PUBLIC HEALTH:
FUND THE SYSTEM

A conference of State and Territory leaders meeting in Sydney last 
weekend agreed that the delivery of health services in Australia is under 
unsustainable stress. Amazingly, this conference of national and state 
leaders did not mention the two key factors behind the stress on the public 
health system: lack of government funding for public hospitals, and the 
billions of dollars being diverted from the public system to prop up the 
inefficient and costly private health insurance system.

Funding for public health has for a long time been a political football 
kicked about between state and federal government. Neither level of 
government wants responsibility for funding public hospitals and both have 
constantly sought the ways and means to cut the level of funding.

This is reflected in the conference finding all sorts of reasons to explain 
why the system is under stress: the ageing population, technological and 
scientific advances, inefficient practices, rising costs, shortages of 
skills etc.

The reality is that the hospital systems are under-funded, which is why 
health workers and, in NSW at least, doctors and specialists, are up in 
arms. 

Funding for the public hospital system in NSW has been cut to the point of 
near-collapse of parts of the public hospital system. In Victoria health 
workers have been left with no option but to carry out a concerted 
industrial campaign (see story page 4). All the states and territories are 
experiencing similar problems.

A prime example is Sydney's Westmead Hospital in the western suburbs, where 
funding cuts have resulted in a reduction in the number of beds from 1,000 
in 1979 to 750 today. A proposed further cut of $9.5 million dollars will 
see the number of beds reduced to 660.

At Westmead, cancer patients have been forced to wait up to six weeks for 
urgent surgery. In the week preceding the conference, 12 heart attack 
patients had to wait hours for treatment in the accident and emergency unit 
because no beds could be made available.

The unit itself has recently been forced to close at least once a week for 
other than life threatening cases.    

The Premiers resolved that there should be an inquiry into the efficiency, 
effectiveness and future profitability of the delivery of health services 
in Australia, with a draft report submitted within one year and the final 
report within 18 months.

A number of organisations have called for an increase in the Medicare levy 
to help cover the costs of running state public hospitals.

The Public Health Association of Australia this week said that a one 
percent increase in the levy would largely solve the funding problem, 
without resort to means testing of patients.

The Queensland and Tasmanian Labor Governments have expressed opposition to 
any downgrading of the current level of service or change to the funding 
arrangements and the introduction of "co-payments" for treatment at public 
hospitals has been proposed by the governments of Western and South 
Australia.

Under this scheme a patient would be forced to pay part of the cost of 
treatment at public hospitals, which is currently free of charge. The Carr 
Labor Government in NSW is giving the co-payment proposal a sympathetic 
hearing.

Victorian Premier Jeff Kennett wants to go much further. He wants to see 
the Medicare levy scrapped and all but the most destitute of patients 
forced to take out private health insurance, or pay the full cost of 
treatment.

Kennett is supported in this by the Australian Medical Association which 
has campaigned for many years for the user-pays system for public hospital 
treatment and the scrapping of Medicare.

The Australian Council for Social Services, the Public Health Association 
of Australia, the Brotherhood of St Laurence, the Australian Consumers' 
Association and the Catholic Healthcare Association all called for the 
State and Territory leaders to reject calls for "user pays" policies in any 
form for public hospitals.

The ACTU has also indicated its vigorous opposition to the proposals, 
pointing out such a move would create a two-tiered health system.

ACTU Assistant Secretary Greg Combet said that Medicare had enabled 
Australians to have equitable access to the highest standards of health 
care at a relatively low cost.

"Medicare is one of the cornerstones of the social wage, and universal, 
free access to health care is of critical importance to workers and their 
families. To propose that public hospitals charge patients would inevitably 
lead to a US-style, two-tiered system", he said.

The real aim of the proposed inquiry is to prepare public opinion for the 
undermining of Medicare with the possible introduction of means testing, 
co-payments and other measures that would eventually lead to the 
destruction of Medicare as we know it and the establishment of two systems 
— where the quality of service depends on your ability to pay.

Australians have voted with their feet for Medicare as a system of 
universal health insurance, with bulk billing and "free" hospital treatment 
as central features.

One public health system is the best and most efficient way of providing 
health services for all Australians, rich and poor. The public health 
system, including Medicare, must be defended in its entirety.