Our health system is in crisis, as I’m sure you know.
Well, certainly the Victorian one is — Ted Baillieu says so. Two weeks ago he committed to “taking decisive action to stop the crisis in Victoria’s health system”. He might have been channelling the Herald-Sun, which recently wrote of the “health service bed crisis”.
Victoria, of course, is considered the least-worst state. Everyone knows the NSW health system is in crisis. The doctors. The nurses. The state opposition. And the Queensland health system is in such a crisis Premier Anna Bligh did a shift as a hospital orderly to better understand it.
Kevin Rudd thought our whole health system faced such diabolical problems he made health reform a centrepiece of his government.
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It doesn’t quite rival health, but apparently our education system is pretty shabby as well. Victoria has a “second-rate education system”, Baillieu has said. Teachers’ unions perennially lament the lack of funding going into primary and secondary schooling. Commentators agree. “There is a crisis in public education and the policies of Prime Minister Julia Gillard and Premier John Brumby are making it worse,” opined Ken Davidson on Monday in The Age.
No less an authority than Gillard herself in 2008 lamented that our education system was “underachieving”.
So, particularly for Victorian and NSW voters, and anyone inclined to believe what politicians and unions say, here’s some data on our health and education systems to help you make up your mind if they’re in crisis.
In 2008, the Australian Institute of Health and Welfare looked at how our health has changed in recent years compared to similar countries overseas. Between 1987 and 2005 our health outcomes moved into the top third of the OECD. On life expectancy and mortality indicators, we’re at or near the best in the world. On self-rated health — how healthy we feel ourselves to be — we moved close to the best in the world. We made substantial progress pretty much everywhere except on dental health, where we went backwards significantly — you don’t see too many tabloid headlines about dental health — and in our nursing workforce, where we went from near the the top of the OECD to near the back of the top third.
Ah, but what about hospitals themselves? While one of the Rudd health reforms is focused on extending and standardising hospital performance data, we’ve already got some basic indicators of performance from the AIHW. In the period between 2004-05 and 2008-09, we spent just under 6% more each year on public hospitals in real terms. The number of doctors employed has gone up 8% pa, year after year, since 2004-05; nurses by over 4% each year and allied health professionals by 4%, although the numbers fell slightly in 2008-09.
Non-admission treatments, including accident and emergency, rose 3.5% every year, about the same rate as admission treatments. That represents an increase of about 1.3% every year in treatments per 1000 people. At the same time, hospitals have become slightly more efficient, spending a little less on each treatment each year, partly because the average length of stay has fallen slightly — Australia is well below the OECD average when it comes to length of stay in acute care. In 2006, we had 3.5 acute care hospital beds for each 1000 people — just below the OECD average but more than US, the UK, the Canadians, the Danes and the Israelis and about the same as the Norwegians (the OECD has a great comparison of key health stats here).
So we’re some of the healthiest people in the world, we’ve been increasing the amount of money we spend on hospitals, employing significantly more doctors and nurses (one of the reasons health and care has become the biggest-employing sector in the country), treating more people and our hospitals are becoming more efficient, and are very efficient compared to the OECD at getting people in and out of hospital. All for a country that spends just under the OECD average on health.
Yes, there are glaring problems — dental and mental health stand out in the figures, as does obesity, and we know rural and regional health and indigenous health need significant improvement, but it’s rare that any of those areas attract much media attention, which is focused on the worried well in metropolitan Australia.
What about our education system? Are we failing our kids? Our primary class sizes are slightly bigger than the OECD average but our secondary classes are slightly smaller, and in both cases public school class sizes are smaller on average than private school classes. Our teachers are paid a lot more than the OECD average, except at the top of the salary range, where there’s a big gap between Australia and much of Europe. Students and teachers spend a lot more time in the classroom than their international counterparts. The result: our best performers in maths, science and reading are all in the top 10 of developed countries, and top five in science, and despite claims of a socio-economic divide in our education system we had more students from poor socio-economic backgrounds performing well in science, maths and reading than the OECD average, as well.
Again, this is achieved without spending as much as other countries. In 2006 we spent 3.4% of GDP on public education in primary, secondary and vocational post-secondary systems — just below the OECD average of 3.5%, though above countries such as Canada and Japan.
Our health and education systems may indeed be “in crisis” or “second-rate” but they manage to be among the best in the world despite of it.