It is interesting that there is considerable discussion on what extra might be added to get the Rudd / Roxon Health Reforms over the line in some form similar to that initially proposed.
There seem to have been a number of suggestions that mental health and preventive care may be part of that sweetening package.
Condition critical
PAUL AUSTIN, MARK METHERELL AND MICHELLE GRATTAN
April 17, 2010
IF JOHN Brumby is nervous about waging his spectacular fight with Kevin Rudd over the Prime Minister's showcase hospitals reform in the shadow of federal and Victorian elections, the Premier isn't showing it.
This extraordinary battle of wills and policy between two leaders whose relationship is described as toxic has become more personal and more public the closer the showdown gets.
The stakes are high for both. Rudd has threatened a referendum if he can't get an agreement on Monday, which would have him and Brumby at each other's throats during the federal campaign.
Brumby, on the other hand, risks being labelled a ''spoiler'' who denies the nation a much needed overhaul of its health and hospitals system. Whether, however, Victorian voters would care about this is where the rubber hits the road for the Premier.
While the political conflict goes on, health experts are questioning the Rudd plan, particularly criticising it for being too ''hospital-centred'' when more attention should be directed to primary healthcare, preventative care, mental health and the like.
Lots more here:
http://www.theage.com.au/national/condition-critcal-20100416-skl8.html
We are also seeing commentators express a range of concerns about the package as it presently is.
See here:
Odds are Rudd's funding model won't work
- Michael Stutchbury, Economics editor
- From: The Australian
- April 17, 2010
THE big picture on the eve of Monday's crucial meeting of the Council of Australian Governments is that there is no workable political or expert consensus yet on how to redesign Australia's $120 billion health and hospital system for the looming huge increase in demand for medical services. It needs more work.
Victorian Premier John Brumby this week laid some telling blows against Kevin Rudd's proposed majority takeover of state hospital systems.
The Prime Minister's 60-40 hospital funding split would not end the political blame game. Political responsibility would remain blurred. There could be more bureaucracy, spread over three tiers of governance but more centralised in Canberra.
"I fear that the Prime Minister's plan will leave patients not only more confused about who's responsible for their health care but also more remote from the level of government that's assumed primary funding responsibility," Brumby said in matching Rudd as a health policy wonk.
All the details here:
We also had this out today.
Condition terminal: NSW doctors demand Keneally oppose Rudd's health plan
KATE BENSON AND PHILLIP COOREY
April 17, 2010
The moves comes as Kevin Rudd has left open the possibility of giving the states even more money when he meets the premiers on Monday - but not unless they give up their GST revenue.
Mr Rudd yesterday rejected within hours a demand by Ms Keneally that NSW keep all its GST money on the proviso it promises to spend 30 per cent on health.
The NSW Medical Staff Executive Council, which represents more than 11,000 doctors, called an urgent meeting last night to urge the Premier to delay her decision on the changes for at least six weeks.
They want more details on how NSW will be affected, and greater evidence they will be given enough money to resolve the NSW health system's crippling debt problems.
''We have been waiting for two decades for serious reform efforts and are now concerned that injudicious haste to meet a political timetable may jeopardise the development of the changes we need,'' the co-chairman of the council, John Dwyer, said.
More here:
There was also a very telling paragraph here on e-Health in a larger commentary from an expert to deserves some credibility – having pointed out the plan on the table may be extraordinarily difficult and complex to implement and probably well past the capabilities of the present crop of Federal Health Bureaucrats.
See here:
Package with strings attached: healthcare reform
- OPINION: Robert Wells
- From: The Australian
- April 17, 2010
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.
......
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.
Full article is here:
The emphasis is mine.
Overall it seems to me that the health reform issue has now spun out of control and has deteriorated into slogans and threats. This nonsense talking about 'reform is good' without working out what optimal reform might look like is a disaster. Consultation by walking around hospitals without doing the quality analysis won’t get us there.
The number of experts saying this approach is sub-optimal is also very worrying. (Deeble, Baxter etc)
Overall what should have been done, with the advantage of hindsight, is that the Government should have produced a draft response to the NHHRC Report and then there should have been major consultation on all aspects and the a final complete proposal – rather than this drip feed – should have been delivered for COAG discussion.
If e-Health gets a mention now you can be sure it will be half thought out and not consultative – and will certainly fail.
My view is that the Premiers should knock this back on Monday and insist on a fully worked through and discussed final proposal that they can all live with being developed (including e-Health etc) and agreed over the next 2-3 months. We will otherwise get an incomplete mess.
David.
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