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User-pays system fear as Medicare on life support

| 03.06,09. 01:34 PM |

User-pays system fear as Medicare on life support

June 03, 2009 12:00am

THE Australian system of free universal healthcare is set to disappear in as little as five years, prompting a radical plan for a new federal-state partnership to take control of hospitals and patient care.

It comes amid a push by the Australian Medical Association for hospital specialists to treat patients only four days a week, potentially placing further pressure on a system already hamstrung by work restrictions among emergency physicians.

In a startling warning, NSW Health director-general Debora Piccone has told The Daily Telegraph that Australia is hurtling towards a US-style user-pays system due to an ageing population and out of control costs.

"We are really on the edge of losing the universal healthcare system that this country has," she said.

"I would have (previously) said we'd had 10  years to run. It's now looking like we've got five years to run because the cost escalations are so significant and we haven't prepared ourselves."

Under the US system there is no free health care. Even an employer-subsidised insurance premium costs more than $3000 a year and if you are uninsured you are likely to have to pay several thousand dollars deposit just to be admitted to a hospital.

Professor Piccone and Health Minister John Della Bosca are now working on a plan to pool all state and federal health funding and have it redistributed by a joint partnership between the two governments.

The $13.2 billion state hospital budget - set to grow into almost $50 billion by 2025 - would be integrated with Commonwealth funding towards Medicare, the pharmaceutical benefits scheme and aged care and jointly administered so as to slash red tape and eliminate overlap.

Mr Della Bosca said the overhaul - the biggest since universal health care was introduced under Gough Whitlam - would deliver "a single mandate" of patient care.

"We need a new governance model which takes the massive pool of funds available," he said.

"We need to find a forum to co-ordinate that more effectively and you can only see that as some kind of joint commonwealth-state operation.

"I know the next step is right there and we've got to take it."

In its first stages the move would address:

 The 1000-odd state-run hospital beds occupied by elderly who should be in federally run nursing homes;

 Overlap between drugs handed out in state-run hospitals and purchased via the federal PBS; and

 Revisiting the roles of various state and federally regulated medical staff in rural areas.

The plan would need Canberra's approval, but Mr Della Bosca said he was confident the Rudd Government would respond positively.

An investigation by has also revealed hospitals are struggling under the demands of medical colleges employing tactics that enable specialists to work just three or four days a week while at the same time creating extra demand for themselves.

One, the Australasian College for Emergency Medicine, refuses to accredit emergency departments unless its members work only three days a week in the ward. A fourth day is allocated for study and research and the doctors can also claim up to 25 days a year for conferences.

NSW Health has tried to get the doctors to work a five-day week but they have refused.

ACEM president Sally McCarthy said most emergency doctors worked much longer hours.

Daily Telegraph



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