The COAG Reform Council this week released a report on the national reform agenda of the previous Labor government. The major finding was that the national partnership agreements struck between the commonwealth and the states have failed to significantly improve outcomes in health, education and Indigenous welfare.
The theory behind the agreements was that additional funding combined with stricter accountabilities would allow the Commonwealth to manage the states into lifting their games.
Yet even where the report shows improvements in performance with respect to public hospitals, the results are equivocal.
'Solid' progress is said to have been made in speeding up treatment in emergency departments due to the national roll out of the 'four hour rule.' Under the National Access Target for Emergency Departments, which is being progressively phased in over five years, 95% of all patients will have to be either discharged or admitted within four hours. States failing to meet the target will not qualify for federal bonus payments.
That the introduction of the four hour rule has had an impact is not surprising. Targets often work because what is measured tends to be done, especially when additional funding is up for grabs. Equally unsurprising, though, are the unintended – but predictable – consequences.
The Reform Council reports that despite the improvements in emergency waits, waiting times for elective surgery have increased.
Emergency and elective waiting are directly related, and ultimately come down to how hospitals decide to use their acute beds.
If there is a blitz on elective waiting lists, say, more bed are used to admit surgical patients, and emergency waiting times consequently increase. If cutting emergency waiting times is the priority, the reverse applies, and elective waiting times blow out.
The obvious answer is to increase the total number of beds to admit more elective and emergency patients at the same time. However, increasing bed numbers is very difficult in the highly bureaucratic and inefficient public hospital system in which funding increases struggle to make it through to the frontlines as extra services. As the Australian Medical Association's Hospital Report Card found, the number of public hospital beds in Australia has remained 'basically unchanged' in recent years despite substantial funding increases.
This shows how hard it is for governments to genuinely boost public hospital performance no matter what they spend or what targets they set. It also shows why a micro-economic reform agenda desperately needs to be implemented in the sector to raise productivity and generate a real increase in the overall level of taxpayer-funded hospital services provided to the community.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies. His report, with Professor Peter Phelan, Overcoming Governance and Cost Challenges for Australia's Public Hospitals was released on the 14 October 2013.
Home > Commentary > Opinion > COAG ‘reforms’ fail to fix public hospitals
COAG ‘reforms’ fail to fix public hospitals
The theory behind the agreements was that additional funding combined with stricter accountabilities would allow the Commonwealth to manage the states into lifting their games.
Yet even where the report shows improvements in performance with respect to public hospitals, the results are equivocal.
'Solid' progress is said to have been made in speeding up treatment in emergency departments due to the national roll out of the 'four hour rule.' Under the National Access Target for Emergency Departments, which is being progressively phased in over five years, 95% of all patients will have to be either discharged or admitted within four hours. States failing to meet the target will not qualify for federal bonus payments.
That the introduction of the four hour rule has had an impact is not surprising. Targets often work because what is measured tends to be done, especially when additional funding is up for grabs. Equally unsurprising, though, are the unintended – but predictable – consequences.
The Reform Council reports that despite the improvements in emergency waits, waiting times for elective surgery have increased.
Emergency and elective waiting are directly related, and ultimately come down to how hospitals decide to use their acute beds.
If there is a blitz on elective waiting lists, say, more bed are used to admit surgical patients, and emergency waiting times consequently increase. If cutting emergency waiting times is the priority, the reverse applies, and elective waiting times blow out.
The obvious answer is to increase the total number of beds to admit more elective and emergency patients at the same time. However, increasing bed numbers is very difficult in the highly bureaucratic and inefficient public hospital system in which funding increases struggle to make it through to the frontlines as extra services. As the Australian Medical Association's Hospital Report Card found, the number of public hospital beds in Australia has remained 'basically unchanged' in recent years despite substantial funding increases.
This shows how hard it is for governments to genuinely boost public hospital performance no matter what they spend or what targets they set. It also shows why a micro-economic reform agenda desperately needs to be implemented in the sector to raise productivity and generate a real increase in the overall level of taxpayer-funded hospital services provided to the community.
Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies. His report, with Professor Peter Phelan, Overcoming Governance and Cost Challenges for Australia's Public Hospitals was released on the 14 October 2013.
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