Sue

I suggest you highlight one of the cross subsidisation issues.

The federal gov't seeks to minimise health care costs by on the one hand compelling hospitals to treat the sick and on the other setting the Medicare recompense rate lower than operational cost. In these circumstances, hospitals have to cross subsidise when they treat the income poor, like Centrelink clients.

The 'difference' often comes from State budgets. But, it also comes from higher income groups paying an inflated price for their treatment.

For mine, we can really only get an idea of procedural efficiencies and operational costs when we remove the cross subsidisation process.

I'm not advocating Tea Party ideology. Far from it. Rather, we will endlessly have these public funding contests until we break the nexus between generic cross subsidisation and case by case public funding.

Cheers

Nice idea, ..., but it doesn't work that way. Prevention and education are worthwhile pursuits, but it's a common fallacy that they reduce acute care costs: if anything, they INCREASE them.

You see, acute health care demand is uncapped. IN a risk-averse and increasingly demanding society, acute health care costs will always keep rising as people want access to new and more treatments.

There is no obective level of "enough" health care. Unless we completely stop innovation and improvement, and stop treating people who previously had no access, we won't contain costs.

That means no new imaging technology, no new medications, no better dressings, no better cancer treatment regimes, no better surgical techniques, and no more hospital admissions.

I don't think our community is ready for that yet. Do you?

Sue, I got crook a couple of years ago, went straight to the nearest public hospital. Could have gone private, but knew enough about the possibilities to stay close to quality. On Day One I was asked if I agreed to send the bill to HBA, and happily signed off.
As far as I can work it out, there were three ways my carers could have been reimbursed. (1) entirely within the private system (2) entirely public (if I chose to not sign the transfer) or (3) by the public hospital billing HBA.
All fine, so far, because I received the best of imaging, expensive medications, a long line inserted by an expensive array of staff & equipment, and two weeks of hospital-in-the-home.
Now, I have no idea how much all that cost. But I'm sure I'd still be getting bills if I'd gone private and I'm equally certain the care & treatment could not have been better where I was.
My point is that mug punters have no idea how much their episodes of care cost. (I may have expressed that a bit better in a letter published in the AFR.)
So, if it is necessary to shift costs, or put up claims for safer or improved treatments, tell me how the electorate is able to judge the benefits, if they are entirely ignorant of real costs in health care?
Believe me, I am all for innovation and smarter technology. But, also, when what was the latest in geewhizzery falls out of favour and is parked in the hospital basement, there ought to be openness & accountability on that, too.
I've read Gawande, and Khadra, and know that the acute hospital systems are packed with smart, capable, confident & ethical people. Those staff are not told the whole picture, either, due to the disgraceful lack of comparative & timely data. So, as willing as they may be, most attempts at leadership in reform are doomed.
So, No, the community is not ready for any changes to the health care systems, because they do not have the data on which to make rational choices. However, the experience from overseas is that when adminstrators provide voters with all the information, some communities have decided to ration funding according to a set of objective values. Would that be bad?
Trevor

"Preventive health doesn't stop acute care costs from rising"?!
This is just plain nonsense, as is the rest of your post. There have been no efforts made towards "preventive health" in the existing system ever. And a huge drain on the system is the overwhelming number of patients admitted for adverse reactions from drugs, information easily obtained from hospital records regarding emergency department admissions.
Because the conventional system does not even come close to addressing issues regarding preventive health -- a failing that dates back decades -- the system will continue to face the issue of "different day, same pile". The definition of stupidity is continuing to do what has been shown not to work.

Medical testing is not prevention -- it's a profit centre. Mammography has been found to cause breast cancer, not prevent it.
Calcium supplementation is now a major cause of hardening of the coronary arteries in women. We can thank mainstream medicine for fear-mongering about osteoporosis, and then being completely ignorant of the fact that standalone calcium supplementation is a disaster that ignores all the co-factors necessary for it to be deposited in the right place.
Pasteurized milk is full of antibiotic and pesticide residue and causes all sorts of allergic reactions the chief one being asthma. Who's the moron who thought up the notion that the only mammal on the planet that needs any sort of milk past mothers' milk at infancy is even worth considering?
While we're on the subject, the AMA in the U.S. once advised woman that breastfeeding was harmful. The same guys who told us smoking was good for us...
Type 2 diabetes can be prevented totally through avoiding sugar, especially high fructose corn syrup. It can be cured through dietary changes as well -- thanks to holistic health professions like Homeopathy, Naturopathy and Holistic Nutritionists.
Show me the RCTs and challenge studies for vaccination.
Real disease prevention began with sanitation and water purification.

John Davidson - the issue with capacity for epidemics and major incidents isn't just a physical capacity, it's mainly limited by staff availability.

At the moment, hospitals are experiencing a lot of sickness amongst front-line staff, who are exposed to the seasonal viruses from the patients that they treat. Staff are most exposed to sickness at the times when there is greatest need.

For outbreaks and major disasters, there are plans in place short-term, but staff cannot function indefinitely.

If somebody could contruct a reliable plan for short-term additional skilled staffing at times of need, it would be a huge bonus.

Sue, Having the physical capacity is a start because it makes it easier and faster to bring in people from outside the crisis area. I don't know enough about hospitals to speak with authority but logical options might include:
Using medical people who normally work on lower priority tasks.

Using admin and similar people to take over some of the tasks normally handled by medical people.

Using a volunteer "medical reserve" to help during crisis.

I assume some of this is already part of emergency plans. It would help of course if medical staff were not already working long hours.

If only we could make one of those systems viable.

It's hard to find medical and nursing staff to deploy from "lower priotity tasks" - which tasks would they be? We try to move some of the admin tasks to admin staff but, whenever there are cutbacks, it is promised to get rid of all those "administrators" and preserve front-line clinical positions. And the result? Front line clinicians have to do the clerical/admin work!

Where would we find a volunteer "medical reserve" that has the qualifications and ability to safely and competently step in? And where would we send them back to after the crisis?

I'm not dismissing your thoughts, but I wish there were a viable solution. It's not that it hasn;t been considered before, but practical solutions are not emerging.

Oh, aren't the staff vaccinated against those "seasonal viruses"? Gee, why isn't it working?

Does someone pay you to post excuses? There isn't a single profession in the world that doesn't require some form of written reporting. Suck it up, buttercup. You may not like to do it but it's part of your job description.