Will the federal government take over the health system? It’s the question that many people are asking as the Prime Minister’s health reform bandwagon tours the country’s hospitals.
But it’s the wrong question.
Instead, we should be asking: how can we engineer a Victorian takeover of the nation’s health system?
Victoria has much to teach the rest of the country about how health systems can and should be run.
This may come as a surprise to many Victorians who, like the rest of us, are used to headlines damning their health system. But believe me, if you live in Victoria your health system is streets ahead.
It’s not simply because Victoria worked out a rational funding basis years ago (NSW still hasn’t managed to implement case-mix funding); it’s the way your public sector has worked out how to operate relatively sophisticated partnerships with the private and non-government sectors.
In my own field of mental health, Victoria led the way in implementing the national mental health policy years ago, while other states such as NSW are still working out how they might go about this.
Victoria has also led the way in funding primary care and networking it into the rest of the health system. In difficult areas, such as drugs and alcohol, Victoria has developed systems of care that are much more responsive to the community’s needs.
Sure, some people will say it’s easier to achieve these things in Victoria — it’s a wealthier state without the vast rural distances of elsewhere. But that’s missing the point — that a succession of Victorian governments, of all political flavours, have empowered local and community agencies to deliver services that are relatively responsive to the community’s needs.
It’s not surprising that the National Health and Hospital Reform Commission’s proposals for the federal government to take over primary care has many Victorians terrified (heaven forbid even the thought of a federal takeover of hospitals). The Victorians fear being dragged down to the national average, and that the standards they’ve worked so hard to establish will be lowered.
But rather than dragging Victoria down, the rest of us should be looking to how they could pull us up.
It is not yet widely recognised but there is one option for health reform that could enable those living in NSW, Queensland or even Wwestern Australia to access health systems run by Victorians.
If the federal government had the foresight to leave the Medicare Select proposal on the table (so far all the indications from the PM’s health consultation process is that it’s been pushed far to one side), this could enable Victoria to play a bigger role in the country’s health system.
The competing health plans envisaged under Medicare Select could easily include one run by the Victorian government health plan, and competing — for example — with other health plans both public and privately owned.
I may live in Sydney but I’d be rushing to sign up to the Victorian health plan. If history is any guide, it wouldn’t matter which government held power in Victoria. There is something about the culture and history of the place that has made it the nation’s leader in health care.
I’d rather have my health system run from Little Collins Street than North Sydney or Macquarie Street — and don’t even think of letting Woden run it.
Lets be very clear — what we want is federal money and national rules to oversee the system. What we want on the ground are health providers with a sound track record.
At this stage we need the Victorians to lead a northern intervention to rescue the rest of us from the national reform malaise.
Ian Hickie is executive director of the Brain and Mind Research Institute at the University of Sydney
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