Australia is preparing for a massive overhaul of an ailing public health system that a new federal report has warned the nation will not be able to maintain within 25 years.
The reform commission is urging a dramatic swing to primary healthcare and an all-out attack on waste, inefficiencies and continually lengthening hospital waiting lists.
The commission also recommends the establishment of a national public dental system, initiatives to deal with Australia's rapidly ageing population and a new body to oversee indigenous health programmes.
The report stops short of the complete takeover of state public hospitals earlier threatened by Prime Minister Kevin Rudd but it does recommend a large swing to federal funding that could eventually hand control to Canberra. Rudd warned that federal intervention remained an option and that, if necessary, he would seek a mandate through a referendum on the issue.
Australia's more than 700 public hospitals are at present run by state and territory governments. Frustrated at continued failure to overhaul a system barely coping with demand, Rudd had said if performance had not improved by June this year he would step in.
He now intends to start a nationwide consultation programme to prepare a final reform plan for a meeting with state and territory leaders at the end of the year, where they will be told Canberra will go ahead even without their backing.
Australia has been agonising over its health system, including the soaring costs of the groaning Medicare universal healthcare and subsidised pharmaceuticals schemes. The cost of maintaining public hospitals has topped A$30 billion ($37 billion) a year and has been rising at an annual rate of 6 per cent for much of this decade.
In addition to about eight million admissions a year - and rising - emergency departments have been overburdened by a patient load increasing by about 5 per cent a year and a workload dominated by medical cases. The median waiting time for elective surgery has grown from 28 days five years ago to 34 days.
Heavy pressure has fallen on areas such as chronic kidney disease - which account for more than one-in-10 hospitalisations - and on rural areas, where there are critical shortages of family doctors, specialists, dentists and other health services. The ageing population is expected to add to this.
The commission's report said "adverse events" such as infections and errors in medications affected about 16 per cent of people admitted to hospital with 4550 dying every year as a result. Health systems were plagued by inefficiencies, poorly co-ordinated diagnosis and treatment of chronic conditions, waste and other problems.
Improvements could reduce the national health bill by A$1 billion a year and increase life expectancy by almost two years.
The report made more than 120 recommendations for a reform programme estimated to cost between A$2.8 billion and A$5.7 billion to implement, eased by projected savings of A$4 billion within 15 years. Further capital spending of up to A$7.3 billion would also be needed.
Ten-year targets would be set for national health promotion and prevention that would see a major shift from treatment to prevention. The federal Government would be responsible for all primary healthcare, including a new network of primary healthcare centres and programmes such as nurses at primary schools to help beat childhood obesity.
Surgery would be removed from hospitals and placed in stand-alone units to allow hospitals to cope with emergency and medical workloads, a universal dental care scheme would be established and mental health services would be improved.
Opposition Leader Malcolm Turnbull has rejected the imposition of higher Medicare levies to pay for the dental scheme and has attacked Rudd's decision not to act earlier. "In 2007 Mr Rudd said to the Australian people he would fix the public hospital system by June 30 this year or he would take it over. He has done neither."
But the proposed reforms have been welcomed by doctors', health consumers' and reform groups. "What has been proposed today is a once-in-a-generation opportunity to reduce avoidable hospitalisations and deaths, reduce the burden of disease on society and reduce the overwhelming strain on our health system," General Practice Network chairman Emil Djakic said.
TREATING THE DISEASE
THE SYSTEM
* 700 public hospitals are run by state and territory governments.
* Public hospitals cost A$30 billion ($37 billion) a year to maintain.
* Costs, admissions and waiting lists grow annually.
* 4550 people die every year from medical system problems.
THE MEDICINE
* Reforms to cost A$2.8 billion to A$5.7 billion to implement.
* Capital spending of up to A$7.3 billion.
* Federal Government responsible for all primary health care.
* A universal dental care scheme.
THE OUTCOME
* Improvements could cut national health bill by A$1 billion a year.
* Projected savings of A$4 billion a year within 15 years.
* Life expectancy could increase by almost two years.
* Nurses at all primary schools.
* Surgery units to allow hospitals to cope with emergency and medical workloads.
World
