NSW: The ailing health of health care funding

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NSW: The ailing health of health care funding

By Jim Hanna, State Political Correspondent

SYDNEY, Aug 8 AAP - There will never be a shortage of emergency department horror storiesfor oppositions to exploit, but who's to blame for the crisis?

The public health system always seems to be struggling to cope, despite one-fifth ofall federal spending and one-quarter of all NSW state spending going into health.

Experts blame the decline in bulk-billing, a lack of aged care beds and the chronicshortage of nurses.

The head of medicine at Sydney's Prince of Wales Hospital, John Dwyer, says media imagesof patients waiting for hours in crowded public hospitals will continue until federaland state governments agree to serious changes about how health care is run in Australia.

"At the moment, the problem is more at the federal end of the spectrum than the states,"

Professor Dwyer recently told ABC Radio.

"We've all had enough of this... A Current Affair and all those things, just showinghospitals with ambulances everywhere (saying) `Isn't it terrible, isn't it terrible?'."

The nationwide nursing shortage prevents public hospital beds from reopening.

The NSW opposition says almost 4,400 hospital beds have been shut since Bob Carr becamepremier in 1995.

Only 200 of the state's 1,900 nursing vacancies have been filled since Labor was re-electedin March, allowing just 580 beds to reopen.

NSW Health Minister Morris Iemma acknowledges the states must do more to recruit nurses.

But he also blames the federal government for not funding enough university placesfor nurses to meet the demand.

The system is also suffering because fewer doctors are willing to bulk bill patients,forcing many of them to visit public hospital emergency rooms with ailments a GP shouldtreat.

Last financial year, 9,000 people went to NSW emergency departments with coughs, coldsand sore throats, 4,500 with headaches, and 2,800 with earaches, Mr Iemma said.

Studies show people in towns where GPs don't bulk bill use emergency departments threeor four times more often than people in towns where GPs do bulk bill.

Labor says only 68.5 per cent of GPs now bulk bill (down from 80.6 per cent when thecoalition was first elected) because the Howard government's Medicare rebate to GPs hasnot kept up with the cost of running a practice.

The lack of aged care beds (which are federally funded) is also forcing the elderlyinto (state funded) public hospital beds until an aged care place becomes available.

This means other sick people attending emergency rooms have to wait longer for an acute care bed.

Professor Dwyer acknowledges health care is a deeply political area, especially whena coalition government holds the dollars and Labor governments run all the states andterritories.

But he said better, more integrated planning could extract more health care from thesame amount of money - but it's not happening.

"The states have said repeatedly in the last 18 months that they want a new era ofreform and modernisation (and) Canberra really hasn't come to the party in terms of helpingwith that reform."

Professor Dwyer is part of the 18-member Australian Health Reform Alliance of expertsand providers warning of dire consequences if the federal government does not change itsapproach to health care funding.

In April, the federal government unveiled a bold $42 billion, five year funding offerto the states known as the Australian Health Care Agreement.

It was a $10 billion increase on the previous agreement - but only if states matchthe funding growth.

NSW said it already spends $1.60 on health care for every federal dollar; its healthbudget for 2003/04 is $9.3 billion while its share of the commonwealth's $42 billion wouldbe $14.1 billion over five years.

State Labor ministers rejected the federal offer last week, claiming it would makethem almost $1 billion worse off.

They have until the end of August to sign up or have their funding cut.

The federal government's offer represents a five per cent increase but health costsare rising by around eight per cent annually, Mr Iemma said.

He also said NSW was being short-changed because the last health care agreement tookinto account three major factors driving up health costs - inflation, bigger and ageingpopulations, and more costly technology and medicines.

Using the same formula this time would have given NSW an extra $300 million, he said.

Of course federal Health Minister Kay Patterson believes her package is a generous one.

Senator Patterson said Canberra has lifted its contribution to national health spendingby 28 per cent in real terms while the states made no real increase in theirs.

She also said the government's 30 per cent rebate for private health insurance - costing$2.4 billion a year - has taken demand off public hospitals.

But public hospitals remain under pressure because they provide more services thanprivate hospitals.

For example, just three of Sydney's 40 private hospitals have 24-hour emergency departments,meaning the burden still falls heavily on the public system.

Whoever is to blame, taxpayers know one thing - it's their money and it's not deliveringthe type of health Australians expect.

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KEYWORD: NEWSCOPE NSW (AAP NEWS ANALYSIS)