Transcript: AMA President Dr Andrew Pesce discusses health funding with Fran Kelly, Radio National Breakfast
FRAN KELLY: Well, some major dailies report today that in terms of health funding the states will no longer receive any federal hospital funding. Instead new regional health authorities will manage federal and state funds. And as Michelle mentioned, while the states might not like that, the doctors at least seem to like the sound of it. AMA's president Andrew Pesce wants more details of course but says this sort of funding change would limit some of the blame shifting which now riddles the system. He joins us from Sydney.
Dr Pesce, good morning.
ANDREW PESCE: Good morning Fran.
FRAN KELLY: You're calling this a credible response to the problems at hand. What do you like about the mooted changes to the funding model?
ANDREW PESCE: Well, the first thing is that I think everyone understands that just tinkering at the margins is not going to fundamentally address the significant problems and the challenges which lie ahead for our public hospital system. Remembering that public hospitals aren't the all-in of health reform, but are a very, very important component of it.
What do we like? Well, first of all there is much more clarity in funding. The current mishmash of funding that is provided through a combination of the States and the Commonwealth means that when there is not sufficient funding one arm of government can blame the other. And I think that's something that everyone sees, you know, week in week out in the media where these games are played.
So it is a significant change, which may well address that. And the other thing is that it actually means that funding follows clinical activity, rather than being determined by historical funding with maybe some adjustments to CPI. This means that places that find a way to provide care for patients and patients go and choose those hospitals for their services, well, the funding will follow. Therefore, it'll hopefully encourage good efficient quality care with funding that follows, rather than hospitals being continually strangled by State governments who really need to address the fundamental problem that their revenues are not growing at a rate that is sufficient to meet the emerging costs in our health system.
FRAN KELLY: Well, in fact, some say it's worse than the State funding not growing, some are saying it's retreating. So it's not just blame shifting but cost shifting that this would stop if you put all the money into these new regional health authorities that the Government would set up. Do you think that would stop cost shifting?
ANDREW PESCE: Look, it's very, very important this is done properly and that's why we need to see the details of how this is going to be rolled out. And so if it's not done properly, there can still always be blame shifting and cost shifting. But if it is done properly, if it listens to the needs of the communities, if it acknowledges the input of the local clinicians, then that's another thing which is very, very important.
If funding is going to be centralised to Canberra - that bureaucracy, that arm of government is even more distant from the local hospital level than State governments - it is very, very important that some mechanism is put in place so that local community needs and local workforce input provides a major input into the decision making and management processes of the local hospitals.
FRAN KELLY: We haven't seen the plan yet. We're working off newspaper reports, but one report in The Daily Telegraph suggests that these new regional health authorities that will manage all the funds could be based around, in fact, could use the basis of the existing state based area health authorities. Now, in New South Wales, at least some of the State based area health authorities have come into a fair bit of criticism for inefficiencies. What would your view be of this?
ANDREW PESCE: Well, that's why I say it really comes down to the detail. As a model to distribute funds, you know, they are a credible way of managing funds and distributing them on a caseload basis. But if there is a criticism of the area health services, well, for example in New South Wales where I live, it's because they have become too much focused on the needs to control costs and have long stopped listening, in the vast majority of cases, to the input of their local communities and local doctors and nurses.
So if we're going to have the area health services, or a variation thereof, in control of these funds - and how those funds are distributed - now they do have a very high level responsibility for regional distribution of funding. We have to understand that not every hospital can perform every service efficiently all the time and sometimes those services have to be spread through a region, but that needs to take account of the fact that unless the local communities and the local doctors and nurses have input into the process you can sometimes get, you know, very, very ……and we need, we really need to see that coming through.
FRAN KELLY: Andrew Pesce, we'll leave it there. Thank you very much for joining us.
ANDREW PESCE: Thank you Fran.
FRAN KELLY: Dr Andrew Pesce is the president of the Federal AMA.
2 March 2010
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