The Guardian 2 March, 2005

Hospitals in crisis

Anna Pha

Last week Professor David Morris, director of surgery at the St George Hospital in Sydney, stepped down from his position. "I am aware of two patients that have died waiting and others whose cancer has progressed, and I do not think that is appropriate", said Professor Morris. He added that 732 patients had waited more than a year for an operation and 185 "most urgent" patients had waited more than a month. "We have two theatres empty every day, and that is purely funding, not staffing." The system is in crisis because of lack of funding.

St George Hospital is a major teaching hospital, one of the largest hospitals in NSW. It is not the only hospital in crisis.


The Children's Hospital at Westmead (western Sydney) has a waiting list of around 1550, Gosford has 3181, Nepean 2398, and so the list continues.

Some patients die while waiting for treatment and thousands more are battling in pain and other preventable suffering, as they also count the weeks and months on waiting for admission to a public hospital.

Many families and older people are paying thousands of dollars in private health insurance (PHI) that they cannot afford to pay, so as to avoid being a casualty of such waiting lists. At the same time, public hospital beds and even whole wards remain closed.

Professor Morris is not alone in his concerns. And while he is still operating at the hospital, other doctors have left in disgust. Hospitals are finding it increasingly difficult to recruit nurses. The low pay and highly stressful conditions working in under-staffed, under-funded public hospitals have driven many nurses out of the system and into other employment: they leave because the situation prevents them giving patients the professional care that they are trained to give.

The alarm bells should be ringing. Yet the NSW government's response is one of denial it says it is spending more money and refuses to acknowledge the situation is unsatisfactory.

Other state governments are not much better. The pattern of under-funding of the public hospital system is national and is contributed to by the federal government.

There is enough money. It is a question of how the money is allocated. At present billions of dollars are being thrown to the private hospital system in an effort to shore it up.

People prefer the public hospital system. It offers superior treatment. It can be more efficient and more accountable. Yet many have been driven into taking out PHI cover out of fear that they may one day end up on one of those waiting lists with cancer or some other condition requiring urgent treatment.

The public have voted with their feet when it came to choosing between public and private health care. They have chosen public.

The Howard Government is handing over almost $4 billion a year and it is rising in subsidises to the private system, more than $2.5 billion of that through the 30 percent uncapped tax rebate for PHI.

If that money were redirected to the public health system, public hospitals could be fully staffed, more wards and beds opened and hospital waiting lists eliminated.

In addition there would be millions of dollars left to spend on a universal public dental health system, on rehabilitation programs, preventative health care, aged care and other unmet needs.

The running down of the public hospital system is deliberate. The aim is to privatise both health cover and the provision of health services. As there is little public support for this agenda, federal and state governments have resorted to alternative means such as the rebate and creating a crisis in the public system to force people into the private system.

The Howard Government's "Lifetime Health Cover" was designed to play on people's fears. It oversaw the introduction of a sliding scale of fees based on age the older paying more. (The premium is two percent higher for each year above the age of 31 until PHI is taken out.) Those who take out PHI before the age of 31 and keep it will not be affected by the rising premiums as they become older.

Those who have, quite often very reluctantly, taken out private health cover are faced with what the government calls "choice". And some of these choices could prove quite expensive.

Following the introduction of the 30 percent rebate and the "Lifetime Health Cover" system, the number of people taking out private cover did rise, but that is dropping off again. This is not surprising as the rebate initially made cover 30 percent cheaper, but since then insurance premiums have gone through the roof. The Federal Health Minister Tony Abbott just last month approved further price hikes.

There are dozens of funds to choose from, and each of the funds offers a range of options as to type and extent of cover and whether excesses are paid, whether the full cost of hospitalisation is covered, etc.

The average person does not want all these choices. They expect and deserve quality, affordable services and they want security and peace of mind. The private system offers none of these.

"Health cover is as simple as: 1-2-3" runs HCF's promotional material. HCF is one of the major PHI funds.

Depending on whether you take out "First Choice Saver Hospital", "First Choice Hospital", "Smart Choice Hospital", "Smart Choice Hospital (Excess)", "Blue Ribbon Hospital", or "Blue Ribbon Hospital (Excess)" a single or two parent family would be paying anything from around $1000 to $2473 per annum. And they still might be out of pocket, especially if they insist on choosing which hospital to go to.

The whole notion of "choice" with regards to health care is a farce. Even the choice of hospital is being eroded in circumstances where funds tie up contracts with private hospitals, and where those hospitals which refuse to be dictated to by the PHI funds could see insured patients left thousands of dollars out of pocket.

The PHI rebate must be redirected to the public health system where taxpayers' money will be put to use for the public good.

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