Managing national public hospitals federally a better choice

Comments on "Rudd set to leave health to states", ABC report, 1/03/2010, http://www.abc.net.au/news/stories/2010/02/28/2832348.htm?section=justin

With Australia's small population, it should be much more efficient to have one layer of administration of the national health system, removing duplications between the federal and the States, and the unaccountability or responsibility shifting between the two layers of government.

The key is that there should be an effective strategy to federally administer national public hospitals.

It will and should not be difficult. There are less than 25 million people in Australia, equivalent to a large city in many populous countries.

Why should run the hospitals that difficult? It is the geographic distribution. A nationally managed hospital system should be better in that regard.

But the key strategy for a national management system of public hospitals should lie in the following:

1. Funding nationally administered, assessed and allocated.
2. There can be a few regional offices or regional health boards. The regional hospital boards should be regionally elected by those people.
3. Each hospital of a group of hospitals can sign a contract with the federal health department.
4. Each hospital is independently run subject to funding from federal health department and is accountable for its outcomes.
5. The Health department and Productivity Commission will assess the performance of each hospital and publish the assessment each year and monitor them quarterly. Alternatively, some representatives from hospitals or regional boards can participate in the process of assessments.
6. The regional boards or each hospital staff committee should have the right to choose their board members, CEO and CMO.
7. If a hospital or hospitals in a region continue to fall below set standards, the federal health minister should intervene to appoint a new board.
8. Total hospital funding should be objectively planned and set every 5 years in advance.
9. Private hospitals can get funding if they perform public hospitals roles, with due funding implications for related public hospitals. This will introduce additional competition.
10. The GST to the States should be reduced accordingly and fairly.
11. The health minister should set advisory priorities for public hospitals as a whole and for come individual ones in particular. Those should be part of the assessment.

I think the above should be much better than the current system of State administered and with federal partial funding supports.

Abbott solution to federation no solution

Comments on Paul Kelly “A blueprint for rule” – comments on Tony Abbott’s new book, 25/07/2009, http://www.theaustralian.news.com.au/story/0,25197,25831896-12250,00.html

Mr Abbott experienced some of the problems of the Australian federation and seemed to be frustrated, not only or necessarily by those problems or failures, but by the Liberals loss at the last federal election in 2007.

His solution appears to be a response to Rudd’s election promise of a national takeover of public hospitals from the States if they do improve by the middle of 2009.

Both reflect Abbott’s further failure as a federal politician and his inability to lead the national health portfolio. It is regrettable for him and for the nation.

As a result, both Abbott’s diagnose of the problems or failures and his solution are knee-jerking reactions, as opposed to careful analysis and true leadership based on a rational vision for a better Australian federation.

There is neither a need to change the Australia constitution, nor an abolition of States, nor an increase of the Federal government. There are better and more effective solutions.

For example, the national public hospital system has mostly been funded by federal healthcare grants, a special purpose payment (SPP). The national government should have been able to specify conditions for State governments to meet, or to make changes by the federal government. The federal government have the power to do it and there is no need to change the constitution or federation.

Even for other untied federal grants to the States, the federal government should be able to change them to SPPs and attach conditions.

Australia federation works reasonably well in international standards. Short term politics should not be used to change the constitution.

Abbott had a nice try, but that was not enough.