Comments on Ross Gittins "Increasing GST a fanciful fix for strained budgets", 22/07/2015
And more than what you have already put very nicely is that why the politicians aren't talking about spending restraint at all. Why don't they review the necessity of the ever increasing share of spending on health, is that really the case that each and every dollar spent on health is that important and there is no waste in all that very big and increasing rapidly spending on health? Why don't they consider making the spending more effective and reducing waste and changing people's demand behaviour so the nation as a whole can use less and do more effectively?
All that suggests that the politicians are very lazy and not accountable to the trust that the electorate provided to them. All they do is to use health spending as an excuse to increase taxes. I would suggest that we should have a measure or mechanism that punishes higher taxing politicians.
Perhaps some international comparison would be helpful, but it seems hardly we hear any such discussions..
Showing posts with label health reforms. Show all posts
Showing posts with label health reforms. Show all posts
2011-08-24
Deeble is wrong on PHI
Comments on John Deeble “Health insurance rebate changes won't hurt”, 24/08/2011, http://www.theaustralian.com.au/news/opinion/health-insurance-rebate-changes-wont-hurt/story-e6frg6zo-1226120746949
John Deeble, though architect of Medicare, is using arguments that are out of date and out of appropriate context.
The argument of the "capacity to pay principle" is misleading at best. One should not ignore the fact that the private health insurance has been forced to many people by government and is not their own voluntary choices.
The argument of the "capacity to pay principle" is misleading at best. One should not ignore the fact that the private health insurance has been forced to many people by government and is not their own voluntary choices.
Even taking the point of Deeble's equity argument, there should be at most a ceiling of subsidy to a family, adjusted by the number of people in a household covered by the insurance.
On the contrary, Deeble simply spreads and propagates the government' point of view and argument that is neither equitable nor fair by any reasonable standard.
On the contrary, Deeble simply spreads and propagates the government' point of view and argument that is neither equitable nor fair by any reasonable standard.
His thinking of Medicare principle should have moved on to beyond simple equity measurement and realise and acknowledge the fact that higher income people contribute to a higher share of Medicare contribution per person and in return to receive the same medical services from public hospitals.
The proposed reform by the government masks its out of date ideology and targets many people unfairly just like the payments related to its proposed carbon tax that ignores the fundamental rights of everyone equally to a better environment and is used by the government for income redistribution purpose that is appalling and should not be passed to law.
2011-03-16
Jeremy Sammut has good points
Comments on Jeremy Sammut “Cure Medicare mess”, 16/03/2011, http://www.theaustralian.com.au/news/opinion/cure-medicare-mess/story-e6frg6zo-1226022070655
The following idea of Jeremy Sammut's is worth considering:
"Bulk-billing should be scrapped and the budget savings used to establish a national system of individualised Health Savings Accounts. Consumers will become cost-conscious and overuse will be minimised when they spend their own money on GP and other non-hospital services."
Two points are important in terms of health care. Firstly, its expenses cannot be open ended and funded freely by government alone, because it has some characteristics of luxury goods besides its normal functions of cure needs. There must be effective constraints on them.
Secondly, the best health care system is to have each person in charge of his or her own care needs and the priority of health care spending with a budget constraint that is funded through taxation. Each one can be different and has different needs. It is impossible for a government to be in charge and to provide tail-made health care for everyone.
Rapid growth in healthcare spending is a big problem for governments. Population aging will add further pressure to it. The government should reform the current Medicare system. And it’d be better to start it as early as possible.
The following idea of Jeremy Sammut's is worth considering:
"Bulk-billing should be scrapped and the budget savings used to establish a national system of individualised Health Savings Accounts. Consumers will become cost-conscious and overuse will be minimised when they spend their own money on GP and other non-hospital services."
Two points are important in terms of health care. Firstly, its expenses cannot be open ended and funded freely by government alone, because it has some characteristics of luxury goods besides its normal functions of cure needs. There must be effective constraints on them.
Secondly, the best health care system is to have each person in charge of his or her own care needs and the priority of health care spending with a budget constraint that is funded through taxation. Each one can be different and has different needs. It is impossible for a government to be in charge and to provide tail-made health care for everyone.
Rapid growth in healthcare spending is a big problem for governments. Population aging will add further pressure to it. The government should reform the current Medicare system. And it’d be better to start it as early as possible.
2011-02-16
Kelly is right: no big bang health reform, just realism
This is an expanded version of my comments online. There is a limit of 1200 characters for comments online for the Asutralian.
Comments on Paul Kelly “No big bang health reform, just realism”, 16/02/2011, http://www.theaustralian.com.au/news/opinion/no-big-bang-health-reform-just-realism/story-e6frg6zo-1226006577132
While the basic framework of equal partnership with 50-50 of increased funding can stick, there is no guarantee that the core concept of the single national pool will survive.
Equal partnership clarifies the role of funding by each layer of government. That will save potential future arguments between the federal and state governments that exist under the current funding arrangement. In that sense, it is good for the federation. It also separates the funding responsibility and operational responsibility. So the state and territory governments will be accountable for hospital outcomes.
Further, it was never a good approach to take money from the States and brand it as Commonwealth funding that was the sticking point with the Rudd package last year. Asking the states to give up 30% of their GST revenue to give that to the Commonwealth and to enable to have 60% of funding was simply a very crude political joke.
But there is still the question of hospitals versus primary health care and the cost shifting between them. Better primary care can reduce the high hospital rates existing now and reduce hospital costs.
The states and territories are unlikely to give up their control over their own potion of the health fund. More importantly, they don’t want their funds redistributed among the states and territories. So it is highly likely that it will be either a single fund in name only with eight separate accounts, eight separate pools, or nine (8+1) pools.
The efficiency argument can be empty without substance if the rise in hospital costs is from increasing demand. Further the concept of efficiency funding is easy to say but very difficult to do.
Wages are different between the states and locations within a state. Transport costs are different. Other costs can also be affected by location within a state and between the states. So the notion of a single efficiency price does not exist in reality. You can only compare likes with likes. You cannot compare pears with apples.
It is likely there are many efficiency prices for the same medical treatment between hospitals across different locations and states to reflect those underlying cost differences beyond the control of individual hospitals.
These kinds of cost differences are best reflected in the costing of state services by the Commonwealth Grants Commission in its work to distribute the GST revenue among the states and territories.
Whether it is the Productivity Commission, the proposed to be created newly independent authority or another agency to do the efficiency pricing, it will be a difficult job and there will be a lot of arguments from different states and different hospitals on how their efficiency price needs to be higher.
The jury is still out on whether Gillard can deliver and the crucial test if the single national funding pool where it is likely that serious problems can arise.
Comments on Paul Kelly “No big bang health reform, just realism”, 16/02/2011, http://www.theaustralian.com.au/news/opinion/no-big-bang-health-reform-just-realism/story-e6frg6zo-1226006577132
While the basic framework of equal partnership with 50-50 of increased funding can stick, there is no guarantee that the core concept of the single national pool will survive.
Equal partnership clarifies the role of funding by each layer of government. That will save potential future arguments between the federal and state governments that exist under the current funding arrangement. In that sense, it is good for the federation. It also separates the funding responsibility and operational responsibility. So the state and territory governments will be accountable for hospital outcomes.
Further, it was never a good approach to take money from the States and brand it as Commonwealth funding that was the sticking point with the Rudd package last year. Asking the states to give up 30% of their GST revenue to give that to the Commonwealth and to enable to have 60% of funding was simply a very crude political joke.
But there is still the question of hospitals versus primary health care and the cost shifting between them. Better primary care can reduce the high hospital rates existing now and reduce hospital costs.
The states and territories are unlikely to give up their control over their own potion of the health fund. More importantly, they don’t want their funds redistributed among the states and territories. So it is highly likely that it will be either a single fund in name only with eight separate accounts, eight separate pools, or nine (8+1) pools.
The efficiency argument can be empty without substance if the rise in hospital costs is from increasing demand. Further the concept of efficiency funding is easy to say but very difficult to do.
Wages are different between the states and locations within a state. Transport costs are different. Other costs can also be affected by location within a state and between the states. So the notion of a single efficiency price does not exist in reality. You can only compare likes with likes. You cannot compare pears with apples.
It is likely there are many efficiency prices for the same medical treatment between hospitals across different locations and states to reflect those underlying cost differences beyond the control of individual hospitals.
These kinds of cost differences are best reflected in the costing of state services by the Commonwealth Grants Commission in its work to distribute the GST revenue among the states and territories.
Whether it is the Productivity Commission, the proposed to be created newly independent authority or another agency to do the efficiency pricing, it will be a difficult job and there will be a lot of arguments from different states and different hospitals on how their efficiency price needs to be higher.
The jury is still out on whether Gillard can deliver and the crucial test if the single national funding pool where it is likely that serious problems can arise.
2011-02-14
Gillard health model signed but not sealed
Comments on Matthew Franklin “Strong stand on scrutiny shows PM's mettle”, 14/02/2011, http://www.theaustralian.com.au/news/opinion/strong-stand-on-scrutiny-shows-pms-mettle/story-e6frg6zo-1226005398639
Is this another copy of the mining tax fix just before the last election to show Gillard can achieve as the PM?
Since then we have seen 'all' is not all drama in terms of the mining tax promises.
Subsequent election see Gillard lose the majority and she negotiated very hard with broken promise on carbon tax to just get the Greens and some independents on side to form a minority government.
What is likely to come after this heads of agreement?
One has to wait and see.
But I would bet that the national pool is unlikely to be different from the previous eight pools in practice.
Is this another copy of the mining tax fix just before the last election to show Gillard can achieve as the PM?
Since then we have seen 'all' is not all drama in terms of the mining tax promises.
Subsequent election see Gillard lose the majority and she negotiated very hard with broken promise on carbon tax to just get the Greens and some independents on side to form a minority government.
What is likely to come after this heads of agreement?
One has to wait and see.
But I would bet that the national pool is unlikely to be different from the previous eight pools in practice.
2011-02-13
Transprent health funding commit both layers of government
Comments on Adam Cresswell “Shortcomings aplenty in tempting proposal”, 12/02/2011, http://www.theaustralian.com.au/news/opinion/shortcomings-aplenty-in-tempting-proposal/story-e6frg6zo-1226004693697
It is so misleading to talk about 50-50 funding when it is only applied to growth funding instead of the total funding.
I think the proposed single national pool of health fund may not be accepted by the states - they are unlikely to give up the control of their money.
An acceptable model is for the federal money to be operating in the single pool model that Gillard has proposed and leave the states' money to the states to manage their own money and adopt the national reporting and efficient funding at least for the federal funding part.
The federal government can, together with the states, implement the reforms of transparency and efficiency funding.
It can also demand the states their 50% must exclude their bureaucratic health administration costs.
This fixed funding model commit both layers of government in terms of funding. It also saves the difficult negotiations between the two layers on funding in the absence of a transparent model.
The federal government needs to make sure that it will not reduce its share of contribution to health funding.
It is so misleading to talk about 50-50 funding when it is only applied to growth funding instead of the total funding.
I think the proposed single national pool of health fund may not be accepted by the states - they are unlikely to give up the control of their money.
An acceptable model is for the federal money to be operating in the single pool model that Gillard has proposed and leave the states' money to the states to manage their own money and adopt the national reporting and efficient funding at least for the federal funding part.
The federal government can, together with the states, implement the reforms of transparency and efficiency funding.
It can also demand the states their 50% must exclude their bureaucratic health administration costs.
This fixed funding model commit both layers of government in terms of funding. It also saves the difficult negotiations between the two layers on funding in the absence of a transparent model.
The federal government needs to make sure that it will not reduce its share of contribution to health funding.
2011-02-05
Gillard's changes for changes sake?
Comments on Dennis Shanahan “Just the latest Rudd project to be junked”, 5/02/2011, http://www.theaustralian.com.au/news/opinion/just-the-latest-rudd-project-to-be-junked/story-e6frg6zo-1226000468745
This reflects very badly on all the federal Labor involved in the various Rudd era projects/reforms, including Gillard then as the deputy PM, Swan as the Treasurer, Roxon as the health minister.
It also reflects very poorly on top federal bureaucrats, such as the key people in PMC, Treasury and Health, given that they were closely involved in advising and developing those projects and policies/reforms.
Of course, it is still very early to know whether the changes will be good for Australia or not until the alternative plans are proven to be better. Having said that, the junk of some of the so called greens projects such as the cash for clunkers will be good for the nation as long as the alternative spending is managed well.
It appears, though, that Gillard, Swan and Wong may be more concerned with short term budget bottom line as opposed to real reforms that would create long term benefits to the nation.
Gillard needs to articulate clearly that her changes are not aimed at short term budgetary pressures but in the nation's long term interest.
She must do that with sound reasons and convince the sceptical public.
This reflects very badly on all the federal Labor involved in the various Rudd era projects/reforms, including Gillard then as the deputy PM, Swan as the Treasurer, Roxon as the health minister.
It also reflects very poorly on top federal bureaucrats, such as the key people in PMC, Treasury and Health, given that they were closely involved in advising and developing those projects and policies/reforms.
Of course, it is still very early to know whether the changes will be good for Australia or not until the alternative plans are proven to be better. Having said that, the junk of some of the so called greens projects such as the cash for clunkers will be good for the nation as long as the alternative spending is managed well.
It appears, though, that Gillard, Swan and Wong may be more concerned with short term budget bottom line as opposed to real reforms that would create long term benefits to the nation.
Gillard needs to articulate clearly that her changes are not aimed at short term budgetary pressures but in the nation's long term interest.
She must do that with sound reasons and convince the sceptical public.
2010-11-18
Health reforms and the 30% GST hand over by the states and territories
Comments on Sue Dunlevy “GST row threatens health reforms”, 18/11/2010, http://www.theaustralian.com.au/national-affairs/gst-row-threatens-health-reforms/story-fn59niix-1225955231264
The strangest thing was why those states and territories that will hand over more than 30% of their GST had agreed to the deal in the first place.
According to the revelation of this report, the ACT will hand over back between 48 and 50 per cent of its GST, that is very different from 30%.
I remember that the ACT chief minister Stanhope said it was a good deal for the ACT.
One has to wonder what can be a worse deal for the ACT!
PS: the information on how much a state or territory has to hand over its GST is contained in the federal budget paper no. 3, 2010-11, that has been available since the budget night early this year.
The strangest thing was why those states and territories that will hand over more than 30% of their GST had agreed to the deal in the first place.
According to the revelation of this report, the ACT will hand over back between 48 and 50 per cent of its GST, that is very different from 30%.
I remember that the ACT chief minister Stanhope said it was a good deal for the ACT.
One has to wonder what can be a worse deal for the ACT!
PS: the information on how much a state or territory has to hand over its GST is contained in the federal budget paper no. 3, 2010-11, that has been available since the budget night early this year.
2010-04-23
Health reform agreement and GST implications
Comments on Sue Cato “Post-COAG triage”, 23/04/2010, http://www.businessspectator.com.au/bs.nsf/Article/COAG-health-reform-Kristina-Keneally-Rudd-pd20100422-4R2QT?OpenDocument&src=blb
Many people may be puzzled why the Western Australia Premier Colin Barnett has been alone in not accepting the health agreement deal, including some policy makers and analysts.
It would be interesting to know if Sue Cato understands the GST implications for WA and other States when she judged that Barnett was a loser in not accepting the agreement at its current form.
Had Barnett accepted the deal on Tuesday, WA would or could be a big loser out of GST allocation.
As Barnett said WA now gets only 68 cents in a dollar. If the Commonwealth Grants Commission does not change its assessments and only the GST pool is reduced by a third, then WA is likely to get 46 cents in a dollar, while some other States get more.
While it is likely that Barnett will hand over 1/3 of WA's GST revenue to the Commonwealth in the end, he will make sure that all these changes will not further disadvantage WA in GST allocation by the Commonwealth Grants Commission.
So, it is premature to declare that Barnett is a loser. Barnett is much more clever than many commentators are on this GST issue.
Many people may be puzzled why the Western Australia Premier Colin Barnett has been alone in not accepting the health agreement deal, including some policy makers and analysts.
It would be interesting to know if Sue Cato understands the GST implications for WA and other States when she judged that Barnett was a loser in not accepting the agreement at its current form.
Had Barnett accepted the deal on Tuesday, WA would or could be a big loser out of GST allocation.
As Barnett said WA now gets only 68 cents in a dollar. If the Commonwealth Grants Commission does not change its assessments and only the GST pool is reduced by a third, then WA is likely to get 46 cents in a dollar, while some other States get more.
While it is likely that Barnett will hand over 1/3 of WA's GST revenue to the Commonwealth in the end, he will make sure that all these changes will not further disadvantage WA in GST allocation by the Commonwealth Grants Commission.
So, it is premature to declare that Barnett is a loser. Barnett is much more clever than many commentators are on this GST issue.
2010-04-22
New health agreement/reform is structural reforms
Comments on Arthur Sinodinos “Captain Rudd still hasn't set course for reform”, 22/04/2010, http://www.theaustralian.com.au/news/opinion/captain-rudd-still-hasnt-set-course-for-reform/story-e6frg6zo-1225856600217
Although the health reform agreement is not perfect especially all healthcares are not quite integrated, it should have significant structural reform components in it if the activity based funding and local hospital board are well implemented.
They will increase efficiency and productivity as well as effectiveness.
Of course, further reforms will be needed once the local hospital boards are working well. They may provide a step towards an integrated local health boards to integrate all health.
There will also be a need to consider how small hospitals can be integrated into a whole health system, so the regional distribution of hospitals are optimised to best serve the nation’s and regional health.
Further, there should be some formula to encourage efficiency quasi-activity based funding for small hospitals, taking into account their scale and local population.
Of course, Arthur has a point that the health reform agreement now is quite different from Rudd’s original plan. The agreement, however, is better than Rudd’s original. The argument that States are still involved is misinformed and misconception. States, albeit their shortcomings, are still better positioned to manage hospitals than the Commonwealth from Canberra – more remote from the public and patients needs with no or little complex services experience.
What the change in the plan means is that the original plan was not as good as it could and should have been – a reflection of a gap in its original development and the government’s limitations in its capacity in developing best policies.
Although the health reform agreement is not perfect especially all healthcares are not quite integrated, it should have significant structural reform components in it if the activity based funding and local hospital board are well implemented.
They will increase efficiency and productivity as well as effectiveness.
Of course, further reforms will be needed once the local hospital boards are working well. They may provide a step towards an integrated local health boards to integrate all health.
There will also be a need to consider how small hospitals can be integrated into a whole health system, so the regional distribution of hospitals are optimised to best serve the nation’s and regional health.
Further, there should be some formula to encourage efficiency quasi-activity based funding for small hospitals, taking into account their scale and local population.
Of course, Arthur has a point that the health reform agreement now is quite different from Rudd’s original plan. The agreement, however, is better than Rudd’s original. The argument that States are still involved is misinformed and misconception. States, albeit their shortcomings, are still better positioned to manage hospitals than the Commonwealth from Canberra – more remote from the public and patients needs with no or little complex services experience.
What the change in the plan means is that the original plan was not as good as it could and should have been – a reflection of a gap in its original development and the government’s limitations in its capacity in developing best policies.
2010-04-21
Advice on WA GST issue
WA should and can ask to guarantee its GST allocation will not be affected by health reforms especially the Commonwealth retaining 1/3 of GST revenue.
It can be done by a Federal Treasurer guarantee, through instructions to CGC in its assessments of GST sharing relativities. This can be written in the agreement.
That is perfectly logical, reasonable and realistic.Many things have been done that way, including senate political bargaining for particular states SPP in the past.
WA's case is much stronger, given that this is Commonwealth request, a change to intergovernmental agreement, and the PM has publically said no States will be financially worse off.
So, the WA Premier should be strong, firm and go for it. He will get it.
WA Treasury should be able to advise the WA Treasurer and the Premier on how this can be done.
It can be done by a Federal Treasurer guarantee, through instructions to CGC in its assessments of GST sharing relativities. This can be written in the agreement.
That is perfectly logical, reasonable and realistic.Many things have been done that way, including senate political bargaining for particular states SPP in the past.
WA's case is much stronger, given that this is Commonwealth request, a change to intergovernmental agreement, and the PM has publically said no States will be financially worse off.
So, the WA Premier should be strong, firm and go for it. He will get it.
WA Treasury should be able to advise the WA Treasurer and the Premier on how this can be done.
Colin Barnett has a strong point on GST
Comments on CHALPAT SONTI “WA left out of national hospitals deal as negotiations break down”, 20/04/2010, http://www.watoday.com.au/wa-news/wa-left-out-of-national-hospitals-deal-as-negotiations-break-down-20100420-sr9d.html?posted=sucessful
The WA Premier has a strong point on GST for two reasons.
It is State revenue and should generally be left to the States unless there are solid reasons not to do so.
WA's GST allocation would be impacted significantly if no considerations on future GST allocation by the CGC are done.
Obviously, it is difficult to not to give up WA's 1/3 GST revenue given that all other States and territories have agreed to do so.
However, WA can and should ask the Commonwealth Treasurer to make sure WA is not disadvantaged financially by doing that. That is to say, the CGC assessments should make sure changes in health and the Commonwealth retaining 30% of GST should not affect future GST distributions.
The PM has said that publically that no States will be disadvantaged financially by health reform. So it is perfectly reasonable and realistic for WA Premier to achieve his goal.
The WA Premier has a strong point on GST for two reasons.
It is State revenue and should generally be left to the States unless there are solid reasons not to do so.
WA's GST allocation would be impacted significantly if no considerations on future GST allocation by the CGC are done.
Obviously, it is difficult to not to give up WA's 1/3 GST revenue given that all other States and territories have agreed to do so.
However, WA can and should ask the Commonwealth Treasurer to make sure WA is not disadvantaged financially by doing that. That is to say, the CGC assessments should make sure changes in health and the Commonwealth retaining 30% of GST should not affect future GST distributions.
The PM has said that publically that no States will be disadvantaged financially by health reform. So it is perfectly reasonable and realistic for WA Premier to achieve his goal.
The health deal is a good one
Comments on Dennis Shanahan “It's a 'deal', except not everyone agreed”, 21/04/2020, http://www.theaustralian.com.au/news/opinion/its-a-deal-except-not-everyone-agreed/story-e6frg6zo-1225856147849
Rudd must be commended and congratulated for the achievement of such an agreement, even though with significant compromises.
There are significant reforms that will benefit from improved funding mechanism, hospital management and State health management, as well as significant integration in healthcares.
Many sides have compromised to achieve that.
The compromises are sensible, meaning real cooperative federation with the States. The Commonwealth is not necessarily better positioned to run public hospitals anyway.
He should be able to get WA on side, with some additional financial guarantee in exchange for a third of GST.
It represents real progress and excellent reforms.
It is closer to what I have porposed, even though it is not perfect.
Rudd must be commended and congratulated for the achievement of such an agreement, even though with significant compromises.
There are significant reforms that will benefit from improved funding mechanism, hospital management and State health management, as well as significant integration in healthcares.
Many sides have compromised to achieve that.
The compromises are sensible, meaning real cooperative federation with the States. The Commonwealth is not necessarily better positioned to run public hospitals anyway.
He should be able to get WA on side, with some additional financial guarantee in exchange for a third of GST.
It represents real progress and excellent reforms.
It is closer to what I have porposed, even though it is not perfect.
2010-04-20
Rudd should be congratulated for historical health reform deal
News reports that a historical deal on health reform has been reached between the Commonwealth and the States and Territories governments except the Western Australian government.
There will be a national pool of health (public hospitals) funding with the commonwealth as the dominant funder of 60% to start with and the States have agreed to have 30% of the GST to be put into the pool as part of the Fed's 60%.
The States will be administering the pool of health funding and large and urban hospitals will be funded based on activities. Small rural hospitals will be block funded.
The Commonwealth also become the exclusive funder for primary cares and other cares.
There are a range of improvement targets to be achieved over a period of specified time.
While WA has concerns on the impact on its GST allocation and hard negotiations are still needed to get it on board, the achievement over the past two days is significant.
It is likely to drive hospital efficiency and achieve efficiency dividends to fund ever increasing health public expenses.
State governments are likely to be more efficient in managing health.
Together with other further reforms and improvement, it can be expected that the nation's health will be further integrated and more effective over time.
Even though it is by no means to be perfect, but it has been not easy to come to this point.
Prime Minster Rudd should be applauded and congratulated for his determination and leadership.
States premiers and chief ministers have also played positive roles in the process and their efforts and inputs should be highly acknowledged and commended.
It is likely to have an impact on the relativities assessed by the Commonwealth Grants Commission, through the reduction of the GST pool and the arrangements for the hospitals and other healthcares.
There will be a national pool of health (public hospitals) funding with the commonwealth as the dominant funder of 60% to start with and the States have agreed to have 30% of the GST to be put into the pool as part of the Fed's 60%.
The States will be administering the pool of health funding and large and urban hospitals will be funded based on activities. Small rural hospitals will be block funded.
The Commonwealth also become the exclusive funder for primary cares and other cares.
There are a range of improvement targets to be achieved over a period of specified time.
While WA has concerns on the impact on its GST allocation and hard negotiations are still needed to get it on board, the achievement over the past two days is significant.
It is likely to drive hospital efficiency and achieve efficiency dividends to fund ever increasing health public expenses.
State governments are likely to be more efficient in managing health.
Together with other further reforms and improvement, it can be expected that the nation's health will be further integrated and more effective over time.
Even though it is by no means to be perfect, but it has been not easy to come to this point.
Prime Minster Rudd should be applauded and congratulated for his determination and leadership.
States premiers and chief ministers have also played positive roles in the process and their efforts and inputs should be highly acknowledged and commended.
It is likely to have an impact on the relativities assessed by the Commonwealth Grants Commission, through the reduction of the GST pool and the arrangements for the hospitals and other healthcares.
Important to get the health reform right
Comments on John Dwyer “States shouldn't sell out for pennies from Kevin”, 20/04/2010, http://www.theaustralian.com.au/news/opinion/states-shouldnt-sell-out-for-pennies-from-kevin/story-e6frg6zo-1225855687239
Absolutely right.
The current plans are all focused on public hospitals only, including the proposed local hospital networks.
They will continue to be segmented from primary cares and other cares. The costs shifts will continue and even those local networks are likely to engage in "rent seeking" and compete with other healthcares.
The Rudd proposal and approach are not the right way to reform the nation's health. It is not the right approach to health policy. It is likely to achieve little.
It is indeed better to use this COAG meeting to kick start serious national debate and discussions, especially among the political leaders for an effective health reform.
It does not matter if it is a few months later, but it is paramount and absolutely important to have the right reform being undertaking.
Absolutely right.
The current plans are all focused on public hospitals only, including the proposed local hospital networks.
They will continue to be segmented from primary cares and other cares. The costs shifts will continue and even those local networks are likely to engage in "rent seeking" and compete with other healthcares.
The Rudd proposal and approach are not the right way to reform the nation's health. It is not the right approach to health policy. It is likely to achieve little.
It is indeed better to use this COAG meeting to kick start serious national debate and discussions, especially among the political leaders for an effective health reform.
It does not matter if it is a few months later, but it is paramount and absolutely important to have the right reform being undertaking.
2010-04-19
Unhealthy low politics by a health commentator
Comments on Adam Cresswell “Premiers must put policy before politics”, 19/04/2010, http://www.theaustralian.com.au/news/opinion/premiers-must-put-policy-before-politics/story-e6frg6zo-1225855240872
Unfortunately Adam Cresswell's argument is not only politically driven, but also factionally motivated. And, it is never what Adam Cresswell claims to be policy driven.
How can a 60-40 funding model with 30% GST from the States end any existing problems, as opposed to 40-60 with States use their GST?
Essentially, there is not much difference between the 50-50 and 60-40 funding model, if purely from funding point of view. Anyone has to wonder how Adam Cresswell derived his own incredible conclusion.
Further, how can Adam Cresswell conclude that the Commonwealth will be any better if not much worse than the States to administer health? From lessons learnt from the pink batts home insulation experience? Or from the wasteful experience in the BER projects?
It appears that Adam Cresswell is defying logic to have his argument.
I have read many good opinion articles from the Australian, but some on health are unfortunately not among them, I am afraid to say. Ones like this one have no analysis, little knowledge and information, just full of nonsensical political biases.
Unfortunately Adam Cresswell's argument is not only politically driven, but also factionally motivated. And, it is never what Adam Cresswell claims to be policy driven.
How can a 60-40 funding model with 30% GST from the States end any existing problems, as opposed to 40-60 with States use their GST?
Essentially, there is not much difference between the 50-50 and 60-40 funding model, if purely from funding point of view. Anyone has to wonder how Adam Cresswell derived his own incredible conclusion.
Further, how can Adam Cresswell conclude that the Commonwealth will be any better if not much worse than the States to administer health? From lessons learnt from the pink batts home insulation experience? Or from the wasteful experience in the BER projects?
It appears that Adam Cresswell is defying logic to have his argument.
I have read many good opinion articles from the Australian, but some on health are unfortunately not among them, I am afraid to say. Ones like this one have no analysis, little knowledge and information, just full of nonsensical political biases.
2010-04-18
Health reform - the way farward
The federal and state leaders are going to meet on Monday on health reforms, especially the Rudd health plan. But it does not appear they are likely to reach an agreement based on current state of play.
Both Rudd and Brumby plans only covers public hospital mainly. Health needs to be integrated.
The nation needs health reforms badly and it will be a pity if they can’t achieve agreement on a reform plan.
I think a health reform plan should have the following:
Principle: national cooperative approach to health, with clear funding mechanism, administrative, and service delivery responsibilities and resolution mechanisms
Ministerial Council on health - National health board in charge of national health and national and bilateral health issues
National and State pool of all health funding – including public hospitals, primary and other cares, the Commonwealth will have dominant funding role
Secretariats for State health – up to eight groups, one for each state and territory, including Commonwealth representatives to replace State departments of health, with much fewer personnel
State in charge of administration of health through the secretariat
Local health boards – responsible for local/regional health delivery, secretariat determines how they should be setup
National agreement on:
Size of health funding pool and Commonwealth and State shares - basic formula to link to their perspective revenue shares, a default mechanism for each party to vary its contribution and the other party to respond by a certain proportion if agreement can’t be reached.
A default mechanism individual State obligation if it fails to deliver agreed health outcomes
A default mechanism for resolving situation if an individual local network fails to deliver agreed outcome, or agreement can’t be reached between State secretariat and the local network
Both Rudd and Brumby plans only covers public hospital mainly. Health needs to be integrated.
The nation needs health reforms badly and it will be a pity if they can’t achieve agreement on a reform plan.
I think a health reform plan should have the following:
Principle: national cooperative approach to health, with clear funding mechanism, administrative, and service delivery responsibilities and resolution mechanisms
Ministerial Council on health - National health board in charge of national health and national and bilateral health issues
National and State pool of all health funding – including public hospitals, primary and other cares, the Commonwealth will have dominant funding role
Secretariats for State health – up to eight groups, one for each state and territory, including Commonwealth representatives to replace State departments of health, with much fewer personnel
State in charge of administration of health through the secretariat
Local health boards – responsible for local/regional health delivery, secretariat determines how they should be setup
National agreement on:
Size of health funding pool and Commonwealth and State shares - basic formula to link to their perspective revenue shares, a default mechanism for each party to vary its contribution and the other party to respond by a certain proportion if agreement can’t be reached.
A default mechanism individual State obligation if it fails to deliver agreed health outcomes
A default mechanism for resolving situation if an individual local network fails to deliver agreed outcome, or agreement can’t be reached between State secretariat and the local network
2010-04-17
A way out for Rudd's national health reform impasse
Comments on Paul Kelly, “Showdown in emergency room”, 17/04/2010, http://www.theaustralian.com.au/news/opinion/showdown-in-emergency-room/story-e6frg6zo-1225854720604
There is a way out for Rudd and Brumby as well as for WA and NSW, which is to move to a 100% pool of the nation's total health funding pool.
Given that the Commonwealth funds a lot of primary cares, its total funding is likely to be more than 50%, so it will make it much easier to achieve a 60-40 formula Rudd is asking with no change to the GST funding.
A national health board can be set up to oversee the allocation of the health funding pool.
Local health networks, as opposed to hospital networks can be charged to consider local allocation between hospital and primary cares as well as aged care and etc.
Case mix funding can be part of the national allocation to local health networks to adjust their total health funding.
The Commonwealth and the States can sign a agreement on their contributions to the national health funding pool, based on the current situation and perspective future revenue.
There is a way out for Rudd and Brumby as well as for WA and NSW, which is to move to a 100% pool of the nation's total health funding pool.
Given that the Commonwealth funds a lot of primary cares, its total funding is likely to be more than 50%, so it will make it much easier to achieve a 60-40 formula Rudd is asking with no change to the GST funding.
A national health board can be set up to oversee the allocation of the health funding pool.
Local health networks, as opposed to hospital networks can be charged to consider local allocation between hospital and primary cares as well as aged care and etc.
Case mix funding can be part of the national allocation to local health networks to adjust their total health funding.
The Commonwealth and the States can sign a agreement on their contributions to the national health funding pool, based on the current situation and perspective future revenue.
Funding and administrative model for nation's health
Comments on Michael Stutchbury “Odds are Rudd's funding model won't work”, 17/04/2010, http://www.theaustralian.com.au/news/opinion/odds-are-rudds-funding-model-wont-work/story-e6frg6zo-1225854720830
Why don't the federal and the states take a stock now how much each spend on health, and then decides how much each should pay in proportionate terms for future health expenses? They can even determine a path that links health expenditure with their respective revenue.
All contributions should be paid to a joint health fund. A national health boards consisting federal and states can be set up to oversee how the fund should be spent.
There can be up to eight groups under this national health board, one for each state or territory.
Under the national health board, local health networks should consider all healthcare, not just public hospitals.
Such a model will be better than the current Rudd or Brumby models and should be pursued as priority for national health reforms.
Why don't the federal and the states take a stock now how much each spend on health, and then decides how much each should pay in proportionate terms for future health expenses? They can even determine a path that links health expenditure with their respective revenue.
All contributions should be paid to a joint health fund. A national health boards consisting federal and states can be set up to oversee how the fund should be spent.
There can be up to eight groups under this national health board, one for each state or territory.
Under the national health board, local health networks should consider all healthcare, not just public hospitals.
Such a model will be better than the current Rudd or Brumby models and should be pursued as priority for national health reforms.
Strategy of war versus precesion missle in battle
Comment on Peter van Onselen “Rudd's hospitals sell a precision-guided missile”, 17/04/2010, http://www.theaustralian.com.au/news/opinion/rudds-hospitals-sell-a-precision-guided-missile/story-e6frg6zo-1225854728629
I can’t see how that precision will work if Rudd loses strategically in the war.
Rudd is good at micro managing issues, but this time he appears to have lost the big strategy.
The health issue is becoming a very serious test of Rudd's judgement, character and leadership.
But the COAG will not be the end of the test, even assuming Rudd gets what he wants - a big assumption.
The coalition can find big holes with the Rudd plan after it releases its own health plan and once the federal election officially starts.
Abbott is likely to keep a low profile in the current federal - state debate on health and get ready for a second, more decisive and possibly a fatal kill on the Rudd plan.
I can’t see how that precision will work if Rudd loses strategically in the war.
Rudd is good at micro managing issues, but this time he appears to have lost the big strategy.
The health issue is becoming a very serious test of Rudd's judgement, character and leadership.
But the COAG will not be the end of the test, even assuming Rudd gets what he wants - a big assumption.
The coalition can find big holes with the Rudd plan after it releases its own health plan and once the federal election officially starts.
Abbott is likely to keep a low profile in the current federal - state debate on health and get ready for a second, more decisive and possibly a fatal kill on the Rudd plan.
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