Close hospitals to treat more patients

The AMA is right to be concerned about the impact of the Weatherill government’s plan to restructure hospital services on the number of hospital beds available to treat patients in Adelaide. However, bed numbers of are only one of the factors that determine how long patients have to wait for public hospital care.

This may sound strange, but the way to get more hospital care and reduce waiting times is to close down public hospitals. This is part of the logic behind the controversial proposal to shut the Repatriation General Hospital and close the emergency departments at Queen Elizabeth and Modbury hospitals.

The location of public hospitals across Adelaide, as in all major Australian cities, reflects the transportation and medical realities of the nineteenth century. When the public hospital system was founded in the ‘horse and buggy’ era, every suburb needed its local hospital to provide the community with essential medical and surgical services.

In those days, hospital care was relatively cheap and basic, and it was financially and logistically possible to provide the full range of services then available across all locations.

This has become impossible due to the ever-increasing complexity and technological sophistication of hospital services. Today, it makes more sense to deliver hospital care, particularly high-tech care, in bigger hospitals like the new Royal Adelaide Hospital, especially given modern transport options and how easy it is for patients to travel to access care.

This has left smaller, older hospitals delivering simpler services that often duplicate those that are available in nearby major facilities. The problem with this is that it is very costly to keep open and maintain ageing facilities such as the Repat. The impact on the health budget means that funding has to be spread more thinly across the rest of the system and this reduces the overall capacity to care for patients.

It is common to find units in major hospitals that are under-utilised due to chronic shortages of funding for front-line services. Financial considerations mean, for example, that surgical theatres close at 5 pm, and shut down entirely for many weeks over the Christmas and New Year period.

 The large number of smaller hospitals scattered across rural areas create similar challenges. It is better to concentrate hospital services in larger regional towns and bring in patients from outlying areas either by road or air ambulance, while allowing most country hospitals to operate more or less as GP and first-aid clinics.

However, hospital closures and reconfigurations are emotive and politically sensitive issues. Local communities are strongly attached to their hospitals. When it suits, both sides of politics pander to these sentiments for political advantage. But what isn’t understood is the price the whole community pays for keeping hospitals open – longer waiting times and less hospital care for everyone.

The ageing of the population in coming decades will significantly increase demand for public hospital care. The affordability of the system will depend on ensuring hospital services are delivered efficiently.

If we don’t get the basic structure of the public hospital system right, the state government will find it increasingly difficult to pay for the increased amount of care the community needs.

Closing the Repat and similar hospitals will not just improve the finances of the system, but will also enable funding to be reallocated and ultimately help public hospitals treat more patients.

Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies.