Time to rethink how we fund health

 

Ramping of ambulances outside major hospitals did not occur when I started as a medical intern in Queensland in 1976.

Times have changed and ramping is everywhere. We have seen with COVID-19 that diseases, treatments and responses to health crises evolve.

What is right one day is wrong the next. Health economics is the same. What was true for the health sector in the 1990s is not true now.

Our large teaching and university hospitals in Queensland were pulled down in the 1990s and replaced with buildings that have half the bed capacity.

In the 1970s and 80s, people stayed in hospital for three to five days for simple operations but procedures were quickly becoming safer and faster. The era of the day procedure was dawning and hospital stays shortened.

Ambulance ramping at the Princess Alexandra Hospital at Buranda in March. Picture: David Clark
Ambulance ramping at the Princess Alexandra Hospital at Buranda in March. Picture: David Clark

Fewer hospital beds were predicted by health economists but they got it wrong. Our population has grown 60 per cent and we are ageing. Cancer, vision and joint replacements work and people are receiving these treatments in hospitals in large numbers.

When I started as a doctor, you could not be admitted to some Intensive Care Units (ICU) if you were over 65. Now, most people in ICU are over 65 and being actively treated.

ICUs are full. Emergency departments (ED) are full. Hospitals are full.

Acutely unwell people are waiting for beds and it is not just occurring at metropolitan hospitals.

It is happening at rural and regional hospitals and airports around the state, with emergency flight retrievals and transfers waiting for a bed in Cairns, Townsville, Rockhampton and southeast Queensland.

So, who is using hospital beds? Can we better meet some patients' health needs outside a hospital? Are we using the Hospital in the Home program to its greatest impact for the treatment of simpler health issues?

Is NDIS funding keeping participants out of hospital and returning them home safely and earlier? Can we increase the number of GPs and Registered Nurses in residential aged care to treat older patients where they live?

To ensure we understand who our patients are, Queensland Health needs an urgent bed audit.

AMAQ president Professor Chris Perry at the headquarters in Kelvin Grove. Wednesday June 24, 2020. (Picture, John Gass)
AMAQ president Professor Chris Perry at the headquarters in Kelvin Grove. Wednesday June 24, 2020. (Picture, John Gass)

We also need more hospital beds. Ramping occurs outside full hospitals when there are not enough beds. But a bed is not just a bed; it is a unit of ongoing activity and associated costs including staff, equipment, disposables and more. A public hospital bed can cost between $500,000 to $2 million per year in recurrent funding.

At AMA Queensland, our members give estimates of up to 1500 beds being needed in Queensland public hospitals. That is a lot of taxpayers' money. A hospital saying states, "The enemy of the Health Minister is not the Shadow Health Minister; it is Treasury …"

We need to fund health properly - hospitals and also GPs and private practices too. In the past six months, 1.4 million Queenslanders went to a hospital ED - that is nearly 7000 people every day and it's not slowing down. EDs are free, which makes them attractive.

GPs have to charge out-of-pocket fees because Medicare rebates are at a third of their original levels, while expenses have increased alongside the Consumer Price Index.

Medicare rebates reflect 40 years of stagnation. The bulk-bill fee of $37 for a GP professional service does not cover the true costs of providing appropriate care in a private practice.

There is an additional charge or the practice is closed out of hours. The costs are steering patients to hospitals unnecessarily. Even if you wait for hours, you don't have to pay. This is both a city and regional issue. Private practices prop up public hospitals.

Lifting Medicare rebates for GPs, to cover the true costs, would reduce the pressure on gap payments and flow through to the whole health care system. I have a private surgical practice but still work half my time in Queensland public hospitals, which I love. The people who run them, I hold in the highest esteem.

Everyone tries to do a great job, and they do, but we need to take action to address ramping, which is an issue of funding. Ramping is here and it will visit you and your loved ones unless there are more funded beds.

Professor Chris Perry is the AMA Queensland president

Originally published as Time to rethink how we fund health



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