Public hospitals in crisis: Urgent overhaul needed, warns medical association

MedTech & Diagnostics News: The Australian Medical Association (AMA) has uncovered a series of shortcomings in the public hospital funding arrangement, asserting that the National Health Reform Agreement (NHRA) agreement is in dire need of a comprehensive makeover. The AMA recently submitted its findings to the government’s mid-term review of the NHRA Addendum 2020-25, highlighting critical issues plaguing the healthcare system.

According to the AMA, the current agreement, which still has more than two years remaining, has failed to meet its key objectives and has led to a host of alarming consequences. These include ambulance ramping, skyrocketing elective surgery waiting lists, bed blockages, and overwhelmed emergency departments. Startlingly, the AMA estimates that by the end of this financial year (2022-23), there will be a staggering backlog of 507,764 patients awaiting elective surgery. This backlog has been exacerbated by the growing number of patients requiring admission, resulting in prolonged stays in emergency departments (ED) and delayed handovers from ambulances to ED staff.

Professor Steve Robson, President of the AMA, expressed grave concern over the funding agreement’s ineffectiveness in addressing patient outcomes such as equitable access to care, reduced emergency department demand, and improved mental health outcomes.

“If the agreement is failing our hospitals and our patients,” said Prof. Robson, “it needs a radical overhaul, yet we are stuck with this flawed formula until 2025.”

The consequences of the current funding model are far-reaching and extend beyond mere inefficiencies. For instance, delayed orthopaedic surgeries, like hip replacements, place an additional burden on the healthcare system. Patients require more consultations with their general practitioners, increased medication subsidised by the pharmaceutical benefits scheme (PBS), and income support from the government due to an inability to work. The AMA highlighted a poignant case where a patient had to endure a two-year wait for a hip surgery, rendering him nearly immobile and unable to work.

Furthermore, emergency department performance has witnessed a continuous decline. The percentage of triage category 3 patients seen within the recommended time has dropped from 70% in 2013-14 to a mere 58% in 2021-22, the lowest recorded since the AMA began tracking the data. Similarly, the percentage of ED visits completed within four hours or less has declined from 73% in 2015-16 to 61% in 2021-22, reaching its lowest point since 2011-12.

Professor Robson argued that the funding model for the health system is ill-suited to address the growing population, aging citizens, and complex health needs of Australians. He emphasised the need for increased funding to prevent avoidable hospital admissions and unnecessary re-admissions, expand hospital capacity, and reward improved performance. The AMA’s Clear the hospital logjam campaign calls for a 50-50 shared funding arrangement between the Commonwealth and the states, as well as the removal of the artificial cap that hampers growth in the system.

To achieve these goals, the AMA estimates an investment of $12.7 billion over four years from 2022-23 to 2025-26, with the Commonwealth government increasing its contribution to 50% for activity. Additionally, removing the 6.5% cap on funding growth shared between states and territories would provide an additional $7.8 billion investment over the same period. This investment, according to the AMA, would align the funding model with the current health needs of the community.

In addition to funding concerns, the AMA also calls for a complete restructure of national governance arrangements to ensure accountability and performance monitoring. The current Addendum lacks clear mechanisms to hold parties accountable when they fail to implement their agreed-upon responsibilities and objectives. The AMA advocates for a return to the Performance and Accountability Framework outlined in the National Health Reform Agreement 2011, which provides a template for appropriate governance arrangements.

With the urgency of the situation apparent, the AMA is calling on all health ministers and levels of government to work collaboratively towards a solution that will secure the future of Australia’s public healthcare system.

“We implore all health ministers and all levels of government to work together to get this right for the future and to help our hospitals out in the meantime with an immediate injection of new funds,” urged Professor Robson.

The fate of Australia’s public hospitals hangs in the balance as patients endure extensive waiting lists, overcrowded emergency departments, and a deteriorating quality of care. The AMA’s plea for change serves as a stark reminder that the wellbeing of the nation’s citizens should be paramount. The time for action is now.

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