the public [hospital] system needs to be increasingly challenged by alternatives that can allow its performance to be assessed and where needed, improved over time…

The risks, however, do not come merely from the technical difficulties managing the health system involves. Rather, they also come from the continuing strength of the ideological opposition to a private role in health care provision.

Thus, as recently as May 2007, the Centre for Policy Development – a think tank closely associated with the ALP – published a paper titled “A Health Policy for Australia” which called for the complete abolition of private insurance. While that position is not currently advocated by the ALP mainstream, there can be little doubt that it has many supporters, not least in some sections of the Union movement. As a result, there are powerful voices who would be happy to see the private sector role being wound back.

…sustaining a private sector role is not merely a question of keeping current broad policy settings in place. In practice, there are many decisions a government could take, acting within those settings, which could confine and reduce the effective value of private sector provision…

Whatever government Australia has in future will need to make choices about where it allocates scarce health care dollars in the face of what are likely to be steadily rising costs. The greater the government policy preference for public provision, the more likely it is that those choices will be made in a way that limits competition and choice.

Your Comments

I refer to comments by Prof Brendan Crotty ( Deakin Medical School - school for Drs , recently opened in Geelong). Prof Crotty made mention that the Private Hospitals were not pulling their weight when it came to the provision of training places for Medical trainees -Drs & Nurses.

I hope this situation can be put right. Private Hospitals are direct benificaries of a skilled medical workforce and should meet the training needs of such people. Tony Gleeson

Rather than encouraging people to leave the private health system, the government should be finding new ways of rewarding people for taking responsibility for their own healthcare and reducing demand on the public system.

Just a Hint “watch out for the freedom of the individual and listen to the elders “ particularly the old GPs, like Dr Bert Vanrenen. My contribution is on contestability. I haven't read the paper by economist Prof Ergas but it sounds like what I am thinking too. Perhaps you can post a link to the paper, to save us googling time.

I moved the motion from the Sth Yarra Branch in front of the PM to make the health insurance tax deductible, that led to the policy. He asked journalists what they thought, and the Govt introduced it as the rebate.

The graphs of declining membership were shown to the State Council then. I well remember in researching it, that one business sector wanted the Insurance deductibility restricted to business subscribing for their employees. Seriously!

Ten years on, the Government should now encourage the health funds to offer low claim bonuses or discounts, for healthier lifestyle, or otherwise, and by requiring competing quotations for serious voluntary operations. Not necessarily to accept the lowest, but so that the Insurance companies would tend to become trendsetters of best-practice, in an economic sense, as in the USA. There is no limit to the amount of health care that some people are prepared to undergo and it is unconscionable that others should have to pay for it ALL by way of higher premiums as occurs now. The Coalition should consider increasing the incentive for people with lower risks “ the young“ to become health insurers, and have lower premiums. 10 years is long enough for the health Funds to have significant expertise & assets to do this. There is a win-win that should attract the younger vote, and give some hope to the thriving small budding day hospitals, to invest for the future. At present, they are pulling back from expansion, and this is leading to stagnation and non-competition. Phil Spence

Heaven help us if the private system is phased out on ideological grounds as advocated by the ALP's think tank!

Certainly, Governments could do more to improve the public/private mix to give us a better health system.

Before Medicare was foisted on us by Labor, there was a pretty efficient system of wealth distribution in the way consultant specialists gave their services free to public patients in order to gain admission of their private patients into public hospitals.  There was no bloated bureaucracy to manage this, just the hospitals' normal administration.  And it worked.

While it may be difficult to re-introduce this system, the government of the day could work with the private system to provide better outcomes.  Currently, the Federal Government has to approve rises in private health insurance premiums, but  what is it doing actively to maintain the value of private insurance.  For example, is it working constructively to limit providors' costs and, therefore, the cost to the patient?  What is it doing about setting and encouraging best-practice norms so that health professionals can work efficiently and effectively?

Surely this is the sort of thing governments should be doing rather than trying to limit the amount spent on health care and trying to force us all into 'one-size-fits-all' public system. John Snell

Australia has a good blend of public and private health services and the overall standard of health care here is higher than in most countries which have a wholly government funded(socialist) health service.

Irrespective of what any Australian government might do, some people would continue to seek private treatment but they could not simply cross a border to be treated privately in the USA like our Canadian brothers!

Support of private health insurance allows more Australians to be treated in private hospitals which very definitely reduces the pressure on public hospitals and demonstrates to public hospitals a benchmark of efficiency, e.g., day surgery was developed in private free standing day surgery units and private hospitals before it was taken up by public hospitals.

However, the greatest risk to the standard of health services in Australia is the move to task substitution. If task substitution went ahead as planned by Labour, the not well off would receive their primary medical care from health professionals other than doctors – only the relatively wealthy would go straight to a doctor. Task substitution could delay essential medical treatment and the overall cost would be greater. The Australian Association of Surgeons strongly supports task delegation, e.g., working closely with a urologist, a urological nurse provides specialist advice and treatment of a high standard.

Furthermore, if it were implemented, the planned replacement of State registration and accreditation of all health workers (including

doctors) by a new national organisation could be expected to encourage inefficient task substitution.

John A Buntine

President

Australian Association of Surgeons