Hospital chief has ‘surprising’ primary care stance

Matt Woodley

17/12/2019 4:05:02 PM

The CEO of St Vincent’s Health Australia has said the country needs ‘fewer hospitals, not more’ if it wants to make the most of its healthcare future.

Hospital waiting room
The CEO of St Vincent’s Health Australia has said Australia needs ‘fewer hospitals, not more’ to make the most of its healthcare future. But is he right?

Hospital boss Toby Hall laid out his case in a 1000 word op-ed that calls on Australia to adopt Denmark’s model – which has reduced its hospitals from 98 to 32 over the past 20 years – in order to ease healthcare costs.
Mr Hall pointed to the ‘very large’ number of non-urgent and semi-urgent patients currently seen in Australian emergency departments as evidence for reform, and said medical groups with vested interests are preventing substantial healthcare reform.
‘I sometimes toss around the idea of getting Australia’s healthcare leaders in a room and asking them to nominate one major policy development they are willing to embrace that specifically goes against their self-interest,’ Mr Hall wrote.
‘As the CEO of one of Australia’s leading providers of public and private hospitals, something my organisation has been doing for close to 180 years, I’m happy to get the ball rolling.
‘If Australia is to make the most of its healthcare future, it will likely need fewer hospitals, not more.’
Aside from reducing healthcare costs, Mr Hall believes that better technology and patients’ changing preferences means more healthcare should be delivered in the home, in combination with primary and ambulatory care in localised clinics.
Dr Mukesh Haikerwal, RACGP Expert Committee – Funding and Health System Reform (REC–FHSR) member and former Chair of the World Medical Association, told newsGP he is in favour of more investment in primary care and preventive health, but not at the expense of hospitals.
‘The grass always looks greener elsewhere but when you dig deeper, there are problems in every system [including Denmark],’ he said.
‘You can’t not have hospitals – the hospitals are there to do a job … They need to collaborate better with the out-of-hospital space, including GP specialists, non-GP specialist and allied health specialists. They can leverage their dollars better.
‘But you cannot do one at the expense of the other because they’re already under-resourced, both in terms of infrastructure and capacity.
‘The system has been undercooked for so many years in terms of infrastructure spends in all sectors, and people have been running a really good system … on the smell of an oily rag despite the system, not because of the system.’
More was spent on healthcare in in the 2019–20 Federal Budget than any other area outside social security and welfare, and in 2017–18 federal and state and territory governments allocated a combined $126.7 billion to healthcare – equivalent to nearly one quarter of revenue generated through government tax.
Yet, while it already accounts for a major part of government spending in Australia, Dr Haikerwal believes healthcare should be seen as an investment, rather an expenditure, and that additional resources in the short-term would result in a net long-term benefit.
‘Ultimately, it should be about health, not about illness. At the moment, we don’t have a health system, we have an illness system,’ he said.
‘Take hepatitis C, for instance. Governments have actually done sensible things about investing in medication to eradicate it. The cost is increasing [in the short term] … but in five years’ time, there’ll be no hepatitis C.
‘The significant disease burden of hepatitis C – hepatoma – will no longer happen, so that’s the sort of long-term vision that isn’t currently there because it’s about the next election cycle.
‘I don’t think you need a bottomless pit. I actually think that there is a level of investment in health and sustainable services that will keep us in a much better place into the future.’
According to Mr Hall, an emphasis on public hospitals over primary and ambulatory care has pushed emergency departments to ‘breaking point’. He believes politicians chasing photo opportunities bear much of the responsibility.
‘For the past decade governments and policymakers have failed to comprehensively grapple with the system’s mounting problems,’ he wrote.
‘We need to find a way to encourage politicians not to reinforce these old models of care – such as more hospitals and bigger emergency departments – and instead invest in the redevelopment of health infrastructure, supporting hybrid models that offer a mix of primary, ambulatory and acute care.
‘The challenge is, of course, name a politician who doesn’t like standing in front of a brand new hospital, red ribbon and scissors in hand.’
Nearly 40% of total health expenditure – $74 billion – was spent on hospitals in 2017–18, compared with $63.4 billion in primary healthcare, which includes $12.1 billion on benefit-paid pharmaceuticals. 
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Dr Dannielle Maria Kolos   19/12/2019 11:38:36 AM

There is a necessity to encourage older doctors who may be thinking of retirement, to continue in practice until there is a more substantial number of newly graduated doctors to enter general practice. Doctors are the first to realise when work is beyond them and take steps to reduce their work load. Doctors over 70 years old at present feel like intruders that should be making way for the younger cohort, but that cohort is not coming. The medical community needs to encourage positive reenforcement for older doctors. The patients certainly do - if that doctor has survived to this age, he/she must know something about ,maintaining health

Dr Denis James Carragher   20/12/2019 4:15:48 PM

A small example of this problem is created by the private health funds. In our practice we have offer minor surgery under local anaesthetic for procedures like Vasectomy, ganglion ablation and various skin cancer removals. These are not re-embursed by the private funds, as we are not an accredited surgical theatre. Net result the patient is operated on privately at multiple of the cost to the health system. Equally non insured patients languish on public hospital lists for many years. As we are in an outer urban area we offer a limited ED service, which to us is not cost effective, as we must make a small charge and the patient prefers to wait at a public hospital. It does not make economic sense.