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Our fragmented health system is broken and needs a national fix

by News Desk

Across the country, Australians sit on surgery waitlists, lie ramped in ambulances unable to fit into hospitals and wait months, sometimes years, to see specialists.  

The pandemic remains a convenient perpetrator to blame for the issues in our health care system, but it’s time we owned up to the truth. Our fragmented health system has long been a tangled mess and we need a national approach to fix it.  

Our last major public health reform was in the 1980s, when Medicare was introduced. It was fit for purpose back then – in 1984 Australia had a population of 15.5m people and in the early 1980s, between 55 per cent and 68per cent of the population had private health insurance. Our population was young, too – only 10per cent was over 65. 

In the last 39 years, things have changed.  

Our population has grown and aged – in 2021 there were 25.69 million Australians and 16 per cent of them were over 65. Now, only 45.1 per cent of us have private hospital insurance and a large proportion of those are in the older, higher claiming age bracket.  

The way that the healthcare system is funded no longer suits the complexities of our large, ageing population and the health issues Australians are commonly facing.  The federal government oversees the governance of the private sector, apart from licensing private hospitals. The public health system is run by state governments but under a national health agreement, and these systems don’t communicate with each other well.  

That is one of the reasons why the AMA estimates that by the middle of this year there will be 500,000 Australians waiting to see a specialist and waiting for surgery, and it’s why the peak body is calling for a National Health Agreement that would shift the way our healthcare system operates. 

It’s also why Day Hospitals Australia is advocating for a new approach to national health that would make our system more effective and let day hospitals play a bigger role in alleviating the pressure on the public health system. 

Jane Griffiths, CEO pf Day Hospitals Australia

As the CEO of Day Hospitals Australia, my advocating for Day Hospitals to play a larger role in the health system could be criticised as trying to get more business for private day hospitals. And yes, that is part of why I am pushing for Day Hospitals to play a bigger and more coordinated role, working closely with the public health system in each state. Recent work that we have undertaken demonstrates that there is a potential saving of $508 million if just the top 32 procedures, performed on a day basis, were performed in day hospitals.

As a nurse who graduated in the 70s, I have seen the growth in surgical and anaesthetic techniques that have allowed more surgery to be performed on a same day basis. I have been researching day surgery and its role in health care since 1997, when I travelled to the US on a sabbatical in my role as Nursing Coordinator of Perioperative Services at a large private hospital in Western Australia. I am passionate about the positive clinical outcomes for Day Hospital patients, about the reduction in surgery wait lists that could be made by state health departments better working with the day hospital sector and about the economic benefits of better utilisation of the Day Hospital sector.  

In truth, around the country there is between 20 per cent and 30 per cent capacity in private day hospitals that could be used by the public health system to reduce surgery wait lists. Queensland has arguably made a positive approach for it’s public-private negotiations to deliver surgery – Surgery Connect was set up prior to the pandemic and is a centralised system for all referrals of public work to private hospital providers. In NSW, by contrast, there is no centralised system for public-private negotiations and each local hospital must make its own contract arrangements.  

Tasmania is taking action with the state health department contracting all public cataract surgery to the private sector. In WA, the state health department refuses to even meet with and discuss the contracting of public surgery to the private day hospital sector, despite there being tens of thousands of public patients on waiting lists, and 30 per cent capacity at some WA day hospitals.  

In Australia, we need a centralised health system or at least a system in which the various sectors speak to each other. The pandemic isn’t to blame anymore, COVID simply opened pandora’s box and now our GPs, nurses and specialists in public and private hospitals are left to try to stuff the contents back in. 

And when the state and national health departments do start talking with each other, day hospitals around the country are ready to partake in any plans that will reduce surgery wait times, reduce the cost burden on the health care system and open up new ways of making our health system work, for everyone. 

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