Let me phrase that differently: What does it tell us about the public health system, when an accountant is put in charge? Let's have a quick look at history...
Fong came across from a large, private hospital. Apart from feathering his own nest, with a new head office close by his main place of work -- Subiaco oval -- was he successful? Or was he just doomed to fail... Think about his experience, running a private hospital.
A private hospital charges for its services. You want more treatment? You want better treatment? Fine, you get to pay for it. The more services offered, the bigger the profit. Whereas a public hospital is given a fixed amount and told to work miracles. Fong had absolutely the wrong background, absolutely the wrong experience, to head up a public health system.
Then there was Flett. A doctor. He may well have retained some sense of the need to cure people. No time for that sort of nonsense...
Now we have Kim Snowball. An accountant.
If you put a doctor in charge of health you can't help but think, the focus will be on curing the sick, on preventing illness, on improving the health of the people of the state. Put an accountant in charge and there is only one conclusion: the most important task for the new head of Health, is to balance the budget.
The most important task for the new head of Health, is to balance the budget. Well, actually, there's nothing wrong with that. As long as the aim is clear, and well known.
The scope of health care
Consider this: You have just won $100 and you decide to spend it all on food. Do you, (a) Spend it all on a slap-up meal for yourself and your partner? (b) Bring your family and friends to a take-away food joint and shout them all chips and a drink?You could even go for, (c) invite your neighbours, who have just been through a rather difficult time, to join you for dinner.
All of these options have good points -- and bad. All have equivalent options in spending the Health budget.
Spend the entire health budget on health care for taxpayers and their dependants. Why not? After all, it is taxpayers who provide the money for health. Why should we spend on people who do not pay -- perhaps have never paid -- tax?
We -- taxpayers and others -- seem to accept that the health budget will be used to provide health care for everyone. Whether or not they pay taxes. Especially if they are unable to earn money to make them liable to pay taxes. So (a) is rejected..
Spend the health budget only on taxpayers and their fellow citizens? That sounds sensible. After all, we have an obligation -- a duty of care -- for all the people who live here.
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Only trouble is, there is the same money but more people to use it. There is less Health budget per person.
Invite our neighbours -- those on their way here, those who live in other countries -- to share our health resources. This is a very nice thought. It just costs a lot of money. Or -- with a fixed budget -- there is less health care available per person.
This is what it boils down to: We can spend a lot of money per person on very few people, or not much money per person on a whole lot of people. In fact, we try to strike a balance: spending a reasonable amount of the Health dollar on a reasonably broad range of people.
What do we get for our money?
Back to that $100..Our neighbours are really, really struggling. They are reduced to eating dog food, when they can afford it. Then there's widowed Aunt Mabel, who eats enough but can never afford a treat. The immediate family eat well, perhaps too well, with too much fat and sugar in the diet.
Do we shout the neighbours one, good meal to keep them going for a day? Or perhaps we spread the $100 to a standing invitation to join us for sandwiches, for lunch every day for the next few weeks. Do we spend all the money on the struggling neighbours? Or should we save some for Aunt Mabel...
We could offer our neighbours lunch for just one week. That would leave enough money to provide a treat -- dessert for one meal, perhaps -- for Aunt Mabel.
Perhaps we should spend some -- or all -- of our money on ourselves. After all, if we buy expensive but healthy food for all of this week, our eating habits may improve. This will have long-term benefits... though Aunt Mabel and the neighbours will suffer here and now. (Well, Aunt Mabel won't "suffer". She will just miss out on an unanticipated benefit.)
What do we get for our Health money? There are the same choices: Alleviation of immediate suffering, Short-term improvement, Possible long-term gain... It's a political choice. The head of Health must balance the budget within the choices of the politicians.
Oh, and don't forget that there are demands... Some family members want to help the neighbours. All of you want to give Aunt Mabel a treat, though you disagree over the actual type of treat. Some of you would prefer you usual fatty, sweet meals because the benefits of healthy food are too far away in the future. And no matter how much you argue, the agreed spending is far more than $100.
Then there's the technology of medicine Okay, so you've agreed how to spend that $100. It adds up to $110 but you're sure you can buy some of the food on the cheap.
But you overlooked the cost of food preparation.
You provided fresh food for the neighbours -- but they don't have a fridge. Do you buy a fridge, rent a fridge, share your own fridge (with all the inconvenience that causes)?
You buy a small cake for Aunt Mabel. As you deliver the cake, the car runs out of petrol. You are forced to buy petrol on an expensive day of the price cycle. And the time taken to deliver the cake meant that you missed the first healthy meal with your own family. You just can't be everywhere!
As it turned out, that healthy meal was a waste of money. All the guests brought a plate -- of their favourite sweet and fatty food. Still, one of your children did seem to enjoy the healthy meal and looks like improving their eating habits. Was it all worth it, for just that one improvement?
Unfortunately, that meal had other problems. Because you let you neighbours share your fridge, the healthy food was kept in an esky. Overnight. Your partner is suffering from food poisoning. You are accused of penny-pinching, when you should have simply bought a second fridge...
Spending the Health budget is a lot like that. There are choices, on who to spend it on. There are choices, on what to buy. There are choices -- and possible large costs -- involved in the wide range of available health technology. Do you buy the latest model MRI scanner, or stay with the old one? Do you buy one MRI scanner per hospital, or do you buy more ambulances, to transfer patients to one central scanner?
There are always choices -- and never enough money.
A Snowball's chance in Health
Running a Health system is not about providing a health service. It's about choice, within limited funds. Who do you help? What help do you provide? What technology do you use? There are demands to do everything.To put it another way: Who do you decide to not help? What help do you not provide? What "old" technology do you put up with because the new technology is very expensive? And whoever you do not help -- will complain very loudly.
That's why Health is to be run by an accountant. It's about balancing a budget, not about providing a health service.
Perhaps a juggler would do even better.
Agamedes Consulting. Support for your thought: email nick leth at gmail dot com |
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