Page 3027 - Week 10 - Thursday, 15 September 1994
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than satisfactory. Since 1991, health spending has increased in real terms every year; yet our hospitals have budgeted for only the same number of patients. Despite population growth averaging more than 2 per cent a year, the total number of hospital beds has declined from 900 to well under 600.
Mr De Domenico: That means that it is costing more to do less.
MRS CARNELL: It is costing more to have fewer beds and no more patients. Waiting lists for elective surgery have increased significantly, from 1,789 to 4,416. The average cost per patient at Woden Valley Hospital has remained 30 per cent higher than the national average, and every health budget has been overspent in recurrent terms, while financial management systems have improved only marginally. So, what we see is a system that spends more and more for less and less every year.
The Follett Government - more particularly, Mr Berry - has had more than three years to tackle these problems and turn our health system around. Things have just got worse, not better. Those are not my words; those are the words of EPACT - your own body - the Commonwealth Grants Commission and the Andersen report. The response by successive Health Ministers - Mr Berry and now Mr Connolly - has been to close beds rather than to reduce the cost structure itself. The evidence for this is contained on page 42 of the Andersen consultants report, on which Mr Connolly put so much reliance. It says:
The current service agreement and global budgeting approach focuses Hospital Management on inputs rather than outputs. This funding approach does not provide any direct or explicit link between the level of funding provided and the hospital output. Under the global budgeting approach, expenditure control is focused on inputs to the system that reinforce the use of existing practices and -
wait for this -
encourages cost reduction strategies based on reduced outputs (ie, through bed closure or theatre list reductions) rather than through increased operation efficiency to reduce per-unit expenditure.
That is the report that Mr Connolly loved so much. In the Macklin report - Hospital Services in Australia No. 2 - issued in September 1991 and prepared as part of the national health strategy, it was recommended that States and Territories should be aiming to reduce the number of public hospital beds because of improved technology and shorter lengths of stay. Ms Macklin and her team suggested that there should be 3.3 public hospital beds per 1,000 people by the year 2000. That would mean that we would have 990 beds in Canberra, without even taking into account the fact that Woden Valley Hospital provides services to the whole region. That adds another 300,000 people to the ACT's 300,000, which is growing - although last week we found out that it is not growing quite as fast. I wonder why. This is in stark contrast to Mr Connolly's stated goal of 600 public beds, which is approximately two beds per 1,000 people.
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