Transcript: AMA President, Dr Andrew Pesce, Doorstop Press Conference - Government health funding announcement

The focus on improving patient care, through changing the structures in our public hospital system is a very important one and I think the announcements are focused on that.  It's very, very important also to acknowledge that the Prime Minister has heard the problems as he's gone on his consultation sessions with the doctors and nurses who work in the hospital system and it's very important to incorporate the solutions that they have suggested, so their decision-making can play a role in the reform of the health system.

It's very, very important and gratifying to see that the decision to be the dominant funder is balanced by a decision to maximise local decision-making and that was always a balance that the AMA said was very, very important.

It seems that from the announcement - and we still have to look at the details – there is nothing in the announcement that continues the artificial capping and inappropriate capping of patient services.  And the announcement of funding to follow patient care means that health services in hospitals can grow to meet growing patient demand where that's appropriate.

So we need to have a look at the detail.  There's a lot to digest, but it's very gratifying to see a government and a Prime Minister standing up and taking responsibility for major health reform and major reform is needed, not just tinkering around the edges.

QUESTION:    Can you briefly outline what problems you think this would fix?

ANDREW PESCE:    Okay.  Look, at the moment activity at hospitals is very much artificially capped by historical budgets.  The move to casemix funding means that when the amount of services needed to change because of patient growth in population, changing demographics of patients’ mix in the hospital, then funding will follow that.

It's gratifying to see that that is being determined by an independent body to establish the efficient funding price and that that price will be varied in areas such as rural and remote areas where the cost of delivering those services is always going to be higher than in high-volume metropolitan hospitals.

So there are a number of self-correcting mechanisms to take account for potential changes into the future, which is a significant shift from the historical budget funding of our hospital system.

I think there's also a need to recognise that States need to have an interest in the hospital system and the fixed funding split between the Commonwealth and States will provide for that, although the Commonwealth becomes the dominant funder of health.

There is also a good announcement in terms of the local hospital networks.  The AMA is receptive to the various suggestions that could empower local workforce, the nurses and the doctors to provide the decision-making capacity and have input into decisions at the hospitals. So, these are all things that the AMA has been emphasising as very important and they look to have delivered.

QUESTION:    Is there a danger Dr Pesce that this new efficient price will end up a bit like the Medicare rebate and it won't keep pace with the costs?

ANDREW PESCE:    Look, I think that a lot of the hospitals where that's the case, there's been an unmet cost which has been exposed through this, for the teaching and the training, for the complexity of the cases that are coming through the hospital.

Now, I work at Westmead Hospital, which on what I believe is not a very fair comparison, seems to say that we can't treat patients as efficiently.  But I know we get the highest risk pregnancies there.  I know that we get the worst motor vehicle accidents.  I know that we get the most complex liver and kidney transplants.  I know there are a whole lot of things which I don't believe are adequately being measured and aren't being accurately compared.

The devil is always in the detail, and the success or failure of this depends on those comparisons being done properly and accurately reflecting the clinical complexity that the care that's being delivered.

QUESTION:    Dr Pesce, how does this plan compare to what the Opposition's proposing, to have local hospital boards?

ANDREW PESCE:    Look, we were happy to support the Opposition's announcement on local hospital boards because that also was a credible response to our request for re-engagement and re-empowerment of the doctors, nurses and communities in the running of their public hospitals.

But the Prime Minister has announced an alternative structure.  I think both have merit.  We still need to see the detail of actually both proposals.  We still are waiting to see the detail behind the Opposition's proposals and how that's going to work in detail.  And, of course, we now have to see the detail of the Government's proposals.

Both have merit and both have the significant chance of improving the re-engagement of ourhospital workforce and the local communities in the running of the local hospitals.

QUESTION:    Is it a concern for you that this plan doesn't really talk about extra funding anywhere?

ANDREW PESCE:    We need to have a look at that.  I think that it's a fair comment to say that the Prime Minister's discussions today acknowledged the need for extra funding in the health system, both now and in the future as the patient demographics change.  We have an ageing population with more chronic and complex care needs.  It seems that there a lot of mention today of acknowledgement of that.

I haven't yet seen the detail which reassures me that the extra funding will be injected but certainly the framework is there that if we do have increased need for services on the casemix system, there should be an injection of extra funds for clinical services.  If it's done properly, I think there is the capacity to improve the funding of the healthcare system, but I've yet to see the detail.

Okay.  Thanks very much.

3 March 2010

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