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.