Transcript of Radio Interview ABC Radio National AMA President, Dr Bill Glasson, Thursday 7 April 2005

One solution proposed is for the Commonwealth to cut duplication and assume direct management of the hospitals. But no sooner was that proposal put up than wiser heads at the top level knew that it would be a recipe for them taking all the blame, so it disappeared again.

Now a special health taskforce set up by the Prime Minister after the election is reported to be recommending a new three-tier model of health care that would by-pass the states and in theory simplify our current system. Just how that would work remains unclear but at least one key player in the debate says the idea isn't new and it would lead to a rationing of health services to the community.

Australian Medical Association President, Dr Bill Glasson, joins us now. Good morning, Bill.

GLASSON: Good morning, Fran.

KELLY: Now apparently the idea of this funding model is to focus on how the health money is spent and how to get better direct action for the health dollar. What do you understand of the model reportedly being considered?

GLASSON: Well essentially, Fran, to put it very simply for people listening, there's three arms to this proposed model by Podger. One is those that provide the money, and that's governments or private health insurance companies. Secondly those that have actually purchased that money and that may be a regional health authority, it may be a hospital, may be a private company; through to those that provide the service. That's the manpower resources in the sense of doctors, nurses, physios through to the physical infrastructure of the hospital beds, operating theatres; and finally to those that provide the hips, the knees, the implants that actually patients require.

So there are three arms to this, but it is a financial model and people must understand that. And that's I suppose my biggest criticism of this leak from the Podger Review.

KELLY: Well let's just stay with the model before we go to your analysis of it. Essentially money, health money, now goes from the Commonwealth through to the states, and then through to the hospitals and the other providers of health care. This would go direct from Commonwealth - it would cut out the states altogether, would it? And it would go then direct to the hospitals or direct to the regional health services or…?

GLASSON: That's exactly right. Whoever the purchaser of the service is will be the person getting the money. So in reality the state governments will actually be by-passed or can be by-passed in this system. And so it supposedly creates a simpler system but in reality it probably will create a system with more bureaucracy and more red tape.

KELLY: Well why? I mean this has been looked at in other countries; has it worked there?

GLASSON: No it has not, and I think that's what people must understand. This is nothing new. This is something that has been tried in other countries. It's tried to sort of, I suppose, provide a funding model or a new funding model but in reality it does not deliver as far as improved services, improved access to services to patients and the community.

KELLY: But why doesn't it? I mean the AMA and others in the past have been very critical of the proportion of the health dollar taken up by administration rather than actual patient care. Isn't this a plan to cut out one of the big layers of administration, the states, the state bureaucracy?

GLASSON: Fran, the result is that this is putting the cart before the horse. This is actually looking at a financial model, rather than looking at a model of care. And what I'd say to people like Podger is forget about the money; actually look at the model of care. And in reality in Australia we've got an ageing population with a huge burden of chronic disease. We've got increasing expectations from patients as well as increasing costs due to medical technology.

People must understand, unless we get that model of care sorted out, there's no point looking at the money. There are four pillars to the health system. Three of those pillars are well established although needing some modification. One is community care, that's around our GP. That needs modifying to address the issue of the ageing population, and this is to integrate general practitioners better with the allied health professionals. That's the nurses, physios, etcetera.

We've got the aged care sector that needs remedicalising* such as that - that is more than just a facility to house aged people. It's actually where you can attain a level of care, a level of rehabilitation, and a level of quality care.

And the third pillar is the acute care sector which is our acute public hospitals, under huge amount of pressure, a) because they can't handle the demand; and b) there's not - insufficient beds in our public hospitals to meet the needs of our ageing community.

And the fourth pillar, that is really the most important pillar that sits in the middle, that has not been developed and this is what I want Podger to concentrate on is the issue of the transitional or sub-acute care sector. Now this is a sector that really - or the pillar that sits in the middle that allows patients to be assessed in relation to their disability, look at their specific needs, and build a program of rehabilitation such that these patients don't need acute care facilities, that they can be rehabilitated back into their community or particularly back into their home. And I think that's the pillar that we need to develop. Once we have that model, then we can look at the financial model that needs to apply to it.

KELLY: Well if the government's taskforce, if the Prime Minister's taskforce was looking at that model, looking at the care issue primarily and then working backwards, what would they come up with in terms of a funding model?

GLASSON: Essentially if they looked at that in reality, I don't think we necessarily need to exclude the states per se; all you have to do is to ensure that the jurisdictional responsibilities, in other words that the states and the Commonwealth, have a clear line of accountability, that the money flow from the Commonwealth to the states and then to the regions is clearly, I suppose, laid out and that financial responsibilities and accountabilities is clearly laid out, then the system would probably work quite well.

The trouble at the moment is that the Commonwealth passes the money to the states and they pass about 50% of our public hospital money to the states. They have no accountability and no control over the system, and that's the frustration from the Commonwealth point of view and I understand that. And so I think, just think we need to have clear lines of accountability for this to work.

KELLY: Just briefly, rising costs and ageing populations are common challenges in many countries. Are there any shining examples from other countries in terms of delivery of health services that you'd like to see adopted?

GLASSON: The reality is this type of model which we're talking about has been provided in Britain. It has not worked there, and essentially as you know, the British NSH is probably one of the biggest bureaucracies in the world. My concern is what will happen here is this will not necessarily remove the state bureaucracy; it in fact just creates another bureaucracy.

Now we are currently looking at other systems around the world including France, Belgium, which probably has - or have systems that we can actually learn from. But can I say that the Australian system as it operates does in fact operate very well. It just needs some modifications to those four pillars I keep talking about, and I think we can actually then meet the needs of an ageing population, both in terms of demand for the services but also the demands for funds.

KELLY: Going back to the Podger model again, can you give us a practical example of how in an individual case - say a person needing a hip replacement - this model could go wrong?

GLASSON: I can tell you what, because as a purchaser of the money or the services, I may be given money for say 50 hip operations. Your grandmother might be 51 and essentially grandma, who might have been waiting on the list for the last five years, misses out yet again. And so this - the Podger model is about - it's not about improving access; it's about rationing. It's about how we can ration resources to the ageing population. It's not about making the system more affordable; it's actually making, getting the cheapest system not the best system.

It's about removing the independence of the doctor-patient relationship so your doctor works not for you, the patient, works for a third party. It'll remove all choice out of the system. So you'll be told where, how, when and why and so you'll have no choice. And importantly it does not address the quality issue. And essentially quality will go out the window.

So on all of the five criteria on which we judge health system - that's quality, choice, independence, access and affordability - it will fail because they've got the cart before the horse. They're looking at the funding model rather than looking at the clinical care model.

KELLY: Bill, thanks very much for joining us, and good luck with that ride today.

GLASSON: Fran, thank you very much indeed, and good morning.

KELLY: That's Dr Bill Glasson, AMA President who's about to cycle off from Newcastle to the Westmead Hospital in the pollie pedal. Maybe that's the only model that actually works, community fundraising.

Ends