Experts dissect hospital reform plan

Kevin Rudd's hospitals reform plan could end up being a victim of its own success.
Health experts argue this is because so much money will be pumped into hospitals at
the expense of primary care.
The result could be increased hospitalisation rates, they say.
"This is really more a package about making it easier for people to get into
hospital than it is a package about helping people stay out of hospital," Australian
National University health policy expert Robert Wells said.
Mr Wells welcomed $5.4 billion of additional cash for elective surgery, emergency
departments and hospital beds.
But he said the deal signed by Labor leaders on Tuesday was "very disappointing"
because it failed to outline how governments planned to overhaul care provided in
the community.
Mental health advocate Ian Hickie says the new intergovernmental agreement means
mentally ill people will be increasingly hospitalised.
Federal Health Minister Nicola Roxon had wanted to take over community mental health
care from the states but was rolled at this week's COAG meeting.
The commonwealth caved in to the states' position, which maintains the status quo,
Prof Hickie said.
"If you're a smart state health bureaucrat you'll move all that (community mental
health care) to a hospital, so we're back to cost-shifting and blame-gaming.
"This has been taxation reform, not health reform."
Under the deal signed by all the states and territories except Western Australia,
the commonwealth will fund 60 per cent of hospital costs and 100 per cent of primary
and aged care.
But community mental health as well as alcohol, drug, maternal and child services
have all been left with the states.
Victoria argued they couldn't be transferred without causing substantial gaps and
disruptions in delivery because they were delivered in partnership with state and
local government support.
But Prof Hickie says the result is just $120 million worth of new money for mental
health.
Catholic Health Australia is so worried about the lack of detail in Labor's reform
plan it wants an implementation council established to fill in the gaps.
"There remains a great sense of uncertainty as to what the reforms will mean in
practice," chief executive Martin Laverty said in a statement.
An implementation council would "create the blueprint that is currently missing on
how to get the reforms in place".
Mr Wells says the reforms certainly don't end the blame game because one level of
government isn't clearly accountable.
"The states are still going to run the hospitals," he said.
Doctors are also worried.
"There is still a concern ... that state bureaucracies could seek to control local
hospital networks," Australian Medical Association president Andrew Pesce said.
"Doctors and nurses must ... not be pressured by the state bureaucracies."
But the Rudd government insists the enhanced role of the states - the price it paid
for a deal - actually improves the new structure.
The prime minister said pooled funds increased transparency.
"We (the commonwealth) have this transparent flow of funds through to local hospital
networks based on activity-based funding to the people who are delivering frontline
services," Mr Rudd said.
"You now have the same transparent flow coming through this joint funding authority
from the states as well."
But Opposition Leader Tony Abbott wasn't buying that.
"These changes won't put one level of government clearly in charge," he told ABC Radio.
"The whole thing is still going to be an absolute dog's breakfast of divided
responsibilities."
The opposition's finance spokesman Andrew Robb says the government's health reforms
will be put under the microscope before the coalition decides whether to support
them in parliament.
He says the plan is scant on detail and more people besides state leaders and
bureaucrats should have been consulted.
And MPs are only being given a few weeks to dissect the plan.
"If it's supposed to be a revolution in the health sector, you would have thought a
considered, well discussed, thought out consultation with people much wider than the
premiers and other bureaucrats would be essential," Mr Robb told reporters at a
community mental health forum in Adelaide on Wednesday evening.
"This is a political exercise, nothing more, nothing less.
"He is looking to take something to the election and he wanted a win out of health."