[ExI] Australian state public health system update

[Stathis Papaioannou]

On 18/03/2008, Lee Corbin <lcorbin at rawbw.com> wrote:

>  > In the final analysis, public hospitals have to give their employees
>  > reasonable pay and conditions or lose them to the private system,
>  > interstate or overseas.
>
>
> But doesn't the tax payer already feel like he's *owed* treatment,
>  and so if he goes private or offshore he'll essentially be paying twice
>  over?  That could discourage a lot of people, (except the very rich).

No, I was actually talking about hospital *employees*. Public
hospitals try to entice doctors and nurses to work for them with
promises of better pay and conditions.

There is a constant pressure from management (who, now that Victorian
public hospitals are "corporatised", earn ten times as much as the
people who do the actual work, in keeping with private enterprise
tradition) to improve various outcomes such as number of patients
treated, complication rates, readmission rates, waiting times for
elective procedures, and so on, while keeping to a budget. Gathering
these statistics is a pain in the neck for clinicians who are
interested only in the welfare of the particular patients they are
looking after, not some theoretical model of cost/benefit analysis.
Pushed too hard, either staff leave and go elsewhere, or outcome
measures slip, or both. This creates pressure for budget increases to
hire more staff, buy more equipment, build new hospitals.

All patients do have the option of going to their publicly funded,
private doctor rather than the public hospitals, but for inpatient
treatment they need private health insurance (or a lot of cash) if
they want to go to a private hospital. High income earners save on the
portion of their taxes used for public health funding if they take out
private health insurance, the idea being to take some of the strain
off the public health system. However, many people pay for private
health insurance for the tax benefits and *still* choose to use the
public hospitals, or are advised to go public by their doctors due to
the complicated nature of their condition.

Equality of access is only one advantage of a publicly funded health
care system. The other advantage is economic efficiency. Health
outcomes in Australia are about comparable to those in the US, but the
US spends about 50% more for its health care as a proportion of GDP
than other OECD countries. In fact, even *government* spending on
health care in the US is higher than government spending in other
countries with a universal health care system.




-- 
Stathis Papaioannou