Health Reform: Where is it heading?

[trainspotter]

GOSH - So under this new helalth reform system we will have a Federal bureaucracy, A state bureaucracy, local hospital networks, a pricing authority and a national hospitals fund. No duplicity there ?

"Kevin Rudd needs to explain where the money is coming from, he needs to explain what is old money, what is new money and what has been rebadged as part of this package" The mad monk uttered.

Mr Rudd says "Means testing the private health insurance rebate would save 2 billion over the next 4 years" and "All the detailed funding arrangements will be clearly outlined in the May 11 Budget" he squeaked.

What happens if the Opposition blocks passage of these reforms within the Budget? ALSO ... the funds will only flow if WA and Canberra can strike a deal as under the Commonwealth GST Act that ALL states and Territories MUST agree for any tinkering of the GST revenue. PM Rudd dismissed this claim as a mere "accounting measure".

Amazing what you learn when you read up on things Whiskers?

 

[trainspotter]

Coming soon to an operating theatre near you !

 

[Julia]

I think they have recognised long ago that Rudds priority was getting some systemic changes made and the funding was a lower priority as opposed to Howards years where the priority was on 'saving'.

Hmm, well, Australian taxpayers may not be so thrilled about this dubious plan when the Budget begins to detail some of the services that will be lost and the additional taxes applied so the cash handed out with such largesse by Mr Rudd in the last two days may be funded.

I may be doing you an injustice, Whiskers, but I'd suspect that if Mr Abbott put up an alternative proposal for health reform, you'd be amongst the first to cry "but how is he going to pay for it?"

The states only have themselves to blame cos they INSISTED on maintaining full control of management of health services.

Yes, they may have failed to consider the potential adverse effects of this when all is not as rosy as presently being painted.

The point is to preserve that state funding for special purpose health spending as opposed to previously going into state consolidated revenue where the states had total control over where the funding was allocated often displacing from health and other essential services to pork barrel other projects into elections etc.

State GST revenue is growing exponentially and many argue that the states are squandering the GST.

The whole idea of the 30% of current GST being preserved for health spending is to avoid a situation when the fed starts providing more funds for health, that the states don't relocate some of their existing health funding elsewhere and scream poor for more from the fed.

Agreed that this does make more sense, as does the activity based funding model, though it's difficult to see how this is going to work for chronic diseases such as psychoses, cardiovascular disease, diabetes etc.
Sure, have a specific payment for a basic appendectomy, but I can see lots of bureaucratic wrangling in the less clearly defined areas.

Well according to the AMA at least it provides secure funding for 6,000 more doctors. That's the fundamental place to start for long term health planning cos as has been highlighted for years now there is a shortage of doctors.

True, and much of the reduced funding for training of doctors can be attributed to the Howard/Abbott years.


The following is an extract from today's editorial in "The Australian":

The problem is that these funding and governance changes, while significant, leave the nation far short of the comprehensive health reforms Mr Rudd promised before the 2007 election. More than two years on, it is still not clear how the new model will transform the current patchwork of programs and services across the country into an integrated health system appropriate for the 21st century.

Mr Rudd's message was that if Canberra pays for 60% of hospital funds and 100% of everything else, we would end up with a better health system. That looked like a leap of faith in a government that has so comprehensively botched delivery of the home insulation program, to name just one area

That final paragraph seems a pretty good summary of why so many of us are less than convinced the events of the past few days will provide us with a future health nirvana.

 

[Whiskers]

Hmm, well, Australian taxpayers may not be so thrilled about this dubious plan when the Budget begins to detail some of the services that will be lost and the additional taxes applied so the cash handed out with such largesse by Mr Rudd in the last two days may be funded.

Yes, I'm expecting increased tobacco and maybe alcohol taxes to start with although that is probably a good thing. I'm struggling to find many opportunities for them to increase tax revenue or cut back services in light of all the things they have increased and promised.

I think they are also probably budgeting for increased tax receipts from the mining boom picking up again and borrow the balance.

I may be doing you an injustice, Whiskers, but I'd suspect that if Mr Abbott put up an alternative proposal for health reform, you'd be amongst the first to cry "but how is he going to pay for it?"

No, I believe there is, or at least was, scope to spend or borrow a little money for improved health services in particular. I'll wait for the budget forcasts before I worry too much.

I've already stated on another thread that I like Abbotts idea of reverting back to local hospital boards to manage or at least have a say in some of the day today affairs of local health delivery. I think that's an important safeguard to have in the system again.

Since Rudds idea of local/regional hospital management has been loudly rebuked by the states and traded away at COAG, I'm interested now to see if or how Abbott can still accomplish that.

 

[noco]

I have always beleived, the training of doctors and nurses and the administration of universities were a state responsibility. Correct me if I am wrong and the Labor Party have been in power in Queensland since Joh; lost count of the number of years. 15+

The building of new hospitals was also a state responsibility and for years, hospitals were administrated by boards consisting of doctors, senior nurses and financial wizards. I believe that was all changed when Dr. Death was the state director general in the Goss Government in Queensland. Now Dr. Death, as he was known, the one who reduced the number of hospital beds in Queensland by some 2000, says hospital boards should be reintroduced.

As I mentioned before, Townsville with a population growth of 8% per annum, had a new hospital constructed 15 years ago, smaller than the one the state Labor Government demolished and that was when Rudd and Swan worked for Wayne Goss. I hope Rudd has a bit more foresight than he did under Goss. Now Rudd is talking about another 6000 beds Nationally, but of course when is the question!!!!!!!! Maybe Wiskers can enlighten us on that one.

 

[trainspotter]

Whiskers wrote "Since Rudds idea of local/regional hospital management has been loudly rebuked by the states and traded away at COAG, I'm interested now to see if or how Abbott can still accomplish that."

Ummmmm Whiskers old chap ... How can Abbott change what has already been done? PM Rudd has agreed to the deal with the Premiers of each state (less WA of course) and it looks as if this will be set in stone. If and it is a BIG if, the Libs win the next election (or even the one after that) what do you believe Abbott should do about this conundrum? Rudd has created this mess, why does Abbott need to get involved in trying to mend something he did not break?

 

[trainspotter]

THE Federal Government has left the door open to changing the amount of GST it takes back from the states and territories as part of its health and hospital reforms.

In the National Health and Hospitals Network Agreement, signed with the leaders that were on board with the deal, no GST amount is specified.

The agreement also states: "There will be a review of the level of GST dedicated once the system has transitioned to an efficient price."

http://www.coag.gov.au/ for the FACTS and FIGURES ... at last Whiskers !

My favourite bit is "Western Australia has not agreed to either the retention of the goods and services tax (GST) or the associated funding governance arrangements. Western Australia and the Commonwealth have agreed to continue discussions."

Should it read "Western Australia has not agreed to being a signatory to the National Health and Hospitals Network which has been setup to provide seamless care across sectors of the National health system."

Hmmmmmmmm .... GST grab ...... LMAO

 

[Whiskers]

I have always beleived, the training of doctors and nurses and the administration of universities were a state responsibility. Correct me if I am wrong.

Happy too... pretty simple really.

I'm not a medical person, but like many Uni positions there are quotas on the number of positions available. There has traditionally been a pretty tight limit on the number of doctors to maintain quality by picking of the best high school score's and also to protect the financial stability of doctors professions.

If I recall correctly Bligh funded some additional positions a few years ago for Qld, but I think it's normally mostly a federal funded thing as it's a national accreditation scheme.

When Rudd and Swan worked for Goss, Goss was the boss and called the shots. Surely that one is obvious.

Now Rudd is talking about another 6000 beds Nationally, but of course when is the question!!!!!!!! Maybe Wiskers can enlighten us on that one

As I mentioned previously the AMA has said there is spare capacity in some areas of health professionals that can be utilised as soon as there are beds available. It would seem that at least some beds should be able to be made available come July when the first money is available.

Ummmmm Whiskers old chap ... How can Abbott change what has already been done?

The same way it was done... renegotiate it or an alternative.

PM Rudd has agreed to the deal with the Premiers of each state (less WA of course) and it looks as if this will be set in stone. If and it is a BIG if, the Libs win the next election (or even the one after that) what do you believe Abbott should do about this conundrum?

At this stage, until the full details are available after the budget, probably not much, except press on with more detail for his local hospital management idea.

Rudd has created this mess, why does Abbott need to get involved in trying to mend something he did not break?

It seems generally recognised that the system did start to become 'broken' under his term as health minister for Howard and a long period of funding stagnation.

If he wants to win the next election he needs to come up with something better.

 

[Whiskers]

THE Federal Government has left the door open to changing the amount of GST it takes back from the states and territories as part of its health and hospital reforms.

In the National Health and Hospitals Network Agreement, signed with the leaders that were on board with the deal, no GST amount is specified.

The agreement also states: "There will be a review of the level of GST dedicated once the system has transitioned to an efficient price."

http://www.coag.gov.au/ for the FACTS and FIGURES ... at last Whiskers !

My favourite bit is "Western Australia has not agreed to either the retention of the goods and services tax (GST) or the associated funding governance arrangements. Western Australia and the Commonwealth have agreed to continue discussions."

Should it read "Western Australia has not agreed to being a signatory to the National Health and Hospitals Network which has been setup to provide seamless care across sectors of the National health system."

Hmmmmmmmm .... GST grab ...... LMAO

Wrong! So ignorantly and carelessly Wrong!


If you read the correct detail http://www.coag.gov.au/ further down the page under National Health and Hospitals Network Agreement RTF 1.05 MB | PDF 406KB and Schedule C, it spells it all out.

 

[Calliope]

Wrong! So ignorantly and carelessly wrong!
If you read the correct detail http://www.coag.gov.au/ further down the page under National Health and Hospitals Network Agreement RTF 1.05 MB | PDF 406KB and Schedule C, it spells it all out.

(I have deleted all your silly shouting)

You are having a hard time trying to sell this package. I know that in your eyes we are ignorant rabble rousers. This is the same view that Rudd takes and you are hoping to get noticed by the Party Machine. I suspect that you are part of it already, or are in receipt of largesse from their lax money management.

Your fine print contains nothing of substance. All we have so far are vague promises of more beds, more doctors, reduced waiting lists, maybe improved mental care, at some vague time in the future.

Sure, there will be some sweeteners in the budget before the election. But this is only to keep the health pot boiling until they get re-elected . After that the whole edifice will come crashing down.

It's only today that the Government has admitted that it can't manage the home insulation scheme. I think the hospital mess would be much more difficult to sort out.

You should give up. The Party Machine will give you marks for trying.

 

[Whiskers]

Talking about silly!

Just for you Calliope, the gist of my conversation that you jumped into was to correct some profoundly incorrect statements of fact in trainspotters post.

It has nothing to do with party politics (which I am not), plain and simply using the correct data and information to make informed specific judgements as opposed to loose, generalised waffle.

Let me further demonstrate.

Your fine print...

It is clearly not my fine print.

It's part of the detail of the CAOG Agreement of which you know I had no part of.

...contains nothing of substance.

How silly again!

So if the COAG agreement contains nothing of substance you tell me what is more substantive.

Whether we agree or dissagree with what was agreed to, that is the total substance of the progress of health reform to date. It's a legal binding contract between the fed and states.

In fact there is quite a few $billion of extra substance in it to be scrutinized.

I'm certain I'd rather rely on that for my critique of COAG agreements and health reform in particular than most of your useless analysis and commentry.

................

Meanwhile, on a brief read of the agreement, it seems Rudd has also secured full control of GP training from the states in the future.

That may be a good thing to have a one stop control of GP training... but it also means the fed effectively has the health system by the proverbial Ba!!s in terms of future staffing and ultimately expansion of the system. Potentially, no agree with fed at future COAG's, no new doctors, system shrinks.

 

[trainspotter]

Wrong! So ignorantly and carelessly Wrong!


If you read the correct detail http://www.coag.gov.au/ further down the page under National Health and Hospitals Network Agreement RTF 1.05 MB | PDF 406KB and Schedule C, it spells it all out.

Ummmmmmmm Whiskers ... it does not give a GST amount? Read it again there old chap. It says the amount of GST dedicated to health care will be fixed blah blah blah .... oooooopsies ! Devil in the details again perhaps?

Which part of this is ignorant and wrong Whiskers? Please stop using the colour and the bolding ... it hurts my eyes and it means you are struggling to get your point across.

Read here http://www.wabusinessnews.com.au/en-story/1/79977/Health-deal-leaves-GST-door-open- if you want some factual reporting on the subject matter at hand.

 

[trainspotter]

Whiskers wrote "Just for you Calliope, the gist of my conversation that you jumped into was to correct some profoundly incorrect statements of fact in trainspotters post. "

What part of NO GST AMOUNT do you not comprehend? Read it again Whiskers for the love of BEER ! Your rhetoric is like Japanese water torture to my brain. You are forcing words and attributing them to me is growing unbearable to read. Take the emotion out of your context and have a meaningful discussion on this thread please.

Again just for comedy purposes only - http://www.wabusinessnews.com.au/en-story/1/79977/Health-deal-leaves-GST-door-open-

Announcing his original plan in early March, Mr Rudd flagged the GST clawback would be around one-third of revenues.

But in the National Health and Hospitals Network Agreement, signed with the leaders that were on board with the deal, no GST amount is specified.

The agreement also states: "There will be a review of the level of GST dedicated once the system has transitioned to an efficient price."

It does, however, again commit that no state government will be worse off in the short-term and "all will be better off in the long-term".

The language has also shifted to reflect the greater role the states will have in managing the system.

Mr Rudd has consistently stated his reform plan is all about creating a system that is "funded nationally and controlled locally".

But the new intergovernmental agreement, released publicly on Wednesday, now makes clear the national health and hospitals network "will be a nationally unified and locally controlled health system".

In order to get NSW and Victoria onside, Mr Rudd had to agree that federal and state funding would be pooled in state-based "funding authorities".

The prime minister had wanted the commonwealth to directly fund the networks.

 

[Whiskers]

Ummmmmmmm Whiskers ... it does not give a GST amount? Read it again there old chap. It says the amount of GST dedicated to health care will be fixed blah blah blah .... oooooopsies ! Devil in the details again perhaps?

Which part of this is ignorant and wrong Whiskers? Please stop using the colour and the bolding ... it hurts my eyes and it means you are struggling to get your point across.

You apparently don't know how to read reports.

If you had read the document in context ie the parts that the afforementioned Schelule refers too, (below) you would see that there is no 'open door', the states have agreed to a process and formula for the GST over the next few years.
:

Read here http://www.wabusinessnews.com.au/en-story/1/79977/Health-deal-leaves-GST-door-open- if you want some factual reporting on the subject matter at hand.

What... factual Reporting! Dramatic reporting more like.

PS: For the love of mike, trainspotter... read the definition and what the agreement says about "efficient price". That transition process has been agreed to.

 

[trainspotter]

So you agree then Whiskers there is NO GST AMOUNT specified other than a formula that cannot be quantified due to no end point? WTF?

 

[Whiskers]

So you agree then Whiskers there is NO GST AMOUNT specified other than a formula that cannot be quantified due to no end point? WTF?

Fair dinkum mate! How dumb is that statement! The GST amount is and always was dynamic, you know what that means... changing every year.

There is a 30% of current GST specified and there is an agreed process and formula to workout the amount for following years.

If you want to work out the exact amount of $ simply find the lastest GST revenue and apply the agreed process and formula and you will have an end point, quantified for one particular year.

What do you want... someone to say the GST amount is fixed at $x for this year and ever after.

Obviously it's not... it's a dynamic amount!

 

[Calliope]

Just for you Calliope, the gist of my conversation that you jumped into was to correct some profoundly incorrect statements of fact in trainspotters post.

At least you got "gist" right this time. So you're learning. Good boy.

It has nothing to do with party politics (which I am not), plain and simply using the correct data and information to make informed specific judgements as opposed to loose, generalised waffle.

Rubbish.

Why don't you get a job? Or are you paid to spread party propaganda?

 

[trainspotter]

Fair dinkum mate! How dumb is that statement! The GST amount is and always was dynamic, you know what that means... changing every year.

There is a 30% of current GST specified and there is an agreed process and formula to workout the amount for following years.

If you want to work out the exact amount of $ simply find the lastest GST revenue and apply the agreed process and formula and you will have an end point, quantified for one particular year.

What do you want... someone to say the GST amount is fixed at $x for this year and ever after.

Obviously it's not... it's a dynamic amount!

Show me WHERE in the document this is stated? The 30% that is? Nup .. nowhere ! Please stop the character assasinations and name calling please as it reflects poorly on your ability to communicate.

I completely understand the funding is open ended and is indexed to the GST amount and that the GST revenue can rise or fall of each state etc ad infinitum. I get that Whiskers .. that was never a moot point. You raised this issue NOT ME. I am merely asking for you to evidence the 30% of GST in the document you prescribe to. Nup, nowhere is it written? It has been widely reported in the media that the number is 30% but not factual in the COAG document. You will note that it does say in the document that the GST injection is dependent on efficiencies and it GUARANTEES that no state will be worse off.

It appears that what we have here is a failure to communicate.

Trainspotter out.

 

[Whiskers]

Show me WHERE in the document this is stated? The 30% that is? Nup .. nowhere ! Please stop the character assasinations and name calling please as it reflects poorly on your ability to communicate.

I completely understand the funding is open ended and is indexed to the GST amount and that the GST revenue can rise or fall of each state etc ad infinitum. I get that Whiskers .. that was never a moot point. You raised this issue NOT ME. I am merely asking for you to evidence the 30% of GST in the document you prescribe to. Nup, nowhere is it written? It has been widely reported in the media that the number is 30% but not factual in the COAG document. You will note that it does say in the document that the GST injection is dependent on efficiencies and it GUARANTEES that no state will be worse off.

It appears that what we have here is a failure to communicate.

Trainspotter out.

The 30% is a nominal average amount that the states already spend on health that the fed wanted to quarantine for health permenantly.

It is implied in the words of par 14 particularly "as outlined in this Agreement", in other words state funding will continue as per current SPP's and, normal proportion of GST, nominal 30%, plus additional fed funding as specified through the transition period and 'efficient price' establishment.

You will note that there is a requirement for the interchange of documents and statistics through the transition period... so if anyone tries to significantly sway their spending to distort the transition calc's they will not only face the wrath of the fed, but the other states.

 

[Julia]

This writer to "The Punch" has a good point about paying for private health insurance.
If we are to believe Mr Rudd's assurance that waiting times for elective surgery will be magically reduced, if necessary by utilising private hospitals, then why would we continue paying the ever increasing private health premiums, along with subsidising our fellow citizens who choose to have no private cover?

Brenda Posted at 7:48 AM Today

I wish someone would stop this man. He's out of control. Rudd's health plan, meant to take pink batt deaths off the front pages, is already floundering. At the least, if it eventuates (and I doubt it) that very soon we can all be guaranteed a public hospital bed within 4 weeks or taxpayers will further subsidise us into a high cost private hospital bed, I will be able to drop private hospital insurance. No point in paying big premiums if private hospital care will be taxpayer funded. Therein lies the next monumental stuff-up.