implementation will severely test the commonwealth's legislative and administrative capacity.

Existing federal arrangements will be pressed to adapt to the rearrangement of a sector that constitutes 10 per cent of economic activity.

Robert Wells is director of the Menzies Centre for Health Policy and the Australian Primary Health Care Research Institute at the Australian National University and former first assistant secretary in the Department of Health and Ageing.

The devil is always in the detail. When Wayne Swan was questioned as to HOW he was going to pay for the EXTRA billions Rudd is throwing into this catstrophe he replied "All will be revealed in the May Budget which is several weeks away from announcement" Pressed further on the funding matter he let it slip that the extra funds have been achieved by "cost cutting" ??? Cost cutting what exactly .... can't tell you .. ner ner ner .. wait for the budget.

 

[Whiskers]

I may need to enlighten you Whiskers !

Nothing enlightening there mate. That's all old hat now... t'was just idle speculation.

As I originally pointed out you were fundamentally lacking to be in any position to be too critical.

But as I said before the states have been in negotiation for two previous COAG's so they obviously know more than they are telling us too. That's what I'm interested in... what they are not yet telling us.

So if the states agree to something this COAG, then some responsibility for the success or failure of any agreement must rest with the states also, since they went into it in the best interests of their citizens.

 

[noco]

I suppose the GFC and the states refusing to hand over full control all at once had something to do with that... but at the end of the day I just hope they can all agree on some constructive reform to get the ball rolling now.

Don't blame the GFC or the states, that had nothing to do with the National take over of hospitals. Rudd has the constitutional power to take them over and does not need approval from the states. He was afraid of another debacle like all fo the other projects he touches. Now he has the states to blame if things go belly up. That's our Prime Minister.

 

[trainspotter]

Nothing enlightening there mate. That's all old hat now... t'was just idle speculation.

As I originally pointed out you were fundamentally lacking to be in any position to be too critical.

But as I said before the states have been in negotiation for two previous COAG's so they obviously know more than they are telling us too. That's what I'm interested in... what they are not yet telling us.

So if the states agree to something this COAG, then some responsibility for the success or failure of any agreement must rest with the states also, since they went into it in the best interests of their citizens.

So it's all in the detail? Which there isn't any? So it's all been worked out at previous COAG's? With no information forthcoming? So it's all in the Budget? Which will not be revealed for several weeks? So it's all in the Henry Tax Report? Which the Labor Govt will not release until after the May budget?

And you say I am fundamentally lacking to be too critical?? LOLOL ... you funny.

 

[Whiskers]

Rudd has the constitutional power to take them over and does not need approval from the states.

Yes via a referendum if successful... BUT if they did completely take over 'hospitals' they would ALSO obviously need to recoup some of the GST currently going to the states via the IGA to be spent on hospitals.

The only way they can alter that is via a re-negotiated IGA which typically happens at COAG and presumably going on now.

 

[Whiskers]

So it's all in the detail?

Trainspotter, this is what I mean by half-cocked Rabble-Rouser... seeking support by appealing to popular passions and prejudices.

Obviously... as I said before, that the fed and states have a lot more info than you or I and neither are sharing much.

You can get your nickers in as big a knot as you like but it won't change anything cos you are not party to the negotiations, luckily, or I could see them going nowhere fast.

And you say I am fundamentally lacking to be too critical?? LOLOL ... you funny.

Not funny, just realistic. :

 

[trainspotter]

Ohhhhhhhhhh Whiskers, Whiskers, Whiskers, play the ball and not the man for a change will you. Take the emotion out of your context and try and have a meaningful debate. There is no detail on Health Reform (which I have posted), Where is the money coming from? Savings in the Budget (which will not be revealed for several weeks) You referred to the Henry Report (which ALSO will not be revealed until AFTER the budget)

You really cannot see that this is going to be another Rudd monumentous stuff up? Surely you of all people would have to entertain the thought that Rudd is trying to reform a health system but without any overall policy structure in place? Once again ... I repeat ... NO DETAIL.

I am all for Health reform in it's purest form, but chucking more money at something does not instantly make it work? Another layer of bureacracy has to be levelled over the top under Rudd's plan (which has not been worked out who will actually be running the show) and as per my previous post UP TO 10,000 helath workers and administrators will be affected by this vague and wishy washy, visionary, lack of detail attempt to fix something he knows nothing about.

I beseech you Whiskers to open your eyes, or better yet, hand over the information rather then this policy on the fly, popular vote grabbing palava we are seeing unfolding right here, right now in front if us!

P.S. - Not seeking support with popular passions and prejudices (whatever this means?) Just trying to obtain some CLARITY and FACTS on the situation rather than an opinion

 

[Julia]

Alan Kohler's take on what this is all about:

http://www.businessspectator.com.au...economy-pd20100420-4NSGE?OpenDocument&src=kgb

 

[Whiskers]

Alan Kohler's take on what this is all about:

http://www.businessspectator.com.au...economy-pd20100420-4NSGE?OpenDocument&src=kgb

Not sure I'd go so far as to say John Howards GST deal was reckless, politically expedient maybe.

But the following is clearly a thorn in the states side that could get pretty sore if they went to a referendum.

The states, meanwhile, are in breach of contract. They have ignored the bargain struck in 1998 to cut small state taxes like payroll tax and stamp duty, and have instead used the money to grow fat.

Specifically, they have blown the GST on employing public servants.

 

[trainspotter]

Deadlock ! Great link btw Julia. It would appear there is more to this than meets the eye !

Speaking after NSW agreed to allow Canberra to retain 30 per cent of its GST revenue to fund hospitals, Victorian Premier John Brumby indicated he was willing to pay an equivalent amount into a pooled fund.

Mr Brumby said this arrangement would not require legislative change and preserved the integrity of the intergovernmental agreement.

Mr Brumby framed the compromise as a shift of position for Victoria. However, he said it was still "hard to tell actually how today will turn out".

Presenting a united front with Mr Brumby, Mr Barnett said the compromise position handed Mr Rudd "a deal on the table".

"Everyone has given some ground here," Mr Barnett said. "And now Victoria and Western Australia are saying we will provide the money, exactly the same amount of dollars, but we will pay it directly into the pool.

"It is within the Prime Minister's grasp to achieve his health reform very quickly he will achieve everything he set out to do so long as he doesn't try and retain one third of the GST."

 

[Calliope]

Alan Kohler's take on what this is all about:

http://www.businessspectator.com.au...economy-pd20100420-4NSGE?OpenDocument&src=kgb

So the Health Reform charade was just a Trojan Horse to get past the States' defences, and snatch back some ot the GST. It's no wonder we were never told any details about it. Rudd is as cunning as a sewer rat.

 

[Calliope]

Promises, promises, promises, but no time scale. A lot of people will be dead and buried before this golden age of health care kicks in;

"This, ladies and gentlemen, is a very, very big reform of the health and hospital system of Australia," he said.

Work will begin in July to deliver Australians five key changes in health care, Mr Rudd said.

That is 1300 new hospital beds plus another 2500 for those in aged care, as well as 6000 new doctors.

Emergency waiting times will take no longer than four hours and elective surgery is to be delivered on time in 95 per cent of cases.

The fifth element was a ‘‘historic’’ mental health reform, in which 20,000 young people will get access to services, Mr Rudd said.

http://www.smh.com.au/national/rudd-strikes-deal-with-labor-leaders-20100420-sra1.html

 

[Beej]

So the Health Reform charade was just a Trojan Horse to get past the States' defences, and snatch back some ot the GST. It's no wonder we were never told any details about it. Rudd is as cunning as a sewer rat.

Why should the states be allowed to keep GST revenue anyway??? They all waste it massively anyway! Read the Kohler article posted above and note the bloating in the NSW state bureaucracy since the intro of the GST!

 

[IFocus]

Alan Kohler's take on what this is all about:

http://www.businessspectator.com.au...economy-pd20100420-4NSGE?OpenDocument&src=kgb

Thanks for the link Julia hence WA's Liberal premier Colin Barnett wont part with our GST (WA gets ripped of as it is) which I agree with but note he agrees with pretty much every thing else.

Also note it didn't take much to buy Brumby.

 

[IFocus]

Not sure I'd go so far as to say John Howards GST deal was reckless, politically expedient maybe.

But the following is clearly a thorn in the states side that could get pretty sore if they went to a referendum.

Nice commentary Whiskers, Howard did buy the states over by handing out to much but I think the up side beats the down side.