Top 10 Health Reform Questions for the PM Author : Melissa Sweet Prime

Crikey.com.au Page 1 of 2 03-Mar-2010 Page: 1 Current Affairs By: Melissa Sweet Region: Australia Frequency: MTWTFSS

Top 10 health reform questions for the PM Author : Melissa Sweet

Prime Minister Kevin Rudd is unveiling his government’s plans for health reform at the National Press Club right about now. (The ABC was reporting the Government will claw back $50 billion in GST revenue to directly fund the public hospital system as Crikey went to press.) So what should journalists be asking him and ministers Nicola Roxon and Warren Snowdon in the days that follow? The main questions that emerge from a deluge of suggestions from Croakey contributors are:Just what exactly is the problem you’re trying to fix, and how will you know that you’ve fixed it?How will these plans for hospital funding do anything to produce better integration between hospital and community care, in particular for people with chronic diseases?How will these plans do anything to redress the major inequities in the system, especially for under-served areas such as rural and remote regions, mental health, dental health, aged care, and Indigenous Australians? Meanwhile, here are some other choice questions from a range of health and policy experts: Health policy analyst Yvonne Luxford: Given that the stated objective has been to keep people healthy and out of hospital, why haven’t comprehensive announcements been made about prevention before addressing hospitals? Professor Stephen Leeder, Menzies Centre for Health Policy, University of Sydney: How will he measure outcomes—improvements in health—as opposed to outputs which at present he proposes to reward? Outcomes concern the nutritional value and flavour of the sausages. Outputs as in case-mix are just sausages—neatly packaged, vacuum sealed, but untested sausages of variable quality nevertheless. Associate Professor Gawaine Powell Davies, UNSW Research Centre for Primary Health Care and Equity: How will the new system avoid “provider capture” where providers organise

Ref: 65620327 Crikey.com.au Page 2 of 2 03-Mar-2010 Page: 1 Current Affairs By: Melissa Sweet Region: Australia Frequency: MTWTFSS

services in ways that suit them rather than the public? Robert Wells, director, Menzies Centre for Health Policy, ANU: Will you proceed if only some states accept? If not, what precisely is your next step? Professor Mark Harris, executive director, Centre for Primary Health Care and Equity, University NSW: How will public health and health promotion services be funded (as they don’t provide care to individual patients)? Professor David Penington, former vice-chancellor and dean of medicine, University of Melbourne: Public concern prior to the election was with the quality and safety of public hospital services after disasters in Bundaberg, and then at the Royal North Shore and even in the Road Traffic Unit at the Alfred in Victoria—all hospitals performing well on budgets and patient number indicators. How will the new model safeguard quality and safety with appropriate clinical governance overseeing the quality of medical services delivered? Dr Peter Mansfield, Healthy Skepticism: Given that misleading promotion of health products (including pharmaceuticals) has killed far more Australians than terrorists during the past decade, why isn’t the government giving the issue proportionate attention? The final question is, of course, whether Rudd et al will have the answers to the complexities raised by many of these questions—or whether their replies will be aimed squarely at capturing the headline grab. I suspect it will be quite some time until we gain a true understanding of the answers to these questions and the impact of Rudd’s plans. For more on Rudd’s health reform announcements stay tuned to Croakey…

Ref: 65620327 Dow Jones Newswires 03-Mar-2010 Business & Finance By: Rachel Pannett Region: Australia Frequency: MTWTFSS

Australian Govt Wants To Take Responsibility For Funding Hospitals

CANBERRA (Dow Jones)--The Australian government on Wednesday proposed that it take over from the states majority funding responsibility for the country's public hospital system, and introduce tough new national health-care standards, in a bid to increase efficiency and shoulder more of the burden of rising health costs. Currently, Australia's state governments are responsible for running the country's public hospitals and rely on the federal government for funding. Under the plan unveiled Wednesday, the federal government of Prime Minister Kevin Rudd would bring together eight disparate state-run healthcare systems, and take the dominant funding role for the entire public hospital system. "These changes will end the blame game, eliminate waste, and shoulder the burden of funding to meet rapidly rising health costs," the prime minister said in a statement. It amounts to a A$30.9 billion takeover of funding responsibilities over the next four years, he said. -By Rachel Pannett, Dow Jones Newswires; 61-2-6208-0901; [email protected]

March 02, 2010 20:31 ET (01:31 GMT)

©2010 Dow Jones & Company, Inc. All Rights Reserved. Ref: 65621552 Australian 04-Mar-2010 Page: 15 Editorials Region: Australia Circulation: 131246 Type: Australian National Size: 284.62 sq.cms Frequency: MTWTF THE AUSTRALIAN THE HEART OF THE NATION Hospital funding flan is not a comprehensive cure But ending state administration of the wards is a start

MONEY is the lifeblood of hospitals days of the Howard government, it hospital boards dominated by doctors and for too long too many of them havewould be cynical of the Opposition will only work if they are expert, not been getting as much as they need Leader to reject taking control of independent and efficient, capable of when they need it because of clogged hospitals away from the states. Mr controlling costs and making hard administrative arteries. Kevin Rudd Rudd's proposal for a third of GST decisions on patient care. Some announced he had a cure yesterday, revenue to go direct from Canberra to doctors, trained to order ever more promising to surgically remove small networks of hospitals, run by tests and to keep dying people alive a centralising bureaucracies. This is their own boards, could ensure more little longer whatever the cost, will have sensible stuff, a change from his money goes where it is needed most, trouble stopping spending, even when preference for concentrating control inwithout any increase in overall they are responsible for cost overruns. Canberra. However,it ishardly the spending. At times the states have usedBut even this would be better than miraculous political medicine the commonwealth grants, presently 35 perboards, which will be established under government's build-up to the cent of total hospital outlays, instead ofstate legislation, if they came to be announcement encouraged us to their own budgets to fund their public controlled by patronage appointments. expect. There was no election-winningsystems. To be worthwhile, the Prime There is also an accountability issue in promise of enormous amounts of moreMinister's plan would also reduce the the plan-who will front the cameras money, or specific undertaking to cut army of administrators, when a patient dies after an waiting times for surgery and reduce 450,000-strong, who supervise the unacceptable wait in a casualty ward or errors in operations - what people 290,000 doctors and nurses who walk when a hospital board ignores a think hospital reform is all about. And the wards. There is also a case that surgeon's incompetence? The state the Prime Minister's warning that autonomy helps hospitals make minister will blame Canberra for unless the states give up $30 billion in efficiencies. The evidence exists in inadequate funding and leave it to a GST revenue, so that Canberra can Victoria, where hospital boards enjoy alocal administrator to face the cameras, fund hospitals directly, he will put the fair amount of control over their pretty much as happens now. Nor is proposal to a referendum, has a sense ofbudgets, which are allocated accordingthere much evidence that a centralised confected conflict about it. Labor to the agreed cost of specific services, approach will ever address the specific premiers did not reject the idea outrightrather than based on total spending in circumstances of a sea-change yesterday and Mr Rudd could find a the previous year. But if state ministerscommunity hospital, battling to meet way to reallocate the GST without and mandarins lose under Mr Rudd's the needs of recently arrived retirees or constitutional change. Referendums proposal, will frontline health workers the problems of a remote health service rarely pass without bipartisan support,and, most important, patients, win? that could spend its entire budget on which the opposition signals is unlikely,While it is important to eradicate the dialysis for a large indigenous suggesting the warning was about cost-shuffling and blame-shifting that population. Mr Rudd says an finding somebody to blame on now harm our hospitals, the political "independent umpire" will set an hospitals come the election campaign. test of reforms will be whether fewer "efficient national price" for services in But while the proposal is not the people wait longer for elective surgery the context of local factors. But who will circuit-breaker Mr Rudd needs to end or emergency treatment than the umpire be? How will they get across the impression his government talks a nationally agreed objectives say they the local circumstances of every lot and achieves little, this is no reason should without blowing the budget. hospital in the country when state to underestimate the good it could do Unless there are commitments on the officials have failed to do it on much over the next decade. It has the metrics that matter, reform plans do smaller scales? Yesterday's potential to stabilise the hospital not amount to much. Given simplifyingannouncement was a sketch, not a system and prepare it for the complex the regulation of state and federal strategy, and more detail is needed - and continuing surgery needed to dealgovernment services is the most but on the basis of the soft questions the with the ever-increasing costs of important source of productivity electronic media bowled up to the medical technology and the health improvements to come, there is a greatPrime Minister yesterday, he may not needs of our ageing population. Since deal riding on the government getting feel under much pressure to explain the Tony Abbott proposed decentralising the detail right on hospital funding. hard issues in his plan. hospital administration to local boards And for all Mr Rudd's optimism, when he was health minister in the lastthere would be side effects. Local

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PRIME Minister Kevin Rudd yesterday could not and measures to levying taxes. even get the premiers to agree on when they will The funding plan outlined by Mr Rudd would not discuss his national health overhaul, let alone coax begin fully until 2013 -just before the election them into signing on immediately. after next which means it is at least three years, The Council of Australian Governments one general election and possibly a referendum (COAG) will consider the plan on April 10. Or it away from implementation. might be April 12 or April 11. The states and the The first big step will be the COAG meeting and Federal Government couldn't decide. the Prime Minister acknowledged he had "a way to The inability to even answer this relatively minorgo" with the states, but said: "I believe we have a logistical question was a sign that the path of the reasonable prospect of making progress". Government's overhaul of public health funding He spoke to premiers in a one-hour conference and pricing will not be easy. call yesterday morning which one source described Mr Rudd will go to an election expected late thisas a "description" of the funding overhaul, rather year asking voters to have faith in his than a detailed consultation. Government's ability to deliver a huge massive When the GST take was outlined to premiers, overhaul that would dwarf even an emissions "Some. .. were monosyllabic," joked Mr Rudd. trading scheme. Even Health Minister Nicola Roxon was And he might also have to ask voters to help himadmitting the tough road ahead. "I think it will be get around dissenting premiers by granting the difficult to land agreement for every state and Commonwealth "all the power it needs" to imposeterritory," she said yesterday. the reforms on states. But she said the plan amounted to the This would add a tough referendum battle to theCommonwealth taking on a bigger share of health election, to change section 51 of the Constitution spending from the states. which deals with the powers of the Federal "I think that's going to be a pretty attractive Parliament in matters ranging from setting weightsposition ... that'll be hard to walk away from."

Tough road ahead: Nicola Roxon

Copyright Agency Limited (CAL) licenced copy Ref: 65637889 Australian 04-Mar-2010 Page: 6 General News By: Adam Cresswell Region: Australia Circulation: 131246 Type: Australian National Size: 121.39 sq.cms Frequency: MTWTF Questions over bureaucracy pledge

KEVIN Rudd'spledge to ensure between one and four hospitals planned "Local Hospital creating the likelihood there Networks" will not create more would be at least 200 such bodies bureaucracy has come into nationwide, each as a state question after it emerged that statutory body with its own chief more than 200 of the new executive and governing council. organisations are likelyto spring Asked yesterday about the up nationwide. potential forjob losses in existing The networks, announced as state bureaucracies, Mr Rudd part of the government's proposed accepted this was likely, saying if reforms to hospital fnding and "it means shifting a position from governance, have been sold as an the main street of Sydney to, attempt to ensure health services frankly, a Local Hospital Network are run locally instead of by in downtown Port Macquarie, I'll impersonal state bureaucrats. tell you where I'll be supporting Detailing the proposals in his that's downtown local Port National Press Club address in Macquarie, and the same right Canberra yesterday, Mr Rudd said across the country". the networks would ensure that if But several health experts a patient could not be admitted at remained concerned at the their local hospital, "then the potential for duplication and Local Hospital Network will find uncertainty over how decisions that person abed at another would be made over which hospital within the networkor hospitals would be singled out to with a private hospital if one can't receive specialist treatment readily be found". The network centres that were not cost- would also be more likely to effective at every hospital. The greenlight new ways of treating detailed policy document patients that made sense in a local revealed state governments would area, he said. But experts say the retain some central planning proposal raises many troubling functions. questions, and may even need to Jane Hall, professor of health be re-thought, because of the economics at the University of sheer number that will be created Technology Sydney, said it was and a perceived lack of clarity over unclear how the local networks vital policy and planning issues. could function properly. Each network would comprise ADAM CRESSWELL

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II J}:11 C' IR I:44Wi' I;I. I. HEALTH EDITOR icians and to stop giving the states but what about the others? a blank cheque for services that We already know that one of KEVIN Rudd sauced his health leave much to be desired at thethe biggest problems preventing policy pie with more blokey charm delivery end. people receiving hospital care they at yesterday's launch, likening the But there are large questions need is that of "access block", be- past two years to the tedious but still to be answered about how this cause wards are clogged with eld- necessary process of sanding the will work, and larger ones that go erly people who can't be dis- cracks before painting a wall. to other aspects of the health sys- charged because there is no "step- The operative word is process.tern the government did not even down" facility where they can be That's what was unveiled yester- attempt to address yesterday. Last sent to continue their recovery. day: a process that may indeed year's national health and hospi- There was no word in yester- bring improvements, but certainlytals reform commission reportday's announcement about pro- as far as patients are concerned identified the system's most press- viding one extra bed, let alone the won't come overnight, or even for ing problems. thousands that would be needed to a couple of years. Theseinvolvedaccessing clear these blockages. No word More to the point, there's littlehealth services, such as the diffi- either on where we will find the ex- evidence the process will require culty of being admitted to hospital tra doctors, nurses and allied the commonwealth to deplete its or getting in to see a GP; equity ofhealth professionals to get the sys- coffers in an election year. The health service provision, particu- tem back on its feet. hard part, paying, is put off for larly for Aboriginal people and The government has been another day. those in the bush; financial sus- clever here, because it is saying As many experts have said, at tainability; safety and quality; more announcements are to come first blush the policy looks good. workforce shortages, inefficiency that will address these issues. Its sensible to increase national and fragmentation of care. Voters are in effect being told to standards and accountability, and Of those, yesterday's policy trust the government, to "wait and to put the system on a more sus- announcement deals with maybe see", when they have already been tainable financial footing. two financial sustainability and waiting for more than two years Its equally welcome to give inefficiency. for the government's solutions. more say to the coal-face clin- Important problems, to be sure,

"This doesn't produce any more money for the hospitals, so it won't solve the waiting list problems immediately."

HEALTH ECONONIISTTOHN DEEBLE. LEFT. ONE OF THE ARCHITECTS OF MEDICARE

"It's a bit like looking at a sketch for a new kitchen - it all looks good and the colours are nice, but the question is does the stove work and does it all hang together?"

STEPHEN FEEDER.RIGHT.DIRECTOR OF MENZIES CENTRE FOR HEALTH POLICY

Copyright Agency Limited (CAL) licenced copy Ref: 65637450 Australian Page 2 of 2 04-Mar-2010 Page: 1 General News By: Adam Cresswell Region: Australia Circulation: 131246 Type: Australian National Size: 609.84 sq.cms Frequency: MTWTF "There is no way that in a involved with the public duplication between short time a high level of hospitals, and a new layer ofhospitals, or solve the expertise in management willmanagement at the local continuing problem of be able to be developed network level. elderly patients occupying embracing all of Australia's "It is hard to see that this willinappropriate beds in high 753 public hospitals, even if deliver better services, to cost acute hospitals." address the need to greatly grouped into local area PROFESSOR DAVIDPENINGTON. LEFT.SENIOR networks. improve the interface FELLOW AT THE GRATTAN INSTITUTE. AN INDEPENDENT.MELBOURNE-BASED THINK "Inevitably, there will be twobetween hospitals and TANK, AND A FORMER VICE-CHANCELLOR OF levels of bureaucracy directlyprimary care, rationalise MELBOURNE UNIVERSITY

Copyright Agency Limited (CAL) licenced copy Ref: 65637450 Australian 04-Mar-2010 Page: 1 General News By: Dennis Shanahan Region: Australia Circulation: 131246 Type: Australian National Size: 150.90 sq.cms Frequency: MTWTF PM stakes his reputation on big-bang reform KEVIN Rudd has produced big- bang reform on health funding that is tailor-made for an

.I . . I %. . . '.\ ". 1 I H. BSI. I.t?I r;71;

election campaign and He's promising that new Once again Rudd has put designed to switch attention accountability and national himself at risk by staking his from his current political performance benchmarks will reputation on a proposal that is difficulties over the bungled deliver the changes voters wantgoing to be difficult to get past $2.45 billion roofing scheme to surgical waiting lists, doctor the states, has fallen behind his and broken election promises. and nurse shortages, waiting own schedule of election The Prime Minister has times for emergency treatmentpromises, is a complicated committed his government to and availability of medical careprocess, carries a huge price tag funding 60 per cent of public outside hospitals. and is arm's length from hospitals direct to local It's also designed to end the addressing the real problems community boards via a grab blame game between the voters experience every day. for 30 per cent of the states' federal and state governments Continued on Page 6 GST revenue. over health funding. PM stakes his reputation Continuedfrom Page I could directly and positively affectdouble- dissolution election and their wellbeing. an effective "referendum" on the It's also a process-driven solution It also carries with it the threat"greatest economic and moral that depends on solving currentlyof a referendum on federal powerschallenge of our time". intractable problems such as over health, to be held at the same Hospital reform is something doctor shortages by managerial time as the election. that has been necessary for ages incentives and isn't what the A referendum battle is and strikes a deeply responsive public thought Rudd had distracting and draining for a nerve with the public. It is also promised in 2007 when he said government and doomed to fail ifsomething the Prime Minister put he'd take over public health. it does not have bipartisan supportat the middle of Labor's last Like the emissions trading and the backing of the states. election pitch in 2007. scheme to address climate There is also the issue of Voters took him at his word last change, this proposal has the priorities for the next election, time and he's asking them to do so potential to offer great hope that with health overtaking climate again at his peril. can nevertheless sink when change, which Labor has people begin questioning how it suggested could form the basis of a

Copyright Agency Limited (CAL) licenced copy Ref: 65637451 Australian Page 1 of 2 04-Mar-2010 Page: 1 General News By: Matthew Franklin Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 490.56 sq.cms Frequency: MTWTF $50BN FEDERAL TAKEOVER BOARDS TO RUN HOSPITALS STATES STRIPPED OF CST Rudd's magiccure: more process

41 A II'I ll:l41 I{AN KI. I N, 11)MAIII;R

KEVIN Rudd has set up a federalduced a watered-down proposalrent arrangements the common- election campaign dominated byunder which the commonwealthwealth provided block hospital health, unveiling plans to strip the would fund 60 per cent of the costfunding to states, which deter- states of 30 per cent of their GST of public hospital services up mined how and where money was receipts to fund a federal takeover from the current level of 38 perspent. of state-run public hospitals. cent. "That is like providing a blank The Prime Minister also plans "People across Australia are fed cheque," the Prime Minister said. to sideline the states on hospital up with the blame game," Mr Rudd "Neither the Australian tax- administration, instead doling outtold the National Press Club. payer nor the Australian govern- tied grants to new local boards "They are fed up with waste inment had any idea where the which would deliver services in the system. They want to see that money went or if it went to hospi- accordance with strict require-fundamentally so we can get ontals. This must stop" ments set in Canberra. with the business of delivering He promised any new jobs on And Mr Rudd has created the better health and better hospitalsthe Local Hospital Networks mechanism to campaign on the for all Australians." would have to be matched by job issue in this year's election, threat- Under the proposals, the fed- reductions within state health ening a referendum if states do not eral government would bankrollbureaucracies. hand over 30 per cent of their GST its extra responsibility by seizing Mr Abbott said Mr Rudd's pro- revenues to bankroll his plan. the GST receipts from the states, posals were light on detail. The health blueprint, unveiled which would be left to handle "The timing of the rollout of this in Canberra yesterday, sparked40 per cent of hospital fundingproposal also raises suspicions immediate political sparring, with with their administrative respons- that this is a fix for an election the West Australian Liberal gov- ibility limited to long-term policycampaign, not a fix for the public ernment of Colin Barnett rulingand system-wide contracts. hospitals system," said Mr Abbott, out a handover of GST revenues. Mr Rudd said the boards wouldwho had previously proposed local And while state Labor govern- be called Local Hospital Networksboards to run individual hospitals. ments offered heavily qualifiedand would include no more than "He (Mr Rudd) needs to cobble support, Tony Abbott savaged the four hospitals. They would have something together to take to the plan as a cynical election fix which chief executives and would beelection and this is it. But in the would not take full effect until based within hospitals. end, it's not an answer. Its's a plea: 2012-13. They would be paid by the com- Trust me. "Idon't think many patients aremonwealth on a per-procedure "There is now lingering doubt going to notice any difference any basis, with bonuses for efficient over whether a government which time soon," the Opposition Leader administration which would, over is manifestly incompetent in rela- said. time, extract productivity gainstively modest programs like the There was also doubt about thethat would spread the healthpink batts program can suddenly prospects for any referendum, dollar further. be competent in the most complex with legal experts telling The Aus- Mr Rudd has guaranteed he will Continued on Page 6 tralianthe commonwealth'snot allow state governments to botched $2.45 billion home stack boards governing proposed insulation scheme would provide new local hospital networks with 2 opponents with potent messagespolitically friendly appointees. to fuel a scare campaign. And he vowed his government lMIJA0JFk,.w 1 Mr Rudd made his push to "end 4:*v ka+,iMS+rff would not intervene to stack J"rrr.F, the blame game" on public hospi-boards with Labor mates or trade 4E(, tals a central plank of his 2007 union officials. election campaign. He promised The plan also involves the com- that if states did not improve hos- monwealth taking full control of pital services by June last year he all aspects of general practitioner would move for a referendum for a and primary care services conduc- takeover. ted outside hospitals. The aim is to Yesterday, eight months after deliver better out-of-hospital care the expiry of his self-imposed to ease demand for hospital beds. deadline, the Prime Minister pro- Mr Rudd said that under cur-

Copyright Agency Limited (CAL) licenced copy Ref: 65637452 Australian Page 2 of 2 04-Mar-2010 Page: 1 General News By: Matthew Franklin Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 490.56 sq.cms Frequency: MTWTF Rudd's cure: more process

Continued from Page I back of GST revenue as a"sleight of hand", which would fail without Key details challenge of all, namely running the co-operation of the states. public hospitals." While open to a pooling of FUNDING. The Nationals leader Warren Truss commonwealth and state funds commonwealth will strip said that despite Mr Rudd's for health, Mr Barnett rejected $50bn from the states, one "grandiose promises" that the any notion of form ally handing third of their GST revenue, buck would stop with him on back GST receipts. to fund its health takeover. health, the Prime Minister had Victorian Health Minister failed to outline any new practical Daniel Andrews said Mr Rudd HOSPITALS. The plan to reduce hospital waiting had failed to deliver the key commonwealth will lift its lists or improve healthcare. element needed to improve health share of public hospital "The public needs to know who more money while NSW funding from 35 to 60 per is in charge and who is responsible Health Minister Carmel Tebbutt cent. It will fund 100 per cent when something goes wrong, and and Queensland Premier Anna of GP and prim al'y care instead of clarifying that issue, thisBligh said they needed to see more services outside hospitals. announcement clouds it," Mr detail. Truss said. But Mr Rudd's blueprint won BOARDS. Local Hospital Mr Rudd briefed premiers on the support of South Australian Networks of one to four his plans early yesterday and said Premier Mike Rann, Tasmanian hospitals will be run by he had received "monosyllabic" Premier David Bartlett and health and finance experts. responses. N orthern Territory Chief They will be paid for each But he will confront state and Minister Paul Henderson. service they provide. territory leaders to discuss the Health sector groups also blueprint in detail at a meeting of offered qualified support for Mr STATES. If the states do not the Council of Australian Rudd's approach, although there agree to the deal on April 11, Governments scheduled for next were concerns about rural health it will go to a referendum. month. services and under-utilisation of Western Australia's Mr Barnett private hospital beds to ease described the threatened claw- pressure on public hospitals.

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KEVIN Rudd has guaranteed he "We the Australian will not allow state governments government, however, reserve to to stack boards governing ourselves the right to take a very proposed new Local Hospital careful look at anything, repeat Networks with politically friendly anything, which may occur which appointees. does not reflect local community The Prime Minister has also sentiment in terms of where, for vowed his government will not example, you might want a Local intervene to stack boards with Hospital Network to have its Labor mates or trade union boundaries and secondly, who officials. most appropriately should lead Under Mr Rudd's blueprint for them," Mr Rudd said. the health and hospital system, Mr Rudd said his experience the commonwealth will assume was that most communities control of 60 per cent of funding included local doctors, nurses and of public hospitals, with states community members so sidelined in a bureaucratic sense passionate about local health in favour of local boards. services that they would almost The Local Hospital Networks "self-select" as board members. would include between one and Canberra will not give the four public hospitals and would be states any funding to establish and run by boards appointed under run the new boards. And it will state law. Members would have require state bureaucrats to be professional backgrounds in "devolved" to the networks, which health, financing or management. will be based in hospitals, not state In Mr Rudd's home state of health offices. Queensland, conservative state "Networks will increase governments of the 1970s and 80s accountability by having a used similar local boards to un professional governing council hospitals and often attracted and a chief executive officer Labor Party criticism that people responsible for delivering agreed were appointed by political services and performance affiliation, with the system used as standards," say documents a training ground for aspiring released yesterday. National Party politicians. "Increasing local Asked yesterday what would accountability will drive stop the Labor Party from improvements in performance as stacking the new boards with management is empowered to union leaders, party hacks and make day-to-day operational political mates, Mr Rudd said he decisions that would have would ensure appointees had otherwise been made by a central appropriate qualifications and bureaucracy." experience. MATTHEW FRANKLIN

Copyright Agency Limited (CAL) licenced copy Ref: 65637843 Australian 04-Mar-2010 Page: 6 General News Region: Australia Circulation: 131246 Type: Australian National Size: 47.16 sq.cms Frequency: MTWTF Commonwealth to fund GPs and primary care

THE Commonwealth will takethe number of people needlessly as they often should be," the Prime over full policy and funding res- admitted tohospital. About Minister said. ponsibility for general practitioner 441,000 hospital admissions are "With the Australian govern- and other primary-care services in estimated to be avoidable. ment paying more of the hospital an $18.7 billion rearrangement of "Because one level of govern-bills, it will have the incentive to health system finances. ment will be responsible for bothmake sure people are treated The move, in the health reformthe majority of hospitals' costs andthrough less expensive and more blueprint outlined yesterday by all of primary care, more people appropriate primary-care ser- Kevin Rudd, is aimed at cuttingwill be treated outside of hospitals, vices."

Copyright Agency Limited (CAL) licenced copy Ref: 65637844 Australian 04-Mar-2010 Page: 6 General News By: David Penington Region: Australia Circulation: 131246 Type: Australian National Size: 133.06 sq.cms Frequency: MTWTF High quality services for sick people

ing, will require a central planning I ) I I 1' l I) I1I;N I \ (P, ,],() and oversight process. There is no way that in a short THE performance ofpublic hospi- time a high level of expertise in tals at the time of the last election management will be able to be de- was remarkably similar to that of veloped embracing all of Austra- Britain's National Health Servicelia's 753 public hospitals, even if at the time Gordon Brown called grouped into local area networks. on a brilliant surgeon, Ari Darzi The reality of the recognition of (now Lord Darzi of Denham) to central control of services from review the entire system. Canberra, more remote than that Their system was grinding to a of control from State Health De- halt due to detailed bureaucraticpartments , is borne out by refer- control of all the activities of hos- ence to new national standards of pital staff, without using the performance. powerful professional commit- But there is no indication of ment to achieve high quality ser-how these will be monitored and vices for sick people. reference to an independent um- The review led to major re- pire setting the efficient national forms,gathering all hospitals into price taking into account factors clusters or networks mostly as-such as remoteness and com- sociated with the nation's univer- plexity of patients needs. sity medical schools, which then The balance of 40 per cent of played a critical part in their man- funding will remain the respons- agement. Medical leadership inibility of the states left to pick up partnership with health service the balance to keep hospitals sol- administration was required atvent where current costs vary every level of service delivery. greatly between states. Inevitably Kevin Rudd's plan for Austra- there will be two levels of bureauc- lia's healthcare system is certainlyracy directly involved with the bold and radical. It includes a very public hospitals, and a new layer of major increase of commonwealthmanagement at the local level. funding for public hospitals, but It is hard to see that this will de- can it be made to work in terms of liver better services to greatly im- how they function? The centralis- prove the interface between hospi- ation of funding, with 60 per cent tals and primary care. of what are termed efficient cost of all services, together with 60 per Professor David Penington is cent of capital (operating and senior fellow at the Melbourne- planned) and research and train- based Grattan Institute

Copyright Agency Limited (CAL) licenced copy Ref: 65637845 Australian 04-Mar-2010 Page: 6 General News By: Brendan Nicholson Region: Australia Circulation: 131246 Type: Australian National Size: 137.57 sq.cms Frequency: MTWTF Bid to controlrun-away costs local community needs, and the ritory governments to pay for its Labor's reforms are cost of treating patients varies reformed health system about intended to cut waste widely. As well, the Productivity $90 billion over the first five years. Commission has estimated thatIts goal is to use its control over in hospital services some public hospitals waste up to this money as a lever to create a 20 per cent of their budgets. more integrated national health ISItl:\L)..'Ntci1 }J.4()% The government calculatessystem with national standards that about 441,000 hospital admis- and increased transparency. AS MEDICAL services become sions, or 9.3 per cent of the annual Small groups of hospitals will be more sophisticated and as the de- total, are unnecessary and couldrun by Local Hospital Networks mands of a growing and ageing be avoided if better primary care effectively hospital boards population increase, state and ter- was provided in the community. made up of health, financial and ritory governments are literally Under the present system themanagerial professionals rather running out of money. commonwealth provides money than state or federal bureaucrats. The cost of running public hos- for public health services to theThe commonwealth will pay these pitals is increasing by nearly 10 per states and territories, which then networks directly for each hospital cent a year and bureaucrats have decide how the money will beservice they provide, rather than calculated that by 2045 the cost of spent. giving a pot of money to the state running health services will soak These block grants to states are or territory. up more than all of the revenue not tied to the efficient delivery of The money they need will be collected by state and local gov- services. channelled through a national ernments. To improve efficiency and cuthospitals fund to the local net- And soaring health costs willcosts, the Rudd government wants works. In this way the common- account for two thirds of the in-to make the eight state and wealth will fund 60 per cent of the crease in total commonwealthterritory-run systems part of a na- "efficient price" of every especial spending up to 2050. tional network with national stan- service delivered in Australia. The federal government says dards. It wants to divert a third of The "efficient cost" of running a services provided by Australia'sthe GST revenue the common- hospital will be set by an indepen- 762 public hospitals do not matchwealth hands over to state and ter- dent national umpire.

Copyright Agency Limited (CAL) licenced copy Ref: 65637846 Australian 04-Mar-2010 Page: 6 General News By: Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 116.15 sq.cms Frequency: MTWTF Medicos support `credible' blueprint

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DOCTORS and nurses have of-and inappropriate capping of Mr Laverty said he needed fered qualified support to Kevinpatient services," Dr Pesce said. assurances that blame shifting be- Rudd's health blueprint amid con- "And the announcement oftween state and federal govern- cerns about its slow rollout andfunding to follow patient carements would not continue under doubts it will increase funding formeans that health services in hos-the new arrangements in which services in the bush. pitals can grow to meet growingthe commonwealth would con- Australian Medical Associationpatient demand." tribute 60 per cent of funding. president Andrew Pesce said the Catholic Health Australia chief Rural Doctors Association plan was "very credible". executive Martin Laverty calledchief executive Steve Sant said the "It gives us great hope that weon the government to use privatenew policy did not say how rural are going to move in the right dir-hospitals to cut public hospitaland regional services would be re- ection," Dr Pesce said. waiting lists. vived: "Over the past 15 years, The government's plan to be- "There is capacity in privatewe've seen half of our maternity come a 60 per cent fielder of publichospitals today to treat patients ...services close in rural hospitals hospitals could provide the claritywaiting longer than a clinicallyacross Australia and this plan to of funding the AMA had beenappropriate time," he said. date doesn't actually show us how seeking to avoid blame shifting. "There's currently 89,000 peo-that is going to be improved.". "It seems that from the an-ple waiting longer than the clini- The Australian Nursing Feder- nouncement and we still havecally appropriate time for theiration backed the Prime Minister's to look at the details there issurgery why not use availableplan, with secretary Ged Kearney nothing inthe announcement thatcapacity in hospital beds today aspredicting it would stop cost- continues the artificial cappingan interim measure?" shifting and funding duplication.

Copyright Agency Limited (CAL) licenced copy Ref: 65637847 Daily Telegraph 04-Mar-2010 Page: 3 General News Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 65.42 sq.cms Frequency: MTWTFS- Prescription for working system THE key to Prime Kevin Rudd's hospital reform proposal is a new funding system called casemix funding and a new local management system. Hospitals are now given a set budget each year and if it is not enough to cover all the services they need to provide they create waiting lists for surgery. Under casemix funding there will be no cap on a hospital's annual budget. They will instead get paid for every service they provide. Under Mr Rudd's system, the Federal Government will pay 60 per cent of the cost of each service and the states will pay 40 per cent. The price paid for each service will be set by an independent umpire, with higher fees for more complex cases and those delivered in remote areas. The unpopular NSW area health services will be dismantled and replaced by smaller local hospital networks of up to four hospitals under the control of a local CEO, a local council and taking advice from the nurses and doctors who work in them. Large teaching hospitals are likely to get their own CEO and board while smaller hospitals will be grouped with up to three others and will share a CEO and local board.

Copyright Agency Limited (CAL) licenced copy Ref: 65637888 Daily Telegraph Page 1 of 2 04-Mar-2010 Page: 4 General News By: Alison Rehn Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 601.04 sq.cms Frequency: MTWTFS- Watching howyour hospital r performs

Eagle eye on standards: Kevin Rudd has pledged a website to monitor and compare hospital performance

Alison Rehn Political Reporter

FIRST it was schools soon it will beand Hospitals Network for Australia'about the system to increase account- hospitals. Australians will be able toFuture" has already put the states onability an drive improved outcomes. go online and find more informationnotice, saying they would be subjectedIncreased information will help con- than ever before about the perform-tomore rigorous and transparentsumerstomake more informed ance of the nation's 762 hospitals. performance reporting". choices about their health services." They will be able to see how their "The Commonwealth Government The Government also pledged to local hospital's emergency depart-will require strong national standardspublicly release information on per- ment and elective surgery waitingand transparentreportingintheformance in primary health care. times, bed occupancy rates and deathhealth system, including for emer- Not only will hospital consumers be rates stack up against other facilities.gency department and elective sur-better informed, but the Government The website, partof the Ruddgery waiting times, bed occupancyhopes high-performing hospitals Government's health system shake-rates, reporting of adverse events andwould be able to share their effective up, will probably be called My Hospi-hospitalacquiredinfections,"theand innovative practices with other tal and follow the popular My Schoolblueprintsaid."Throughgreaterhospitalstohelpcreatea"self- online resource set up this year. transparency and the direct funding ofimproving hospital system". Sources said yesterday Prime Min-services, local communities will have The Government's blueprint warns: ister Kevin Rudd would announce Mymore information than ever before on"Over time, the Commonwealth will Hospital later this year perhaps aswhat services a hospital provides, howseek to strengthen the link between aBudget commitment orapre-they are performing and how they areperformance and funding. election pledge in an effort to makespending their budgets. "The Commonwealth will increas- stategovernments more openin "Strong national standardswillingly insist on higher national stan- reporting hospital performances. help ensure consistent high-qualitydards of performance, more consist- The Federal Government's healthhealth care and provide greater levelsently applied across the country." reform blueprint "A National Healthoftransparencyandinformation

Copyright Agency Limited (CAL) licenced copy Ref: 65637890 Daily Telegraph Page 2 of 2 04-Mar-2010 Page: 4 General News By: Alison Rehn Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 601.04 sq.cms Frequency: MTWTFS- M's health revolution

the cost of Prime Minsiter Kevin Rudd's takeover

the amount of public hospital services 2013/14 to be funded by the a third of GST revenue to Federal Gowernment be redirected to the states

Copyright Agency Limited (CAL) licenced copy Ref: 65637890 Australian 04-Mar-2010 Page: 7 General News By: Adam Cresswell Region: Australia Circulation: 131246 Type: Australian National Size: 352.51 sq.cms Frequency: MTWTF Health experts say blueprint `won't prove an instant panacea'

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ECONOMISTS and policy ex- `Each of them will be competing right direction in terms of getting perts have reacted with varying for resources and each will wantsome transparency and account- degrees of cautious optimism to their own specialist centre," Pro- ability into the system". the reform blueprint, with most fessor Deeble said. "It (the plan) is However, he said the hospitals describing it as promising but not going to happen in a hurry, and networks would be bureaucratic, many also warning it will not it doesn't produce any more and challenged suggestions that prove an instant panacea. money for the hospitals as far as I improving primary care would David Penington, senior fellow can see so it won't solve the prevent expensive hospital admis- at the Grattan Institute, said there waiting list problems immedi- sions. "The most likely effect of was no way the necessary exper- ately." Stephen Leeder, director of better co-ordinated care is in- tise could be developed embracing Menzies Centre for Health Policy, creased demand (on hospitals), be- allof Australia's 753 public said the plan to massively increase cause it finds unmet need in disad- hospitals. federal involvement in public hos- vantagedpopulations,"Dr He said it was inevitable there pitals was "a good beginning", but Sammut said. "That's a good out- would be two levels of bureaucracy much crucial detail remained un- come in terms of health but it directly involved with the public clear. Professor Leeder said Local means increased demand for hos- hospitals and a new layer of man- Hospital Networks -that will pital services." agement at the local network level. each comprise between one and Other experts differed on the "It is hard to see that this will de- four of Australia's 763 public hos- plan's merits, with Bob Wells, di- liver better services, to address the pitals risked being too small to rector of the Australian Primary need to greatly improve the in- be able to plan sensibly.. Health Care Research Institute, terface between hospitals and pri- Previous research from New saying it would "be a vast improve- mary care, rationalise duplication Zealand and Australia had shown ment on what we have now" and between hospitals, or solve the that a properly functioning health largely addressed the biggest continuing problem of elderly pa- service area would need to cover structural problems. "The big trick tients occupying inappropriate about 500,000 people, comprising is going to be persuading the states beds in high cost acute hospitals," two major hospitals, up to six or it's in their interests to come on Professor Penington said. seven smaller ones, and 300 GPs, board," Mr Wells said. Health economist John Deeble, 200 community health nurses and Jane Hall, professor of health one of the architects of Medibank allied health workers. "It's a bit like economics at the University of and Medicare, said the Rudd gov- looking at a sketch for a new Technology Sydney, said it was ernment had identified the sys- kitchen it all looks good and the "difficult to see how this (plan) will tem's most pressing problem: the colours are nice, but the question is work" and the sheer number of fact that health costs would soon does the stove work and does it all hospital networks would inevi- outstrip state revenues. But he said hang together?" tably increase bureaucracy. the proposal for a mosaic of hospi- Jeremy Sammut, research fel- Philip Davies, professor of tal networks was "completelylow at the Centre for Independent Health Systems & Policy at the vague" and made little sense inStudies, said the plan to use University of Queensland, said the capital cities, where 70 per cent of activity-based funding, called plan was a "a good first step". Australians lived. "casemix", to pay for hospital costs was "a good one and a step in the

Jeremy Sammut Bob Wells Jane Hall Philip Davies

Copyright Agency Limited (CAL) licenced copy Ref: 65637945 Australian 04-Mar-2010 Page: 7 General News By: David Uren Region: Australia Circulation: 131246 Type: Australian National Size: 209.32 sq.cms Frequency: MTWTF Gamble onstates seeing10 big picture

DAVID ri i N ECONOMICS CORRESPONDENT surgery waiting lists, preventative The Commonwealth Grants health and workforce reform. Commission carves up the GST at THE commonwealth is counting In addition, the states get a freepresent among the states after on the states to accept the long- hand in splitting the GST revenue, making an assessment of the aver- term gains from its health reform which is expected to be around age cost of providing healthcare. to sign away a third of their GST $42bn this year. However, some states, includ- revenue, and is not providing any Treasury has calculated returns ing Victoria, spend a lot more than short-term carrots in return. to the states so abolishing the the commission allows, and makes While the commonwealth has block grants and performanceup the difference by charging fees promised no state would be worsepayments, and giving up about a to users of its health services. off as a result of the reform, some third of the GST, would exactly NSW, by contrast, spends less states, including NSW, which use match its new commitment tothan its allowance on health and money allocated for health onfund 60 per cent of hospital costs pockets the difference for use in other priorities, may lose out. and 100 per cent of primary care. other areas. The commonwealth only com- Although the Rudd govern- Critics say this is one of the pleted a new intergovernmentalment believes the states would reasons why it lags behind the rest agreement on sharing tax revenue make the calculation that their of the country. with the states a year ago, and ithealth costs were rising twice as Under the proposed reform, the requires a unanimous decision to quickly as their GST revenue and states would only be financed by change it. agree to the reform, it argues thethe commonwealth for what they The states spend about $40 bil- biggest pay-off to state budgets actually spend. lion a year on health, of whichwould come from a more efficient This could allow Victoria to rely about 75 per cent is devoted to health system. less on user charges, while leaving hospitals. With fewer people going to hos- the NSW budget short. The commonwealth and thepital emergency when they should Tax specialists say the com- states hammered out a five-yearbe going to GP clinics, the rate of monwealth, or any state, could healthcare agreement as part of health inflation would fall. unilaterally break the inter- the Council of Australian Govern- Although Victoria has ex- governmental agreement without ments reforms a year ago, givingpressed the greatest reservationrecourse to legal action. But it the states about $llbn as a block about the new system, it stands to would set a bad precedent. grant, with a further $lbn tied to gain the most, while NSW is a like- reforms on issues such as elective ly loser.

Copyright Agency Limited (CAL) licenced copy Ref: 65637959 Australian 04-Mar-2010 Page: 7 General News By: George Megalogenis Region: Australia Circulation: 131246 Type: Australian National Size: 137.21 sq.cms Frequency: MTWTF A win for the premiers, despite GST hijacking

with 40 per cent. Presently, the CIX)ItG. I %I - [.I.(.1tCI;\is funding split is more like 35-65 to the states. TO make health a national res- Rudd does take on 100 per cent ponsibility, Kevin Rudd has to re- of primary care, which gives Can- make the GST. berra the incentive to treat people It can no longer be a federalbefore they present to the emer- consumption tax collected on be- gency wards. half of the states, with every dollar Why not 100 per cent on public going to them. Canberra wants a hospitals as well? There are three third of the GST for itself, aboutreasons. $15 billion to $20bn a year, to pay First, if Canberra assumed full for taking over the lion's share ofcontrol of health it would abolish health funding from the states. vertical fiscal imbalance with the But one third of the GST won'tstroke of a pen. The states would cover what Rudd is proposing over be able to pay for all their remain- the long run. He and his successors ing services themselves, leaving will have to tind another source of Canberra with no leverage to pro- cash in the federal budget. pose national goals through the The cost of running public hos- grants system in areas such as edu- pitals is expected to increase by al- cation. most 10 per cent a year while the Second, history says the states GST base grows at just 6 per cent. would still send the bill for future Canberra's funding gap of 4 perblowouts in education, transport, cent a year is the states' bonus. even police back to Canberra, thus The states win in the long run restoring vertical fiscal imbalance providing future federal govern- by default on terms unfavourable ments don't pull a swifty and cut to the national economy. their other grants. Third, the states are still being Canberra thinks the health tab expected to run public hospitals. is better in its hands because it has Leaving them with 40 per cent of the more viable revenue base acro- thefunding responsibility is meant ss the board. It has company taxto act as an incentive to contain and income tax. The states just administrative costs at their end. have their silly transaction taxes The political question is not the which are a drag on productivity. detail this is a good deal for the One of the confusing aspects states but Rudd's ability to stick for voters is the 60/40 model Ruddto the topic long enough to make has offered. He takes 60 per cent of the case in voterland without the funding responsibility for pub- needing to pull a self-defeating lic hospitals, leaving the states referendum.

Copyright Agency Limited (CAL) licenced copy Ref: 65637966 Australian Page 1 of 2 04-Mar-2010 Page: 7 General News By: Nicolas Perpitch Region: Australia Circulation: 131246 Type: Australian National Size: 740.16 sq.cms Frequency: MTWTF Call for beds, not bureaucracy

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FREMANTLE Hospital's director trained in New Zealand, said giv- dictate everything that happened of intensive care, tan Jenkins, wel- ing local professionals the power in state hospitals, saying he want- comes the push from Canberra for to run hospitals could work. ed an ongoing say in health policy. locally run public hospitals but "It's certainly good when they The way Dr Jenkins sees it, the doubts whether a federally funded speak of clinicians being more in- less involvement by distant system would be any morevolved in providing leadership,"bureaucrats and the more local efficient. said Dr Jenkins, who is also on the knowledge in the running of hos- Dr Jenkins thinks it wouldcouncil of the West Australianpitals the better. "It is hard enough make little difference to doctors Australian Medical Association. for a city-based doctor, such as and others working in public "But ... that doesn't appear to myself, to appreciate fully the diffi- health unless the new system always happen. Often people are culties of problems of a vast state could also provide more beds and made accountable without havinglike Western Australia. How much more difficult is it for a bu- services. the resources to provide services "I foresee day-to-day work reaucrat in Canberra to appreciate they are required to provide. The changing very little," he said. the difficulties of providing heal- question is a matter of funding, not "I think it's not going to directly thcare services in the Pilbara?" how it's delivered. The problem is affect those at the coalface. other than if there is more funding that simply not enough adequate fund- will then provide more services." ing and not enough hospital beds `(It) is a matter of Kevin Rudd yesterday pledgedfor our needs," he said. funding, not how hospitals would be better off under "I've been around long enough it's delivered' his proposed national health and to be concerned when in one sen- hospitals network, eliminatingtence they've got the creation of IAN JENKINS DIRECTOR, FREM ANTLE HOSPITAL waste and other inefficiencies. another layer of bureaucracy." Dr Jenkins, who has worked in West Australian Premier Colin intensive care at Fremantle Hos- Barnett yesterday warned that pital since 1995 and was originally Canberra should not be allowed to

Copyright Agency Limited (CAL) licenced copy Ref: 65637976 Australian Page 2 of 2 04-Mar-2010 Page: 7 General News By: Nicolas Perpitch Region: Australia Circulation: 131246 Type: Australian National Size: 740.16 sq.cms Frequency: MTWTF

COL[N MURTY IanJenkins,at Fremantle Hospital yesterday, is not expecting much change at the coalface

Copyright Agency Limited (CAL) licenced copy Ref: 65637976 Australian 04-Mar-2010 Page: 7 General News By: Nicola Berkovic Region: Australia Circulation: 131246 Type: Australian National Size: 168.79 sq.cms Frequency: MTWTF Toomanyfactorsgo againstareferendum

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A KEFEKENDUM on health at the next election would be doomed to almost certain failure and is "an empty threat", constitutional experts say. Kevin Rudd threatened yesterday to ask voters for new powers to deliver his plan to take over the majority of hospital funding if the states refused to come on board. Queensland University of Technology executive dean of law and former attorney-general Mi- chael Lavarch said the commonwealth did not have clear constitutional powers relating to health, so if the states refused to sign up, it Michael Lavarch would need new powers. It would need to acquire that power to be absolutely confident Furthermore,theconsti- of its capacity to deliver on thistutional framework was "messy' program," he said. meaning the commonwealth But Professor Lavarch said this needed state co-operation, he said. would be difficult without the sup- "What you've got here is a consti- port of the opposition and thetutional mosaic there's simply states. no body that has all of the powers." Only eight of 44 referendum University of NSW consti- proposals have succeeded sincetutional expert George Williams Federation the most recent, inbelieved the commonwealth's 1977, concerned Senate vacancies, powers were broad enough to de- retirement of federal judges and liver funding directly to hospitals, voting in referendums andeven in the wake of a High Court none without bipartisan support. ruling last year that found federal "You really do need to have thefunding must be linked to a speci- opposition on board," Professorfic head of constitutional power. Lavarch said. But he said setting up new "(Otherwise) they simply don'tboards to oversee hospitals and get up. People get suspicious and deliverserviceswasmore it's very easy to muddy the waters." problematic. Australian Catholic University "My view isthat ifthe common- constitutional expert Greg Craven wealth is seeking to essentially said a referendum would be almost take over funding, it's likely to be doomed to fail because opponents on safe ground," Professor Wil- could mount a scare campaign liams said. based on the insulation scandal. "Where it gets uncertain and "I assume the referendum is a difficult is if it's seeking to regulate threat. .. I suspect a lot of state or run the services itself." premiers will look at that and say, For a referendum on health to `Pull the other one its got pinksucceed, it would need the support batts attached to it'," Professorof a majority of voters nationwide Craven said. and a majority of states.

Copyright Agency Limited (CAL) licenced copy Ref: 65637977 Adelaide Advertiser 04-Mar-2010 Page: 24 General News Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 24.14 sq.cms Frequency: MTWTFS- Trauma help for refugees THE Federal Govern- ment will provide more than $5 million for mental health services for traumatised refugees. Ithas not revealed whether mandatory detention in Australia con- tributed to the issue. Community Services Minister Jenny Macklin yesterday announced $5.4 million in funding for the personal helpers and mentors program, to target new refugees. It will set up services in inner-north Adelaide and southwest Sydney.

Copyright Agency Limited (CAL) licenced copy Ref: 65638855 Daily Telegraph 04-Mar-2010 Page: 25 General News Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 21.62 sq.cms Frequency: MTWTFS- Loan for addict's surgery THE family of a young drug abuser will be lent $250,000 by the West Australian Government for a second liver transplant overseas. Mother-of-two Claire Murray is ineligible for a second transplant in WA after health authorities ruled her out because of continued heroin use. The interest-free loan will fund her surgery in Singapore, with a liver donation from a family member.

Copyright Agency Limited (CAL) licenced copy Ref: 65638879 Daily Telegraph 04-Mar-2010 Page: 26 General News Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 42.31 sq.cms Frequency: MTWTFS- $5m helps ease pain MORE than $5 million was yesterday pledged for mental health to treat traumatised refugees. The Federal Government refused to say whether cases of mandatory detention had contrib- uted to the issue. Community Services Minister Jenny Macklin announced $5.4 million in funding for the personal helpers and mentors program, which will target new refugees. It will establish new services in southwestSydney, where the Villawood Detention Centreis located and where many refugees have resettled. Ms Macklin said many refugees had left behind difficult lives and were traumatised as a result. "They may have experienced torture and trauma," she said. "It may have happened to their families as well."

Copyright Agency Limited (CAL) licenced copy Ref: 65639128 Daily Telegraph Page 1 of 2 04-Mar-2010 Page: 36 General News By: Sue Dunlevy Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 647.71 sq.cms Frequency: MTWTFS- Rudd's reforms will put hospital heads in thegun t.)== I I I'N a hospital The second big change under this to lift their game and, in the sane way as misdiagnoses you, doesn't system will be a huge increase in the My School website has put school treat you on time and accountability. When Jana Horska had a performance under the spotlight, hospitals when it doesn't pay its miscarriage in the waiting room at Royal will have their performance open to public bills, under Kevin Rudd's North Shore Hospital the buck stopped view and compared with their rivals. reforms there will be for the first time nowhere because that hospital was run by Hospitals not up to the mark may have someone at the hospital you can blame. a remote area health service responsible their management overthrown and face If you need surgery and you want to for a myriad of health services. government intervention to do better. know which hospital has the lowest Rudd's Local Hospital Networks will The other very important aspect of the waiting lists or the lowest rate of bring hospital management back much reforms is they provide a way to fund the infections, you'll be able to find it on a closer to the patient. growth in health care costs into the future. new My Hospital website. Major teaching hospitals like Royal The ageing of our population, our And if you're on a waiting list for North Shore will have their own board, increasing population and the increasing elective surgery, chances are you'll get their own CEO and their own clinical cost of health care mean that by 2045 into hospital faster under these reforms advisory committee. health care costs will be so big they will because hospitals will have an incentive to Smaller hospitals will be grouped consume the entire budget of every state. do more operations. together into a local network with three or States will have no money left to fund There is a problem. You'll have to wait four other similar hospitals and they too transport or education. up to four years and re-elect Kevin Rudd will have their own boards and CEOs. Under these reforms the Federal twice before these reforms take full effect. These local managers will be the people Government takes on responsibility for These reforms have been billed as the who have to explain and fix any problems funding 60 per cent of the growth in biggest reform to our health system since that occur on their turf. These managers health care costs. Medicare. What they will do is completely will also have to pay suppliers, ending There are lots of potential problems recast the incentives within the system to situations where suppliers refused to with these changes. encourage hospitals to provide services. supply hospitals in NSW because area The Federal Government will only fund A hospital's ability to provide services health services refuse to pay the bills. 60 per cent of the "efficient" costs of will no longer be constrained by an Doctors like this change because there hospital services. inadequate annual budget drawn up by will be a clinical advisory board of doctors States like NSW which have high, cost- the state government. and nurses who work in the hospital inefficient service costs could lose out. Hospitals will get 60 per cent of their advising the board and having a say in the If the prices for hospital services don't funding direct from Canberra. At the running of the hospital. keep pace with health inflation, as has moment if someone needs a hip The third big change will be much happened with the Medicare rebate replacement and the hospital's annual increased transparency in our hospital system, patients will lose out. budget can't afford it, that person goes on system. Every hospital will have to provide These changes are billed as ending the a waiting list until next year's hospital annual reports on the size of their waiting blame game between the Federal and budget can pay for the operation. lists, how long you have to wait before state governments but there's still plenty Under Rudd's new system, if someone you're treated in the emergency of room for arguments about whether the needs a hip replacement and the hospital department, how many people contract prices being paid for surgery are high does the surgery the Federal Government post-operative infections and how many enough and whether states are pulling automatically pays 60 per cent of the cost. cases of surgery are performed. their weight with funding. The states will have to pay 40 per cent of This information will help patients pick the cost of service a hospital provides. the most efficient hospitals, force hospitals

Hospitals not up to the mark may have their management overthrown

I Frequency: MTWTFS- Size: 647.71sq.cms Type: CapitalCityDaily Circulation: 359171 Region: Sydney By: SueDunlevy General News Page: 36 04-Mar-2010 Daily Telegraph !L (1 II Page 2of Ref: 65639207 Courier Mail 04-Mar-2010 Page: 4 General News By: Emma Chalmers Region: Brisbane Circulation: 211230 Type: Capital City Daily Size: 162.85 sq.cms Frequency: MTWTFS- Doctors and states applaud proposal but Opposition remains unhappy Emma Chalmers IN CANBERRA

QUEENSLAND has vowed it won'tCommonwealth step into the breach. own IT system or paying their own block Canberra'splanstoreform "The body of government that raisesaward rates, that will fragment the health funding despite worries thatmost of the money will have most ofsystem terribly," he said. hospitals will end up in the hands ofthe funding responsibility," he said. The Labor State Government in inexperienced local boards. "It means they are responsible forSouth Australia welcomed the plan, The reaction to the Rudd Govern-also meeting growth in the number ofwhile the Victorian Government re- ment's $90 billion plan to reform thetreatments rather than just foisting itmained wary and the NSW Labor health system was mostly welcomingon the states." Government offered tentative support. yesterday, with the Australian Medical Mr Lucas said he hoped the plan Federal Opposition health spokes- Association declaring it was a "crediblewould eventually help cut waiting listsman Peter Dutton predicted the Rudd response" to the problems besiegingforspecialistoutpatienttimesinGovernment's announcement would health systems. Queensland and called on the Ruddintensify federal-state blame shifting. State Health Minister Paul LucasGovernmenttoeventuallymove Dr Andrew Pesce, president of the saidthefunding proposal,whichtoward full public hospital funding. AMA, welcomed the plan and said it would strip the states of a third of their However, Mr Lucas said he wasresponded to the needs of patients. GST funding, was "very attractive"concerned about how much power the "We applaud the Prime Minister for because it paid per service provided. Commonwealth planned to hand overtaking responsibility and putting sub- The Deputy Premier saidfixedto local hospital networks and how itstantial reform on the table," he said. funding arrangements had penalisedwould find the relevant expertise in The Royal College of Nut-sing said Queensland because the state had toremote areas. the proposal appeared to be a step meet the demands of a growing "We can't have them off deciding toforward but it was waiting for more population and it was only right thebuild their own buildings, buying theirdetails on the role of nurses.

Irt

I Awl REACTION: (From left) Queensland Health Minister Paul Lucas; Opposition health spokesman Peter Dutton; AMA president Dr Andrew Pesce.

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politically accountable for the system, in terms of the national funding for the Blueprint to system, it's quite clear from what I've said today that we, the Australian Government, have stepped up to the set limits plate to take on this dominant funding responsibility," Mr Rudd said. "The number of meetings I've sat on surgery around where one side blames the other permanently for who is responsible for the overall funding under- wait times pinnings of what we need for the Renee Viellaris future, that is now put behind us." IN CANBERRA He said that within three years PATIENTS have been promised the changes would significantly reshape same level of care no matter where the public system. they live in the country under a Rudd "Let's imagine a 67-year-old man Government shake-up of the health who is retired and lives in the outer system. suburbs of one of our major cities," Mr Prime Minister Kevin Rudd yester- Rudd said. day unveiled his long-awaited health "He's been placed on a waiting list reform blueprint, pledging tobring to get a hip replacement at his local healthservicestothe people and hospital but he's been told there's a provide them with the same level of wait of around 12 months - that's 12 patient care no matter where they lived. months oflivingwith pain, poor For the first time, patients will know mobility and having to rely on his wife how long they will have to wait for to get around. elective surgery and at emergency "On the same day a 45-year-old departments. woman with a similar hip problem A new National Health Hospital living in another major city was told Network to be set up by the states will that her local hospital could give her a determine what services will be pro- hip replacement in five weeks. vided by hospitals and where patients "The new National Health Hospital will need to travel to access services. Network aims to deliver aset of Under the plan, the most efficient national standards, including access to hospitals will be likely to transition electivesurgery. This means both intosuperprovidersforelective would get their operations done in a surgery or maternity services. similar timeframe." Butsomeprocedureswillbe Mr Rudd said patients would be sent stripped out of hospitals and put into to private hospitals, at state cost, if communities so patients don't have to they could not be treated within the travel long distances. agreed time period. Mr Rudd yesterday said the buck He will ask the states to sign-off on would stop with him under plans to set the deal next month. If they don't they up mandated waiting times for elective could face a referendum. surgery, emergency departments and Under the plan, the Commonwealth GP visits. will pay 60 per cent of costs, set targets States will be stripped of 30 per cent and be in charge of workforce plan- of their GST funding - about $90 bil- ning. The stateswill pick up the lion over five years. remaining 40 percent tab and main- Mr Rudd said he could end the tain capital planning rights. "blame game" because the Common- The Queensland Government has wealth would become the "dominant" been promised it will be better off by health funder. 3.5 billion from 2014-2020. "In terms of who ultimatelyis

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The Commonwealth States will have to direct their national hospitals fUnd over the Government becomes majority own money Into the network first five years of reforms funder of public hospitals Hospitals will be paid for each An independent unnplre will he The Commonwealth will take all service they provide and will have set up to determinehow much funding and policy responsibility to release an annual report on hospitals should be paid for each for GP and primary health care performance surgery/service Networks will have a governing The deal will be put to states States will have to sot up council and chief executiue officer at the Council of Australian several Local Hospital Networks, Governments meetingin April which will determine how About one-third of GST funding hospitals are run to states will be quarantined Kevin Rudd will seek a for health services and the referendum at the next election If The networks-small groups proportion of funding will be fixed states refuse of public hospitals and services from 2013-14 The Government will also consider - will be funded directly by the About $90b In GST revenue taking to a referendum a 100 per Comnnonwealth will be Invested through a new cent takeover If states refuse The Government will find 60 per cent of the "efficient price" of every public hospital service Abort 60 per cent of recurrent expenditure on research and training done now in public hosplta Is

About 60 per cent of public hospital capital expenditure

eM Up to 100 per cent of primary health-care equivalent outpatient services provided to public hospital patients

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Copyright Agency Limited (CAL) licenced copy Ref: 65639210 Courier Mail 04-Mar-2010 Page: 5 General News By: Stefanie Balogh Region: Brisbane Circulation: 211230 Type: Capital City Daily Size: 127.53 sq.cms Frequency: MTWTFS- Hospital change to prop up a sick Government Stefanie Balogh billion over five years - which will be NATIONAL POLITICAL CORRESPONDENT dedicated solely to health. After briefing premiers, Mr Rudd KEVIN Rudd hasrolledout thesaid the reaction was mixed but that he centrepiece of his re-election strategyhad not stepped away from his threat - a bold plan to turn around theto force through the changes. nation's broken public hospital system. "If the states and territories do not The Prime Minister's ambitious re-sign up to fundamental reform, my forms, which see him spoiling for a fightmessage is equally simple-we will with the unpopular state governmentstake this reform plan to the people at and the Opposition-dominated Senate,the next election, along with a refer- has Canberra taking control of 60 perendum by or at that same election to cent of hospital costs and introducinggive the Australian Government all national healthcare standards. the power it needs to reform the health It is partly a bid to seize the agendasystem," he said. from a resurgent Opposition and halt Premiers will consider the plan at the recent slide in political fortunes. the next Council of Australian Gov- His gamble also places health at theernments meeting next month. centre of the electoral battleground. Mr Rudd will also need to get his Unveiling his plans, Mr Rudd saidreforms through a hostile Senate. health and hospitals were a core His blueprint isnot a complete priority of his Government. financial takeover of hospital services Delivering reform was part of hisbut makes Canberra the "dominant" pledge "to do better, deliver more, getfunder of public hospital services, and on with the job, and deliver the basics".putsitinchargeofallfunding "The Australian people will makeresponsibility for GP and primary their judgments on whether we're fairhealth care services. dinkum about reform or not." Opposition Leader Tony Abbott But his reforms won't be fully upsaid the reforms were light on detail and running until after Jul), 2012 -and the timing raised suspicions that it towards the end of any second term ifwas a fix for an election campaign. the Prime Minister is re-elected. "In the end, the Rudd Government Mr Rudd must now convince thewill go to an election without patients states and territories to hand over one- seeing any improvement in their local third of their GST revenue - about $90hospital services," he said.

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SIN taxes for poor lifestyletralia's Future report, released Patients of GPs who don't choices and paying doctors toyesterday, said the Governmentbulk bill will receive a higher spend more time withsickwould also "build on existingrebate for longer and prevent- patients will be rolled out by theinvestments in prevention, agedative health consultations. Federal Government. care, dental health, electronic And families struggling to After announcing the biggesthealth and mental health". pay for healthy meals could be shake-up to the public health Itisexpected Mr Rudd'sgiven subsidies to steer them system since Medicare, Primereview into taxation will recom-away from junk food. Minister Kevin Rudd yesterdaymend an exciseincrease to Mr Rudd has been urged to revealed further health over-tobacco - the first in a decade. develop subsidies that increase hauls were on the way. It means the average price ofthe availability of fresh food for The Rudd Government willa packet of 30 cigarettes couldregional and remote areas. outline further revamps to pub-rise to $20 within three years. And then there's work and lic hospital emergency depart- Doctors will be paid extra ifhome. It is understood Health ments and for people withthey end their"six-minute"Minister Nicola Roxon is con- chronic health needs - such asmedicineandspendmoresidering a home and workplace those with diabetes. time trying to convince patients"intervention",plus new sin Mr Rudd pledged he wouldto cut back on calories andtaxes to stop people smoking, outlinelong-termplansforditch cigarettes. abusing alcohol and gorging on preventativehealth - which From May, doctors will re-fatty foods. was at the centre of his com-ceive up to $1.85 extra for each Mr Rudcl has been handed a missionedNational Prevent-patient who has preventative orreport that centres on a bold plan ative Health Strategy reportchronic illness such as diabetes,for Australia to be the healthiest released last year. obesity, heart disease - mostlynation within 10 years. HisNationalHealth andconditions that can be treated Hospitals Network for Aus-by a healthy diet and lifestyle.

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THE Federal Government's bungling ofto the Princess Alexandra hospital. Onwelcome, the Moorooka mother isn't sure the roof insulation scheme has madeevery occasion, she said her family hasshe wants the Federal Government more Brisbane mum Rosie Payne nervousreceived first-class treatment. involved. about the Commonwealth taking greater "The level of care that we received was "I can definitely see the efficiency in it," control of the nation's hospitals. fantastic," she said. Ms Payne said. Ms Payne has had plenty of recent As a result, she is not convinced the `But it's one of those things ... it could experience of some of Brisbane leadinghospital system needs the kind of drasticbe like the insulation scheme. If it doesn't hospitals. overhaul described by Prime Ministerwork out, who cleans up the mess? She gave birth at the Mater 20 monthsKevin Rudd as the most significant "I think most people would be con- ago. Her daughter was also treated therereform since Medicare was introducedcerned about that,given therecent for a dislocated hip and her husband has anearly three decades ago. debacle with the insulation scheme." heart condition that requires regular visits And even while some changes may be Melanie Christiansen

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RETIREES Mvkola and Taisia They're hoping the much needed Serdiuk don't have a good word to operation will happen soon. say about Australia's public hospitals, But despite their disillusionment after watching their daughter wait with the health system, they don't three painful years for a gall bladder trust the Federal Government to fix operation. things, dismissing Prime Minister "She has threechildren,two little Kevin Rudd's promise that the shake- ones and one is 13," said Mrs Serdiuk. up would reduce lengthy waiting lists. "She's having problems even "He is not doing what he promised sleeping." to do," Mrs Serdiuk said. The Brisbane couple (left) said The couple - who came to their daughter arrived for surgery Australia from the Ukraine 49 years and was getting ready for the ago - said more people waiting for operation,only to be told someone elective surgery in public hospitals had failed to book a bed. should be treated privately.

Copyright Agency Limited (CAL) licenced copy Ref: 65639339 Age 04-Mar-2010 Page: 1 General News By: Imichellegra1tan I Region: Melbourne Circulation: 202100 Type: Capital City Daily Size: 183.68 sq.cms Frequency: MTWTFS- A dose of political reality may undo that Ruddy glow of health

MICHELLE GRATTAN

KEVIN Rudd has put forward a bold lem. John Brumbyhas a looming brings a hostile Senate into play. Even but measured plan for hospitals state poll and limited incentive to if the states agreed to the hospitals reform, but lie will have an uphill sign up to a quick deal, especially deal, under the government's time- battle to translate it into reality any with the state opposition hostile. Thetable legislation on the GST would time soon. attraction is that state hospital costshave to pass the Senate before the Rudd is offering the states more will eventually spin out of control, election. It would have trouble. money in exchange for Canberra get-but an election focuses attention on If Rudd can't get the states to sign ting the whip hand to force greater here and now. In coming weeks, on, he will take to this year's poll a efficiency and higher standards. TheRudd will toss out some extra moneyreferendum to obtain federal power Coninionwealth would pay for 60 peras bait - but will that be enough to to make policy on hospitals. A refer- cent of hospital funding, up from thesway Bruniby? endum must win an overall majority present 35 per cent. But initially the Rudd is also under election pres- and a majority of states. The coalition funds would simply come from the sure, so he has given the states an would oppose; the recalcitrant state states - they are being asked to giveearly April deadline. That's too soon;or states would cry "states' rights". up a third of their GST revenue. Theyhe should have had this blueprint outWithout bipartisan support, it is hard would be better off in real terms onlylast year. to see a referendum being successful. from 2014, when the Commonwealth The large federal dip into the GST When asked what was his plan C, would meet the gap between the GSTcomplicates things. The GST is the if both the pitch to premiers and a money and 60 per cent of the (more Coinnlonwealth s tax but John referendum failed, Rudd did not give efficient) system's costs. Howard gave the states the revenue an answer. He isn't worrying about Unsurprisingly, the proposal is a as a sweetener, and the states now that far ahead. In the short term, he compromise, retaining a role for theregard it as their tax. Canberra couldlooks in action mode, with some- states. It was always unlikely that in theory unilaterally override the thing positive to talk about on an Rudd would go for a full federal take-agreement providing the states with issue important to voters. That will over. 100 per cent of it, but the optics win a tick from many, but for an This is a long-term plan but it would be bad. Anyway, trampling elephant stamp lie needs to be able could be tripped by the immediate over that agreement would be futile to deliver. politics. Victoria, with the nation's because changing the GST distribu- best hospital system, is the big prob-tion also requires legislation -that

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Funding will be the key, says AMA

By NATASHA WALLACE

DOCTORS havegivenin-delivery of the extra funds thattoday." principle support to the Ruddare needed," Dr Pesce said. "The Associate Professor Gawaine government's reform plan forPrime Minister... seemed toPowell Davies, chief executive of Australia's hospital system, butacknowledge that." the Centre for Primary Health some are not convinced it will He said it appeared the gov-Care and Equity at the Uni- lead to better access to servicesernment might also be willing toversity of NSW, said the policy for patients and take pressureremove the "artificial" cap ondid not adequately explain how off hospitals. hospital budgets, which didn'tprimary health care services The Rudd plan, while aimingallow them to always deliverand the proposed new hospital to use centralised funding tonecessary services. networks would work together help unclog hospitalsand Catholic Health Australiato achieve better management provide better and more timelychief Martin Laverty welcomedof patients. care in the community, failed tocomments from Prime Minister Professor Powell Davies sup- explain exactly how this wouldKevin Rudd that the govern-ported federal funding of pri- be achieved, it was claimed. ment would consider using themary care but thought the Chris Mitchell, the Royalprivate sector to supplementpolicy lacked vision. Australian College of Generalpublic health services. "The people with poorest Practitioners president, said the "The Prime Minister deserveshealth and those who aren't government's plan was "a mis-full marks for recognising thecoming to use services are the sed opportunity to talk directlyrole the private sector can play,"ones that you are most con- about investment in generalMr Laverty said. cerned about, and the policy is practice, primary healthcare "However, reform isstillvery much focused on providing and prevention". likely to be three years away andbetter services for those who are Australian Medical Associ-that's if lie can get the agree-already receiving healthcare," ation president Andrew Pescement of state premiers, that's ifProfessor Powell Davies said. said the framework appearedliecan get the agreement He was also concerned that worthy but in the end it wouldthrough a referendum. some services might be in come down to funding. "This is "We're saying to the Primedanger of being overlooked, good health reform in prin-Minister there's no need to waitsuch as sexual assault and eth- ciple," he said. three years to help reduce pub-nic health services, if there was "One of the things that thislic hospital waiting lists; there istoo much focus on general prac- will succeed or fail on is thecapacity in private hospitalstice. With AAP

Copyright Agency Limited (CAL) licenced copy Ref: 65641222 Age 04-Mar-2010 Page: 6 General News By: Nickmiller I Region: Melbourne Circulation: 202100 Type: Capital City Daily Size: 204.39 sq.cms Frequency: MTWTFS- It's still all about money:hospital care costs,OK?

ANALYSIS NICK MILLER

"LET'S imagine a 67-year-old in the longer term, in efficient. man who is retired and lives in preventative health. Efficiency means more bang the outer suburbs of one of our There's a caveat: at the for your buck: more operations major cities. He's just been moment some people go to per extra billion you throw at the placed on a waiting list to get a hospital who don't need to, problem. But Victoria is very hip replacement at his local because hospitals are the last efficient already. So we don't get hospital but he's been told resort of sick people that no onemore operations unless we get there's a wait of around else wants to treat. more money. 12 months." Mr Rudd said once the same This is the crux. After all the Yes, let's. government pays for care shuffling between the GST, This was the hypothetical outside hospitals and inside federal health grants and state case study introduced by Prunethem, there will no longer be thegovernments, do the actual Minister Kevin Rudd in his same incentive to shove peoplehospitals end up better off? speech yesterday as he outlinedinto hospitals without a very The answer seems to be: not health reform. This plan was thegood reason. at first, but maybe later. "human face" of the "current This makes good macro State governments, with problems" in the system. sense, but it's less clear if it will their limited tax options, were In other words, the narrow make a huge difference on the finding it harder and harder to (but deep) reform announced isground. Individual services willkeep up with the galloping cost to be sold on its potential for still have budgets, will still wantof health. In a few decades, it reducing waiting lists for to keep the easy cases and would have overwhelmed their elective surgery and reducing liandpass the hard ones. budgets completely. the real suffering that those Buck-passing doesn't just With the feds taking the new waiting lists represent. happen between hospitals and lions share of responsibility, Will it do this? Will it do it forprimary care, it happens even there's a bigger pot of money to Victorians in particular? The between hospital departments.draw on. On the other hand, answer is ... maybe. Maybe Buck-passing is human nature.federal money doesn't grow on later. Which brings its to the otherthe magical money tree. It still Waiting lists happen becausesolution: get hospitals to do comes from taxpayers. If we people get sick and need more surgery. don't find a way of slowing our surgery faster than hospitals can Activity-based funding is spiralling need for expensive get through it. You fix this in twogood for this. By paying a fixed hospital care, we're all going to ways: either hospitals do more amount for a service (say, our pay for it, no smatter which level surgery, or fewer people need man's hypothetical hip of government is in charge. surgery. operation), you encourage Either that, or our 67-year- The latter solution is yet to hospitals to be as efficient as old roan will just keep waiting to be outlined. It requires reform possible. Victoria, the hone of fix his dodgy hip. in aged care, primary care, and activity-based funding, is very

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RURAL communities will beresistance to the plan in regionalger administrative overhead. "marching on Canberra" if theVictorian towns, where local He also did not see an end to new health reform plan putsboards run small communitybuck-passing. "The blame game their local hospitals at threat, ahospitals. that currently exists will con- hospital chief executive has "If you suggest amalgamat-tinue," he said. "The state gov- warned. ing them into regional healthernment will continue to be But other hospital chiefs toldnetworks then that will be res-responsible to make the services The Age they were cautiously inisted by the local community,"work on the ground but without favour of the deal if it meant alie said. "They would be worriedthe financial ability to drive stronger guarantee of growth inabout the temptation to closechange." funding to meet the surging costand rationalise services in the But done properly it could be of their services. bash." a solution to the problem of Austin Hospital chief execut- He said lie did not see anygrowing demand and the lack of ive Brendan Murphy said lie sawgreat advantage for metropol-infrastructure funding, lie said. potential benefits in the newitan hospitals either. President of AMA Victoria deal. "There seems to be a com- "The state [health] depart-Harry Henley said the reform mitment to meeting the fundingment has a good knowledge ofplan contained no extra funding challenges of the future," he said.what's happening down theand would not affect patient However, he said it was notroad; Canberra would be morecare. clear how the "dual accountabil-remote," lie said. "The federal government ity" of a hospital to both levels "We have done the hardappears to be taking with one of government would work. yards [of reform] in Victoria, ithand [holding back GST rev- Dr Murphy said hospitals inseems a shame to dismantleenue] and giving back with the other states would benefit fromwhat's in place to fix up theother," lie said. the introduction of activity-problems in NSW and Queens- "Pretty much nothing will based funding - but he alsoland." change for patients. You will still expressed concern that Victoria Northern Health chief exec-be able to go to your local public might be held back while theutive Greg Pullen said lie wouldhospital, with a one in three rest of the country caught upbe worried if the state govern-chance of waiting too long for with activity-based funding. ment lost too much influence inyour health care." "I think any system thatplanning and service delivery to Stateoppositionhealth might help its get more moneyCanberra. "If the state Depart-spokesman David Davis said it into the system to meet healthment of Health is dealt out ofwas a half-baked solution to a demands is a good thing," liethe equation, that would be ofproblem created by Labor mis- said. "[The plan] recognises thatconcern to me," he said. management of hospitals. some form of local accountabil- Victorian Healthcare Associ- "There's no evidence that in ity and governance is a goodation chief executive Trevor Carrthe long term Victoria or Vic- way to deliver services." said the idea of devolving statetorian patients will be advant- But another hospital chiefhealth bureaucracies into localaged, and there's every reason to executive, who did not want tonetworks "seems a bit crazy",believe they will not be," lie said. be identified, predicted strongand could end up creating a big-

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By NICK MILLER and JULIE ROBOTHAM

VICTORIAN hospitals may gethospital services. "Price loadingsviced, and health indicators extra money if they are locatedwill be established to recognise,such as tobacco use and dia- in disadvantaged communitiesfor example, the particular cir-betes prevalence. under changes proposed in thecumstances and healthcare Glenn Salkeld, a professor of federal government's healthneeds of people living in ruralhealth economics and head of reform plan. Australia, and indigenous Aus-the school of public health at The national activity-basedtralians," the plan says. the University of Sydney, said funding proposed in the plan The move mirrors a "case-the national move to case-mix, has been in place since 1993 inmix-plus" idea that the Vic-"ratchetsupthelevelof Victoria, where "case mix" setstorian doctors union recentlyaccountability in the system'. standard prices for operationsproposed. But lie said it only addressed and treatments to encourage "It's time to give case-mix athe funding of forms of care that efficiency in hospitals. Differenttweak," AMA Victoria presidenthospitals already offer, and treatments are weighted at dif-Harry Hemley wrote. "Case-mixwould not help their grapple ferent levels. For example, a liveractually provides a disincentivewith broader questions such as transplant get 27 times thefor long-term investments in ourhow to balance high-technology amount of funding of the aver-health system, as it only rewardssurgery against more standard age operation- so hospitals areshort-termactivity.Further,treatments. And it did not assess not tempted to perform thecase-mix does not allow morewhether the health of the com- cheapest or easiest surgery. vulnerable communities to beinunity improved as a result - But the new federal plan hasdirectly targeted for assistance,potentially prejudicing funding foreshadowed a new element:unless they need hospital care."for hospital treatments if there the "price" of a treatment will The AMA suggested fundingwas no reward for keeping vary according to the particularshould take into account thepeople out of hospital. needs of the community that thesocio-economic status of the coninnunity that a hospital ser-

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Guarantee no state will be r FUNDING worse off RUN BY A governing council 60% CANBERRA appointed by states 40% STATES WHAT'S LEFT Canberra has power of veto FOR EXAMPLE If Canberra says an operation should cost $1000, FOR STATES? it will pay $600. State pays $400, Hospital ownership SCRUTINY plus any blow-out costs. Decide who provides what services Independent umpire set up by States lose one-third GST Ambulance services Canberra to: and federal grants Hospital IR policy Assess performance No extra money until 2014 , Set funding for specific treatments Monitor quality and safety

WHO TO BLAME The states, according to Kevin Rudd. His document says "The Commonwealth will be alerted to poorly performing hospitals and will require states to step in and fix these problems:'

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Five things about According to the University of Canberra, one- Each year, more than 17,000 in-five Australian families will experience the Australians are forced to stop income-protection loss of one parent's income as a result of working permanently or for an insurance: 1death. accident or serious illness. extended period.

395%offamilies The typical family would lose half Underinsurance is expected do not have or more of their income following to cost the federal adequate a serious illness or injury as a government about $1.3bn insurance. 4result of underinsurance. 0 )over the next decade.

Copyright Agency Limited (CAL) licenced copy Ref: 65640185 Sydney Morning Herald 04-Mar-2010 Page: 1 General News By: Peter Ha Rtc H Er Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 161.50 sq.cms Frequency: MTWTFS- PM scrubs upfor his toughest operation

PETER HARTCHER COMMENT

KEVIN RUDD has openedhisre-election on health by46 per cent to 32, according to a campaign by painting a vision of a shining hospitalNewspoll last month. on a hill. The wellspring of strategic thinking, Sun Tzu, The vision rests on safe political ground, but devoted more attention to the subject of battle- Rudd has left us with big unanswered questions ground than any other aspect of warfare. It is about how it would work. And we have reason to decisive in winning or losing. question the qualifications ofthe builder. But TonyAbbott, brimming with jut-jawed truc- The public hospital system is overburdened andulence, will not give Rudd a millimetre. underfunded. And with hospital costs rising at IesterdayAbbott pointed out that the Rudd plan 7 per cent ayear, twice the pace of economic is light on detail. Health experts made the same growth, the future is dire. Reform is vital. point: "Today's announcement is only one part of By taking policy control of hospitals from the the mosaic," said Paul Gross, an authority on the states, Rudd's National Health and Hospitals subject, with more announcements yet to come. Network is one of the most ambitious reforms in But even if Rudd fills in all the blanks, Abbott will the history ofthe Federation. still find grounds to oppose it. Then Rudd will face It is a change on the scale of the Howard govern-the same problem he faceswith his emissions ment's takeover of industrial relations powers or trading scheme. He doesn't control the Senate, and Curtin's wartime seizing of the right to tax income.cannot expect to after the election, either. "It calls into question exactly what the purpose Rudd has a problem of credibility on big reform. of the states is," says the constitutional expert He failed to win the signature reform of his first George Williams. term, even though he enjoyed a national consensus As little as possible, according to Rudd's plan. on his emissions trading scheme for a while. Through impressive incompetence, the states have Why should we expect him to do any better with in effect invited Commonwealth intervention. the big reform of his second term? If Rudd wants us This is one reason why Rudd's imagined hospitalto take him seriously, he needs to show that he is a is on safe political ground. It is likely to be popular.real fighter, not just a clever campaigner. Other- Another reason is that Australia has a long- wise it's not a shining hospital on the hill but just a standing historical readiness to trust Labor on chimera. health policy. We prefer Labor over the Coalition

Copyright Agency Limited (CAL) licenced copy Ref: 65641358 Sydney Morning Herald Page 1 of 2 04-Mar-2010 Page: 1 General News By: Phillip Coorey Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 836.97 sq.cms Frequency: MTWTFS- Doctor Rudd orders shock treatment Phillip Coorey cially beneficial to NSW, which As flagged by the Herald, the CHIEF POLITICAL CORRESPONDENT has one of the nation's most dys- funding changes would involve KEVIN RUDD has promised a ref- functional health systems. the states surrendering 30 per erendum on healththis year "I can think of nothing more cent of their GST revenue, worth unless the states agree to sur- fundamental that will make a $90 billion over the firstfive render about $90 billion in GST difference for the good people of years from 2011-12. funding so the Commonwealth NSW, and from time to time, the The Commonwealth would can take responsibility for most very long-suffering people of put this money directly into a publichospitalexpenses and NSW when it comes to certain of National Hospital Fund to be meet all outpatient costs. their hospitals," he said. given to the networks. States have until a Council of A senior NSW government Unanimous agreement from Australian Governments meeting source said Mr Rudd wanted to the states is needed to change this on April 11 to give their answer. pick a fight with the states. funding arrangement because the Mr Rudd said if they do not "sign "We won't be taking the bait. 1999 Intergovernmental Agree- up to fundamental reform" he will We will beworking co- ment guaranteed the states would hold a referendum either before operatively with the Common- receive all GST revenue. or at this year's federal election "to wealth. Any decision will put the Also, the Commonwealth give the Australian government all needs of patients first." would keep the remainder of the the power it needs to reform the The reforms, which would be $64 billion in federal health grants health system". phased in over four years starting it agreed last year to pay the states All the states must agree if the on July 1 next year, would involve over five years and redirect it to reforms are to go ahead and the Commonwealth liftingits the hospital networks. Western Australia and Victoria share of public hospital funding Mr Rudd said the states would were the most hostile when Mr from 35 per cent to 60 per cent. no longer have to meet rising Rudd spoke to each leader indi- It would meet 100 per cent of health costs which are growing vidually yesterday morning. all GP and primary care services. at a rate faster than revenue Senate support will also be The states, which now fund and, within 25 years, would con- needed andtheOpposition 60 percentoftheirhealth sume more revenue than the Leader, Tony Abbott, indicated budgets, would only have to pay states collect. the Coalition would block the 40 per cent. TheCommonwealth would reforms,sayingtheyadded Public hospitals would be run assume the burden for meeting another laverof bureaucracy by a new National Health and the growing gap, beginning in and would take too long to come Hospital Network, a collection of 2014-15, by when the federal into effect. about 150 regional bodies com- budget is expected to back in stir- Cementinghealthas the prising local health, management plus. The Commonwealth would centrepiece for this year's federal and financial professionals. pay an estimated $15 billion in the election,thePrimeMinister While health and hospitals five years from 2014-15. unveiled his health reform pack- will be funded nationally, they will Mr Rudd said: "We have a age yesterday which he described be run locally," Mr Rudd said. reasonable prospect of making as bigger than the introduction of Funding would go directly to progress with them. Medicare in 1984. thehospitalnetworks.They "A rationalanalysis from a He said it would deliver "much would pay hospitals for each ser- state's point of view may point more acceptable levels" of care vice delivered at an "efficiency you in the direction of working including shorter waiting lists price" to be set by a new inde- with its, rather than against us." for elective surgery and emer- pendent umpire. gency treatment, and be espe- Copyright Agency Limited (CAL) licenced copy Ref: 65641408 Sydney Morning Herald Page 2 of 2 04-Mar-2010 Page: 1 General News By: Phillip Coorey Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 836.97 sq.cms Frequency: MTWTFS-

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Copyright Agency Limited (CAL) licenced copy Ref: 65641408 Adelaide Advertiser Page 1 of 4 04-Mar-2010 Page: 1 General News By: Mark Kenny Miles Kemp Lauren Novak Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 1504.07 sq.cms Frequency: MTWTFS- VITAL SIGNS PM's hospital cure welcomed MARK KENNY, MILES KEMP to run and fund the network. back in the hands of the people LAUREN NOVAK Branding it the biggest shake- who did the caring such as AUSTRALIA willget an up since Medicare in the 1980s, doctors and nurses, and end the efficient and accountable he said "it must begin now". "blank cheque" approach of national hospital system Medical groups and health giving billions to the states governed by strict standards advocates were generally wel- without "any real idea of where coming of the plan, which they the money went, or even if it and managed at a local level, all went to health". Prime Minister Kevin Rudd hope will deliver better ser- promised yesterday, announc- vices to patients. Mr Rudd said ing a historic plan for Canberra he wanted to put management Continued Page 4 DOCTOR RUDD CQ,mmnnvra it. -o essjire inCr: rst d frn dir.g responsibiIries mr haspi`aIs-

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Copyright Agency Limited (CAL) licenced copy Ref: 65637862 Adelaide Advertiser Page 2 of 4 04-Mar-2010 Page: 1 General News By: Mark Kenny Miles Kemp Lauren Novak Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 1504.07 sq.cms Frequency: MTWTFS- The health care reform_,,

From Page 1 The federal Opposition, whose funding, which will fund hospitals support in the Senate could be per procedure. Vowing to end the blame game,crucial, responded coolly, describ- Royal Australasian College of he said there would be "one set ofing it as merely a political fix. Surgeons president Professor Ian tough national standards" under a The federal Treasury predicts Gough predicted that measuring system "funded nationally but run the states will go broke in the next how the hospitals performed in key locally" with as much as an extratwo to three decades as soaring areas would improve the service. $11 billion a year tipped in, oncehealth costs consume their entire For example, he said states it was operational. revenue streams. would no longer be able secretly "For the first time, eight state- But radical though the policy is, to cut funding when extra money run systems will become part ofpatients will not see an improve- came from the Federal Govern- one national network," he said. ment in services between now and ment. "For too long state govern- Cabinet signed off on the policy the election, and only when and if ments have often responded to yesterday, allowing Mr Rudd anthe states agree to hand back a injections of federal funding into hour on the phone, speaking to the third of their GST and give up the the health system by quietly cut- premiers. "They said a lot of thingsrunning the hospitals. That power ting their own health expenditure," . some of them were monosyl-would go to a new Canberra-based Prof Gough said. labic," Mr Rudd said, joking. National Health and Hospital Net- Australian Medical Association Victoria and WA are expected towork, which in turn would deliver president Andrew Pesce saidit resist. On the hustings, Premier60 per cent of hospital funding appeared the Government might Mike Rann welcomed the reforms. directly to multiple Local Hospital also be willing to remove the "Following discussions with Networks. The states would still be "artificial" cap on hospital budgets Health Minister John Hill andliable for 40 per cent of funding. which was not matched to services health officials I am prepared to These LHNs would bring togeth- provided. "One of the things that strongly support the direction ofer and manage small groupings of this will succeed or fail on is the these reforms," Mr Rann said. hospitals and be responsible for delivery of the extra funds that are Incontrast, SA Opposition controlling budgets and delivering Leader Isobel Redmond said she co-ordinated patient care. "would not be interested in hand- Their performance would be ing over our health system to aopen to scrutiny on everything federal Labor Government that has from efficiency to infection and so badly mismanaged the homeaccident ratesvia the hospital insulation scheme". "We have noequivalent of the new My School more faith in Kevin Rudd than wewebsite. One of the most important do in Mike Rann to run our ailingchangesisso-called case-mix health system," she said.

Copyright Agency Limited (CAL) licenced copy Ref: 65637862 Adelaide Advertiser Page 3 of 4 04-Mar-2010 Page: 1 General News By: Mark Kenny Miles Kemp Lauren Novak Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 1504.07 sq.cms Frequency: MTWTFS- needed," he said. Royal College of Australian Chamber of Com-iculous". At 3.30pm, only a few Nursing chief executive Debra merce and Industry chief executiveseats in the waiting room were Cerasa called for nurses to have aPeter Anderson said a more ef-vacant and three people waited on say on the plan. ficient service could be created by gurneys in the room. "It is imperative that the nursing the new system. Doctors and nurses treated some profession isappropriately rep- "The establishment of the Na- patients in the room as they waited. resented at all Local Hospital Net- tional Health and Hospital Net- One woman, who did not wish works and within the associatedwork ... holds the prospect ofto be named, said she went to the governing councils," she said. bringing structure and greater ac-emergency department at 11.30am Consumers Health Forumcountability to the call on taxpayerafter a referral for appendicitis. executive director Carol Bennettfunds," he said. She was still waiting four hours said patients would judge the re- Australian Health Care Reformlater, at 3.30pm. "It (the wait) is forms on their ability to deliverAlliance chairman Tony McBride ridiculous," she said. "They said services. warned the focus of the plan wasthere are still seven more people "What consumers want is a more on hospitals not other health care.in front (of me). We will be here flexible system with services "In the next set of announce-all night. You would think you closer to home that provide a range ments there needs to be an empha-would be in quicker than that." of choices that doesn't force them sison prevention,earlyinter- She said that some patients re- to go, needlessly, to hospitals forvention, primarycare,dentalported waits of up to seven hours treatment," she said. health and aged care, to balancebefore they were seen. Aged Care Association Australia today's almost exclusive focus on The woman's friend, who also chief executive Rod Young said the hospitals," he said. did not want to be named, said her reform would not tackle health and Yesterday, The Advertiser visi- housemate experienced a similar other issues in the aged-care sec- ted the Lyell McEwin Hospitalwait on Tuesday. "My housemate tor, which needed $21 billion in emergency department, where pa-came here at 5pm and still had funding over the next 10 years. tients said waiting times were "rid-nothing by midnight," she said.

DOCTORS WAITING Clinicians will have a greater say in the run- TIMES ning of hospitals, with The system will for the positions on the local first time set national standards and hospital network boards and much measure the ability of management INFRASTRUCTURE more direct lines of communication to reduce emergency department with the localised management. and elective surgery waiting times. The Commonwealth will take Some have complained however, Other measures of how well a responsibility for capital funding of that the new system does nothing hospital is providing service will hospitals, estimated to be about for the training of new doctors in thebe bed occupancy rates, reporting $90 billion in first five years. hospital system. of hospital accidents and hospital infections. Health costs are increasingly crip- pling state budgets. Shifting responsibility to the PATIENTS Commonwealth will allow access to SERVICES more money for hospital infrastruc- Federally funded lo- States which providE cal management will ture. poor services will increase accountability and limit the ability of different be made to lift their standards to the national level and levels of government to blame each other when services are not up to smaller states with less access to scratch. tax revenue will be financially better off. Enhanced transparency will allow Funding will be allocated for patients to shop around and go to the better hospital. services that are provided, rather RESEARCH than capped funding which does Emphasis will be on keeping not always reflect the demand on a Improved hospital performance people out of hospital if they can be hospital. and better primary healthcare cared for elsewhere and co-ordinat- should free up specialists for more ing their overall care. When one service is not available in a hospital, the local management teaching and research functions, board will be required to locate and and allow a greater proportion of provide alternative services - even inhospital budgets to go to these a private hospital. functions rather than duplication, and remedial treatment.

Copyright Agency Limited (CAL) licenced copy Ref: 65637862 Adelaide Advertiser Page 4 of 4 04-Mar-2010 Page: 1 General News By: Mark Kenny Miles Kemp Lauren Novak Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 1504.07 sq.cms Frequency: MTWTFS-

SPECIALISTS Specialists will have access to better facilities as new Commonwealth investment improves hospital performance. Some will have direct input thorough local boards. Greater co-ordination of patient care should facilitate better outcomes.

FUNDING The plan will be funded nationally but run locally. The Common- wealth's share of funding will rise from 35 per cent to about 60 per cent over time. Funding will be managed through a new direct mechanism of activity payments revolving around payment per healthcare service rather than block grants. The National Health and Hospital Network will oversee funding paid directly to local networks, bypassing state governments.

Copyright Agency Limited (CAL) licenced copy Ref: 65637862 Age Page 1 of 2 04-Mar-2010 Page: 19 General News By: Stephen Leeder Region: Melbourne Circulation: 202100 Type: Capital City Daily Size: 346.65 sq.cms Frequency: MTWTFS- Rudd's reforms a good start to fixing ailing health system

STEPHEN LEEDER

Canberra will control the purse strings, locals the service delivery. F ANYONE doubted Kevin welcome and should not be an active interest in standards Rudd's determination to overlooked. Again, this commit- and quality of care. Much honour his promise to attend ment gives the Coninionwealth a remains to be done. National to the nations ailing health controlling, but not monopol- standards for waiting tinges, for services - even if it involved a istic, interest. example, would be established. Coinnionwealth takeover- Importantly, the plan rids the This has previously not attracted yesterday fixed that. system of the blame game and investment because of its com- The announcement of an incentives for cost shifting due to plexity and political sensitivity, Australian health and hospitals different levels of government yet it is critically important. To network, with federal govern- paying for different parts of the manage a health system in ment funding of up to 60 per health system. The continuing which demand for the care of cent of costs in public hospitals, role of states and territories in people with long-term chronic constitutes serious reform. the management of public hos- problems already consumes However, while this is a step pitals would change substan- about 75 per cent of the budget, in the right direction, there is no tially, and the details of how this the search for efficiency is essen- single magic bullet forAustralias might work will need careful tial. Modern technology allows health system and it is important clarification. more to be done more efficiently, to he realistic about what the But by leaving one-third of and areas such as the treatment plan might achieve. public hospital funding with the of trauma and cancer continue On the positive side, Rudd states and territories, the Prime to justify increased investment. seems to have acknowledged the Minister sees a continuing role But in other fields, high-tech need for more local flexibility for them in management and does not hold the answer. and control in healthcare, delivery of care. He spoke of A failure to achieve the bal- balanced by leadership from a enfranchising clinicians in the ance of community and hospital higher level of government. The management of local hospital services for the care of people new network would distribute networks, which, he hoped, with chronic illness is a glaring the billions the Commonwealth would be better integrated with example. We need information now provides directly for public community services, including on the best way to provide this hospital services (35 per cent of general practice. care and the political will to total costs) and add to this By ensuring in future that all change the allocation of enough GST clawed back from community services, including resources. At present, too little is the states to lift Canberra's share major integrated clinics of spent on community care and to a controlling 65 per cent. general practitioners and others, too many people are in hospital This would enable the Coni- were centrally funded, the inappropriately as a last resort. inonwealth to put in place the incentive to move patients This is but one example of the first substantial service change: prematurely from hospital to challenge facing the Australian to bring public hospitals home to avoid state-based costs, health and hospitals network. together in local networks with a or from ]ionic to hospital to If one adds, as Rudd did, how high level of autonomy and the avoid Coinnionwealtli costs, best to provide mental health capacity to respond with greater would be reduced. care - a desperate defect of our agility to local need. The motto is The blame game and cost f The plan rids the system "Funded nationally; run locally". shifting would become less satis- Rudd's commitment to meet- fying and less lucrative. of the blame game and ing 60 per cent of capital and But it is not all about finance incentives for cost shifting. 9 infrastructure funding for new and governing bodies. The and existing health facilities is network, Rudd says, would take

Copyright Agency Limited (CAL) licenced copy Ref: 65641539 Age Page 2 of 2 04-Mar-2010 Page: 19 General News By: Stephen Leeder Region: Melbourne Circulation: 202100 Type: Capital City Daily Size: 346.65 sq.cms Frequency: MTWTFS- system - and dental care, then a ing in the old one remains." decade-long agenda is easy to The proposed network has foresee. the word "health" in its title and The Prime Minister referred we may therefore hope that to direct payments to hospitals prevention may surface again for services provided, which because of what it offers in many wotild be a good prelude to mov- fields - indigenous health, ing progressively to payment for mental health and dental care services that we know are good among then. value for money. And while Rudd made refer- While it is always a vexed ence to his commitment to question as to what we should workforce development, the pay to save a life or preserve a broader matters of education year of life, treatment options and research that are crucial to may make no sense at all in the future of healthcare and some circumstances, as sig- medical science are yet to come. nalled by wide regional vari- Nevertheless, yesterday's pro- ations in procedure rates that posals are a good beginning to cannot plausibly be related to ensure that we have a health variations in illness. system attuned to special needs To quote British health policy andopportunities of the future. academic Nick Bosanquet: "There will be no incentive to Stephen Leeder is a professor of public invest in a new kind of health health and community medicine at the service while the easy option of University of Sydney and director of the continued growth in high spend- Menzies Centre for Health Policy.

Copyright Agency Limited (CAL) licenced copy Ref: 65641539 Sydney Morning Herald 04-Mar-2010 Page: 6 General News By: Julie Robotham Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 197.18 sq.cms Frequency: MTWTFS- Expertsseeflaws in rewards for thrifty hospitals Julie Robotham for both the Commonwealth7 per cent more in NSW than HEALTH EDITOR and the states", the governmentmost other states, and that announced yesterday. patients stay in hospital longer. HOSPITALS would be rewarded Glenn Salkeld, a professor of Under the new formula, NSW for reducing spending underhealth economics and head of would therefore risk receiving a the federal health reform plan,the School of Public Health at relatively lower proportion of its but experts say this could dis-the University of Sydney, said costs from the Commonwealth, tort patients' treatment andthe proposal, "ratchets up thecompared with other states - may not account sufficientlylevel of accountability". But the though the federal government for differences between states. change would only address the said no state would be worse off Under the plan, the govern-funding of forms of care that under the changes. ment would give public hospit- hospitals already offer, he said, Jim Gillespie, deputy direct- als 60 per cent of independently and would not help them grap-or of the Menzies Centre for arbitrated "efficient prices" forple with broader questions such Health Policy at the University patient care. Uniform national ashowtobalancehigh- of Sydney, said "efficient price" prices for everything from hip technology surgeryagainstpayments would make hospit- replacements to stroke rehabil- more standard treatments. als more accountable. itation - to be phased in over And it did not assess whether Although thepayments several years - would mean hos-the health of the communitywould ostensibly be adjusted pitals which find ways to treatimproved as a result - poten- toallow for the additional patients less expensively would tially prejudicingfundingneeds of indigenous and rural benefit from an extra windfall. towards hospital treatments ifpatients, the states would need Those where costs were higher there was no reward for keep- to argue their own cases for than the predetermined price ing people out of hospital. special consideration, he said. would be left out of pocket. So-called casemix or activity- John Deeble, the architect of The level of payments wouldbased funding is already being Medicare and an emeritus fellow beset by "an independentintroducedacrossAustralia of the Australian National Uni- umpire at arm's length fromunder agreements withthe versity, said the funding shift Commonwealth and state gov- states, replacing recurrentacknowledged states could not ernments [which would] strikefunding based on hospitals' afford thehugeexpected an appropriate balance betweenpastexpenditure.Butthe increase in health expenditure. the sustainability of the hospital reform proposals represent a But the proposal gave the federal system,reasonablelevelsof big escalation of that. government so much control access, clinical safety, efficiency, Australian Institute of Healthover how the money was spent and the significant fiscal impact and Welfarestatistics showthat it would effectively make that hospital funding will havehospital care costs on average the states its "contractors".

Copyright Agency Limited (CAL) licenced copy Ref: 65641612 Sydney Morning Herald 04-Mar-2010 Page: 6 General News By: Natasha Wallace H [A Lth Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 128.58 sq.cms Frequency: MTWTFS- REACTION Doctors welcome primarycare takeover but questions remain Natasha Wallace HEALTH

DOCTORS have welcomed theers,saidit was "a missed Associate Professor Davies federal government's proposalopportunity totalkdirectlysupported federal funding of to take over funding of primaryabout investment in generalprimary care but thought that care - seen as the foundation ofpractice, primary health carethe policy lacked vision. the health system - but are notand prevention". "The people withpoorest convinced it will lead to better Currently the state and feder-health and those who aren't access to services for patientsal governments share respon-coming to use services are the or take pressure off hospitals. sibility for primary health careones that you are most con- The proposal sees central-services, which is provided bycerned about and the policy is ised funding helping to unclogGPsandtherapists,state-very much focused on providing hospitals by providing betterfunded health centres, outpa-better services for those who are and more timely care in thetientclinics and emergencyalready receiving healthcare." community, but fails to explaindepartments. Di O'Halloran, a GP in west- exactlyhowthiswillbe Associate Professor Gawaineern Sydney and primary care achieved, doctors say. Powell Davies, the chief execut-policy adviser, said the states as The government also wantsive of the centre for primaryexperts must retain some con- to move to fully funding somehealth care and equity at thetrol over services.. hospital outpatientservices,University of NSW, said the "We need to have one level of such as physiotherapy and per-policydidnot adequatelygovernment thatisbasically haps even chemotherapy. explain liow the primary Healthresponsibleforthebroad Dr Chris Mitchell, the presi-care services and new hospitalpolicy directions and funding," dent of the Royal Australiannetworks would work togethershe said. College of General Practition-to better manage patients.

Copyright Agency Limited (CAL) licenced copy Ref: 65641613 Sydney Morning Herald 04-Mar-2010 Page: 6 General News By: Phillip Coorey Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 89.59 sq.cms Frequency: MTWTFS- STATE SUPPORT IS CRITICAI Phillip Coorey But the polls have Mr CHIEF POLITICAL Rann's government on a CORRESPONDENT knife-edge and his opponent, the Liberal leader, Isobel AN UPSET win to the Liber- Redmond, rejected Mr Rudd's als at the March 20 South proposal. Tasmania also goes Australian election could be to the polls on March 20 and enough to scuttle Kevin the Liberals are tipped to Rudd's health reform plan, defeat Labor. forcing him to carry out his Mr Rudd has called a threat to hold a referendum. meeting for April 11 at which The plan needs the sup- the states will have to port of the Senate as well as answer whether they will state and territory leaders accept the proposal for the who need to agree to change Commonwealth to take over the rules on how GST reven- 60 per cent of hospital fund- ue is distributed. Mr Rudd ing and 100 per cent of fund- plans to part fund his new ing for GPs and primary care National Health and Hospit- services. als Network by hiving off If Ms Redmond wins the from the states 30 per cent election, she will represent of the GST revenue. SA at the Council of Austra- This would require a lian Governments meeting. restructuring of the 1999 Initial signs yesterday Intergovernmental Agree- indicated Senate support ment which guarantees all was unlikely. The independ- revenue goes to the states. ent senator Steve Fielding, The reaction from the whom the government will states yesterday ranged from need if the Coalition decides cautious to accepting, with to block the plan, was hostile. South Australia's Premier, The federal Opposition Mike Rann, the most effusive. Leader, Tony Abbott, wel- "I am prepared to strongly comed only the part of the support the direction of these plan involving the full funding reforms." he said. takeover of primary care.

Copyright Agency Limited (CAL) licenced copy Ref: 65641614 Sydney Morning Herald 04-Mar-2010 Page: 7 General News By: Mark Metherell Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 233.15 sq.cms Frequency: MTWTFS- `Game-changing' moves get support from former critics Mark Metherell HEALTH CORRESPONDENT

THE patient who has sufferedof the game." inefficiencies? For a start, the the pain of a long wait at casualty Dr Bennett said the shift inplan seems to imply the end of or for a desperately needed newdirect federal payments to theNSW's area health services but hip may question why the Ruddlocal hospital network wouldnot Victoria's more autonomous plan might offer a cure for ourempower hospitalleaderstohospital board system. ailing hospitals. takeinitiativescurrently not The local hospital networks Yes, there will be billions ofopen to them. are planned to sidestep central- dollars more, just like injections The federal government willised bureaucracies giving their in the past that never seemed todirectly fund about 150 localboards and clinicians greater say mend the ailing system. But whyhospital networks which would,on development proposals that would Canberra takingoverit is hoped, have the effect ofpreviously have gathered dust. 60 per cent of public hospitalreducing Australia's over- This is a game-changer," said and allof non-hospital carereliance on costly hospital care.consultant Mary Foley, a former funding snake a difference? Ideally, a patient say with dia-senior executive in the public If it reaches reality, the Primebetes,who becauseoftheand private health sectors, who Minister's announcement signalspresent state-federal divide maybelieves the changes represent a a bigger change to the systemend up being shuntedbigger transformationthan than even Medicare 26 years ago.repeatedly back into hospital,Medicare when it was intro- This $90 billion scheme haswould more likely be placed induced in 1984. drawn support from the healthpreferable lower cost care in the The introduction of a national experts and even Labor's tradi-community. The reform recipeperformance-based funding tionalcritics:theAustralianincludes elements aimed at driv-scheme would provide a plat- Medical Association and the sur-ing efficiency and accountabil-formforsignificantchange. geons. That is largely because ofity. These include an umpire,"This should make the system the promise of an end to blameindependent of state and federalmore patient-focused by fund- shifting and cost shifting butgovernments, who will set theing episodes of care. The dollars also to exposing the secrets ofprices for health services thatstart to follow the patient, what health funding that have camou-governments will have to pay. services they need andwhat they flaged waste and inefficiency. There will be routine disclos-are getting," Ms Foley said. The proposed new healthure of much more information In the run-up to the election scheme will be "funded nation-on how well hospitals perform inthe government will spell out ally, run locally", as Kevin Ruddquality and safety terms, expos-more details on reform, to pri- puts it. The National Health anding patient infection rates, realmary care and general practice, Hospitals Reform Commissionwaiting times and the like. Buton workforce roles, electronic chairwoman, Christine Bennett,why won't a system that seems tohealth developments and said: "This is huge ... This is notadd yet more layers of bureau-changes to emergency care and just a change in fiscal arrange-crats-the local hospital networkelective surgery. ments, but a change in the rulesand the independent umpire - not lead to more obstacles and

Copyright Agency Limited (CAL) licenced copy Ref: 65641627 Sydney Morning Herald 04-Mar-2010 Page: 7 General News By: Kate Benson H [A Lth Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 339.98 sq.cms Frequency: MTWTFS- CHRONIC ILLNESS Wanted: more GPs and waiting times must be slashed Kate Benson HEALTH

LIZ SHIELDS has been admittedyou because it's life-threateningmotion and a strengthened role to hospital more than 20 times but you won't get admitted for GPs, pharmacists and prac- since she was a toddler. because there are no beds." tice nurses; and must also focus Her son, Dominic, 14, has seen The Asthma Foundation NSWon supporting information and his GP four times in the past fort-welcomed the reforms, which education to help and encour- night, and has spent countless are expected to see the construc-age people to control their own nights in emergency depart- tion of more multidisciplinary asthma, he said. ments waiting in vain for a bed. super clinics and money invest- "Our research indicates that Both suffer from chronic ed in GPs, but called for a reduct-far too many people fall back on asthma which needs constant ion in the cost of medications, emergencyvisits to GPs, or to attention and costs the fancily upwhich was an easy way of keep- emergency departments, to to $150 a month in medications.ing people out of hospital. The manage their asthma." But the 40-year-old, one of proposals include some very But the primary care reforms millions of Australians with good ideas, especially the strongcould help diabeticswho would chronic illnesses, is doubtful focus on chronic illness and benefit from super clinics where yesterday's announcement of a improving people's ability to they could access nutritionists, federal government overhaul ofself-manage their illness [but] nurse educators, podiatrists and the primary care system will research shows that people withpsychologists, said the president change their lives- unless it [Pharmaceutical Benefits of Diabetes Australia-NSW, urgently increases the number Scheme] health cards obtain Neville Howard. of GPs and reduces waiting timesabout three times the amount of "We welcome the idea of super in emergency departments. the critical medication needed clinics because the biggest prob- "The health system is at break-to manage asthma than those lent for people with diabetes, and ing point. It's a total mess," Ms who don't have a card," the chiefparticularly type 2, is that they Shields said. "You can't get in to executive, Greg Smith, said. need to see many clinicians... see a GP quickly so you are forced The refornis should include a to go to the hospital. They'll treatstrong emphasis on health pro-

Doubtful ... Liz Shields and her son Dominic, a chronic asthmatic. Photo: Kate Geraghty

Copyright Agency Limited (CAL) licenced copy Ref: 65641633 Herald Sun 04-Mar-2010 Page: 1 General News By: Phillip Hudson And Ben Packham Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 330.15 sq.cms Frequency: MTWTFS- Health revolution promises to cut hospital waiting lists RUDD'S RADICAL SURGERY Phillip Hudson and Ben Packham

KEVIN Rudd says heing lists for hip replace- can cut waiting timesment, saying his blueprint for elective surgery andwould help them get their HOW IT AFFECTS YO emergency treatment ifoperations faster. a But the plan faces a Federal Government to i his radical health pre- boost hospital funding scription is adopted. veto from the states and the Senate. by 3DN9 billion over The long overdue plan, Victorian Health Minis- crafted by the Prime Minis- nex# three yea ter and Health Ministerter Daniel Andrews said it was nothing more than Promise of faster Nicola Roxon, aims to keep re-organising who paid more people out of hospital the bills and there was access to surgery by better managing carenot one extra dollar for and emergency care for those with chronic dis-Victorian patients. eases such as diabetes. Emphasis on keepl Mr Rudd singled out the Special report: Pages 4-5 many Australians on wait- people healthy

Copyright Agency Limited (CAL) licenced copy Ref: 65638183 Sydney Morning Herald 04-Mar-2010 Page: 7 General News By: Andrew Clennell And Louise Hall Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 132.58 sq.cms Frequency: MTWTFS- NSW RESPONSE Macquarie Street bypass as Tebbutt resists penalties Andrew Clennell and Louise Hall

SENIOR NSW governmentcould occur because fundinglocal hospital networks on the sources last night accused Kevinwould be based on efficiency. basis of an efficient price per hos- Rudd of "spoiling for a fight" Sources said the state govern-pital service, determined by an with the states but said they werement was likely to back Mr Rudd'sindependent national umpire. not going to "give it to him". plan as it had little option politic- Official figures show NSW is The Keneally government pub-ally but scepticism remained. less efficient than Victoria in licly gave cautious support to the "You wonder whether it [theterms of how much it spends per Prime Minister's proposed healthplan] is to distract from some ofpatient, but Ms Tebbutt said the reforms but warned it would nottheir other problems," one said.state's 96,000 clinicians were the agree to a national system that"There's a bit of a view around liehighest-paid in the country. penalised the state for its compar-actually wants a fight." "It's just not the case to say atively higher wages, larger geo- Another senior source said:that NSW is not as efficient as graphical area and centralised"It's quite clear lie's spoiling for aother states," she said.Hospit- community care through largefight -we're not going to give it toals in rural and regional NSW are area health services. him ...lie's going to get fullmore expensive to run." The Health Minister, Carmel100 per cent co-operation." The opposition spokeswoman Tebbutt, said Mr Rudd's plans to Sources also questioned whyon health, Jillian Skinner, said strip one-third of the state's GSTMr Rudd made such a largethe federal government had real- revenues would need tobeannouncement concerning theised that smaller health admin- matched with an overall increasedistribution of tax before theistrative bodies delivered better in health funding. The staterelease of the Henry tax review.patient care. would not accept a decrease in Under Mr Rudd's plans, pay- funding, which some speculatedments will be made directly to

Copyright Agency Limited (CAL) licenced copy Ref: 65641653 Adelaide Advertiser 04-Mar-2010 Page: 13 General News By: Ken McGregor Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 223.11 sq.cms Frequency: MTWTFS- Hotel pokier amagnet for casino staff

A NEARBY city hotel became an about 80 Skycity employees with early morning haven for Skycity gambling problems during the Casino staff to play poker past 15 years. machines, a court has heard. Federal senator and no-pokies A coronial inquestintothe KEN campaigner Nick Xenophon, who suicide death of poker-addicted MCGRECOR 81'.4 is acting for Ms Natt's family, told casino employee Katherine the court he wanted the casino to Michelle Natt yesterday heard the introduce mandatory notification Strathmore Hotel would staggerthey wanted to unwind withwhen Skycity employees learnt of its opening times to attract casino friends. a co-worker's gambling problem. patrons and staff to the venue. "They inevitably went across The court heard several of Ms The 24-year-old mother died inand I saw more and more clientsNatt's co-workers were aware of August 2006, after overdosing ongoing to the Strathmore - theher problems but did not report non-prescription drugs. Strathmore name came up moreit to the casino's human resources Vincent Glenn, a Skycity gam- than it should. staff. bling counsellor, yesterday told "That is no reflection on the Skycity human resource man- State Coroner Mark Johns that the hotel or its staff, it was probablyager, Vicki Lee Bastian, told the workers would consistently referbecause they were in close prox- court that there was a "moral" to the hotel during his sessions.imity to the casino." obligation on co-workers to report He said the hotel appeared to Mr Glenn said that studies had an addiction but no written pro- structureits opening hours toshown casino employees are 10cedure instructing them to do. coincide with the casino's formertimes more likely to have a gam- If you are feeling depressed you closing times. bling problem then the general can call Lifeline on 131 114, Sane He said the hotel, which Ms population. on 1800 18 7263, Kids Helpline Natt would frequent often, closed "They areseeing winners 1800 551800 or Mensline Australia between lam and 3.30am, beforeeverywhere, they are desensitised on 1300 789 978. opening again between lam andfrom (seeing) gambling around The Gambling Helpline number 10.30am, stating: "It inevitably at- them every day." is 1800 060 757. tracted the casino staff because Mr Glenn said he had dealt with The inquest is continuing.

Copyright Agency Limited (CAL) licenced copy Ref: 65638397 Herald Sun 04-Mar-2010 Page: 5 General News By: Philip Hudson Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 150.69 sq.cms Frequency: MTWTFS- Big, bold gamble or unhealthy risk?

PHILLIP HUDSON Comment

KEVIN Rudd says the nation's hos- cent of the bill forever. It currently the states for hospitals and move on. pitals are on the critical list and need pays 35 per cent. It will take on the But this is a real attempt to tackle radical surgery. uncapped growth risk and over time the problem of patients being His prescription is to get out the put its budget on the line to keepshunted from GP to hospital to scalpel and hack into the states. hospitals open. specialist and outpatient treatment Federal and state money would go as the different levels of bureaucracy This is big, bold Rudd. And it try to manage their tight budgets. comes with a big risk of failure. intoa body called the National At the heart of this is a genuine With Rudd's previously sky-high Health and Hospitals Network, and desire to do something dramatic to rating in the opinion polls comingit would give out money to smallcut the long hours people spend back to human levels, the health groups of hospitals. waiting in overburdened emergency blueprint is the PM's first, best shot An independent umpire would set departments. To cut the months of at seizing the political momentum the price for operations. If the um-pain people endure waiting for an after the roof insulation fiasco. pire says a hip replacement is worth elective surgery. If he can pull it off it will be a great $1000, the local hospital gets $1000. If Are Rudd and Roxon mad to want triumph, but it relies on agreement it costs $1200, the states have to find to be responsible for every hospital? from all the states and the Senate. the extra $200. Probably, but at least someone is Just who that umpire is and howstanding up. Rudd and Health Minister Nicola they set the price is just one of the Victoria has genuine concerns be- Roxon argue the states are facing a many details that could bring the cause Rudd's plan is aimed mostly at financial time bomb. plan unstuck. the basket-case health systems in Costs are spiralling due to a com- The states aren't convinced. Vic- NSW and Queensland. bination of a bigger and ageing toria says it is nothing more than re- It can't be a good sign that when population, medical technology that organising who pays the cheques. Rudd told the premiers he wanted to is keeping people alive longer and the Still, Rudd and Nicola Roxon meet on April 12 to discuss the deal, burden of treating chronic disease. should be congratulated for having a they could not even agree on a date. Canberra saysitisoffering a red-hot go. It would have been easier rescue deal. It will pick up 60 perto throw extra billions of dollars at

T 04-Mar-2010 eveals a][h Page:fix 2 General News By: Julian Drape Region: Hobart Circulation: 45210 Type: Capital City Daily Size: 363.74 sq.cms Rudd Frequency:reveals MTWTFS- $90b health fix

JULIAN DRAPE If patientscan't getinto rew Pesce said. emergency departmentsor Giving Canberra greater KEVIN Rudd says Aust- elective surgery fast enough,control was "worthy" and ralia's ailing hospitals hospitals will be penalised. shouldn't be dismissed out of are in need of serious The Federal Governmenthand, the Australian Nursing surgery, and lie's plan- also planstointroduce Federation said. ning to bribe the states activity-based funding from The Consumers Health Fo- to give him the power to July 2012. runisaidlocal networks get on with the job. Hospitals will be paid a set should result in people having Under theFederal amount, determined by ana greater say about the com- Government'shealth independent umpire, per treat- munity servicesprovided. plan.the Common- ment. If it costs them more to But the Federal Opposition wealth would fund pub- deliver, the relevant state willslammed the plan, with Co- lic hospitals and locals have to pay the difference. alition leader Tony Abbott say- would run them. It's hoped this will make ing: "The timing of the rollout Under the plan, the hospitals lift their game andof this proposal raises sus- Federal Government save $1.3 billion a year. picions this is a fix for an will take $90 billion over The plan will be put to state election campaign, not a fix for five years - $50 billion and territory leaders at thethe public hospitals system." over the first three - in next Council of Australian If the states and territories GST revenue from the Governments meeting in April are not prepared to give up states for a new Natio- and Mr Rudd has threatened a control in exchange for the nal Health and Hospital referendum on the issue if they Commonwealth paying more, Network. do not agree. Mr Rudd says he will take the In exchange, the states The country's only Liberalplan to the people. will save $15 billion in premier, Western Australia's A referendum thisyear the five years to 2020 and Colin Barnett, believes natio- could"givethe Australian potentially tens of bil- nal funding has merit. He says Government all the power it lions more after that. he'll analyse the plan carefully. needs to reform the health Canberra is promising "This is good health reformsystem", Mr Rudd said. to fund 60 per cent of all in principle." Australian Medi- AAP hospital costs going for- cal Association president And- ward. rather than the current 35 per cent. The Commonwealth also C- - will run and fund all healthcare provided outside hospitals. "The Australian Govern- ment's decision to take on the dominant funding role for the entire public hospital system is designed to end the blame game, to eliminate waste and to shoulder the funding burden of the rapidly rising health costs of the future," the Prime Minister said yesterday. The new local hospital networks, made up of one to four hospitals, will be run by local health and financial professionals "rather than central bureaucracies". They will be required to meet tough national service and performance standards. Copyright Agency Limited (CAL) licenced copy Ref: 65641802 Hobart Mercury Page 2 of 2 04-Mar-2010 Page: 2 General News By: Julian Drape Region: Hobart Circulation: 45210 Type: Capital City Daily Size: 363.74 sq.cms Frequency: MTWTFS-

J Commonwealthto become main sourc of funding for public hospitals. 1 Smal I cIusters of hospita Is to he run by "local hospital networks". Canberra to fund and run all primaryFiealthcar outside hospitals. :] States to lose one-third at their GST revenue to pay for the changes. J $90 bi I lion of GST monies over five years willbe putinto the National Hospitals Fu nd_ 1 Hospitls to be funded for each treabrnent del iaered from 2012- J New national standards and reporti ng regime,

CLEAN BILL: Kevin Rudd is giving Australia's ailing system a boost. Picture: GARY RAMAGE

Copyright Agency Limited (CAL) licenced copy Ref: 65641802 Australian Page 1 of 3 04-Mar-2010 Page: 6 General News By: Paige Taylor Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 1081.04 sq.cms Frequency: MTWTF WAsays no,other states give cautious support

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WESTERN Australia's Liberal of GST was not the way to go. "We the commonwealth and ignore the government yesterday warned will not tolerate a situation where, name-calling that the PM has en- Kevin Rudd it would not surren- from Canberra, all the decisions gaged in in the past 24 hours." der 30 per cent of its GST takings relating to our hospitals and most Queensland Premier Anna and allow health decisions to be Ms Bligh warned Bligh gave qualified support, say- made in Canberra. ing the offer of "growth funds" was Even the Labor states gave she would not allow welcome news. She said it would cautious support to the Prime Queensland to be take several weeks to digest the Minister's health reform blueprint. short-changed package ahead of the Council of Premier Colin Barnett said the Australian Governments meeting commonwealth's proposal to in- of the healthcare decisions are next month. But she warned she crease its contribution to health by made," he said. Victorian Health would not allow Queensland to be taking money from the states was Minister Daniel Andrews said the short-changed. South Australian a "sleight of hand", "very unsatis-priority was to get more money to Premier Mike Rann in the mid- factory" and unachievable without provide more patients with the dle of an election campaign the co-operation of the states. treatment they needed faster. Butwelcomed the "partnership" with Mr Rudd announced yesterday Mr Rudd's new model provided no Canberra as a way of putting more the commonwealth would take 30 new money for at least the next money into the state's hospitals. per cent of the states' GST revenue four years. "That doesn't meet the Tasmanian Premier David Bar- in return for guaranteeing 60 per test we have put down, that is, tlett, also on the hustings, said the cent funding of public hospitals. more money now to provide more plan would result in a net gain to Asked about the premiers' reac- care to patients and their families,"the state over 10 years and end the tion, Mr Rudd said he had received he said. NSW Health Minister "blame game" over hospitals. "monosyllabic answers" duringCarmel Tebbutt said the key to Northern Territory Chief Minister Paul Henderson said the plan phone calls with them earlier yes- getting her state's support would terday. be whether new federal funding would have his support as long as it Mr Barnett said he would con- was directed to hospitals. But a met the needs of remotely located sider a pooling of federal and state senior NSW government source and indigenous Australians. funds if benefits for patients could ADDITIONAL REPORTING: said: "It is clearly the Prime Minis- be shown, but states should con- ter's strategy to pick a fight with MICHAEL MCKENNA, tribute to a common fund by the states but we're not going to MATTHEW DENHOLM, agreement. Handing back a third MICHAEL OWEN AND WIRES give him one. We will work... with

Copyright Agency Limited (CAL) licenced copy Ref: 65642191 Australian Page 2 of 3 04-Mar-2010 Page: 6 General News By: Paige Taylor Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 1081.04 sq.cms Frequency: MTWTF HOW THE NATIONAL HEALTH REFORM PLAN WOULD WOIIT

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Copyright Agency Limited (CAL) licenced copy Ref: 65642191 Australian Page 3 of 3 04-Mar-2010 Page: 6 General News By: Paige Taylor Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 1081.04 sq.cms Frequency: MTWTF

Kevin Rudd announcing the policy in Canberra yesterday GARY RAMAGE 0Cost of running public hospitals is increasing by0With ageing and growing population health nearly 10 per cent per year and by 2045 will be costs will account for two-thirds of the increase in l

more than all of the revenue collected by state andtotal Commonwealth spending up to 2050 1 local governments OProductivity Commisson estimates some public hospitals are wasting up to 20 per cent of their budgets Copyright Agency Limited (CAL) licenced copy Ref: 65642191 Herald Sun 04-Mar-2010 Page: 4 General News By: The Bombshell Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 160.85 sq.cms Frequency: MTWTFS- Brumby could veto deal The states will pay the other 40 pergrowing by ii per cent a year but the cent. If an operation costs more thanGST by only 6 per cent and by 2050 the the umpire's rate, the states will have tostates would have no hope of paying it. Phillip Hudson, Ben Packham pay the difference. Mr Rudd promised the states would Canberra will also pay 60 per cent ofnot be worse off and said Canberra and Stephen McMahon the cost of infrastructure, researchwould inject $15 billion extra from its KEVIN Rudd is on a collisionand training. own budget from 2014. course with John Brumby over a Mr Rudd is taking a third of GST Victoria stands to get nearly $4 bil- revenue from the states - $90 billionlion extra between 2014 and 2020. radical health blueprint thatover the next five years - and giving it Mr Rudd said the hospital system had promises to cut surgery waitingto local hospital networks. too many "cracks and flaws". times and keep more people out He dropped the bombshell on Prem- "Too many of our public hospitals are of hospital. ier Brumby during a phone call yester-struggling as demand on the system is In the biggest change to hospitalsday, just hours before announcing therapidly outweighing the supply," he said. since Medicare, the Prime Minister'splan he claimed would end the blame He said one in three emergency radical surgery would create a singlegame, eliminate waste and duplicationdepartment patients and almost one in national health system with minimumand deliver "better health". six elective surgery patients waited standards for quality, safety and bed It is believed Mr Brumby was the leastlonger than they should for treatment. occupancy rates. supportive of the premiers and Victoria Opposition Leader Tony Abbott said Mr Rudd said the states could notcould exercise its veto power to preventthe plan would add to the level of health meet spiralling health and hospital costsany change to the GST deal. bureaucracy without benefiting patients. and a federal takeover was needed. State Health Minister Daniel An- Family First Senator Steve Fielding, But the Federal Government will notdrews said Victoria had the "best per-who could hold the deciding vote on the take responsibility for all the financingforming health system". plan, said he could not see how it would because Mr Rudd wants the states to "Patients are interestedin morereduce waiting times. "have some skin in the game", ensuringmoney so they can get their treatment The Australian Medical Association they don't start to pull money fromfaster. There is no extra money forsaid the plan would end buck-passing. their health budgets. Victorian hospital patients for four "For the first time we've got a Prime Under the National Health and Hos-years," Mr Andrews said. Minister taking responsibility for major pital Network plan, Canberra will pay Mr Rudd said the reorganisation ofhealth reform in this country," AMA for 60 per cent of the cost of operationsfinancing was critical to meet the long-president Andrew Pesce said. and procedures in hospital with theterm cost of hospitals. price set by a new independent umpire. He said health finance costs were Editorial, Page 34

Copyright Agency Limited (CAL) licenced copy Ref: 65642378 Sydney Morning Herald 04-Mar-2010 Page: 6 General News By: Lenore Taylor Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 179.12 sq.cms Frequency: MTWTFS- ANALYSIS Graphs galore butanswers tobig hospital reform questionsare scarce

WE WERE given a 74-page book- the states (the minorityfunder) or let with colour graphs and tables, the independent umpire (who but we weren't given answers to will decide how much hospitals the two biggest questions about are paid) or the Local Hospital Kevin Rudd's hospitals revolu- Networks (who will run things). tion- how he will payfor it and Or if something goes wrong will how it will end the "blame game". they do what they always do and The plan's crux is that the Coin- blame one another? nionwealth will pay 60 per cent of Again there appears to be a hospital costs and 60 per cent of tom line until 2014-15, one year few things the Commonwealth the amount bywhich they grow. before Labor has promised the isn't telling usyet. In its negoti- That's abigand open-ended budget will be back in surplus. ation with the states it is likely to promise-the ageing population They don't increase to large propose a "reserve power" for and expensive new medical amounts until the following year. itself, a last-resort "big stick" to technologies mean health and But it's a big expense. force a state to step in and clean hospital costs are increasing so Rudd's glossy booklet vaguely things up if a Local Hospital Net- fast theywill blow state budgets promises continued "difficult work does something stupid or within a generation. decisions" on budget savings. to punish an under-performing Now Rudd is saying he will foot Government sources said there or under-paying state. the lion's share of the steadily were more announcements on This reform is by necessity climbing bill. That's the carrot in the matter to come. complex. A 100 per cent federal this deal for the states. Even after Kevin07 said the whole reason funding takeover would have the federal government requisi- for the health funding shake -up made a neater sound-grab, but it tions 33 per cent of the GST it will was to end the "blame game" would have left the states with no be up for an extra $15.6 billion by and to make sure the buck incentives to tryto be efficient 2020 and the liability will keep on stopped with him. But under the with their parts of the system. growing. NSW will be $4.9 billion plan he is banking on to help Important details remain to be better off over the same period. secure his re-election it wasn't at filled in, like how Rudd will pay for The phase-in of the plan all clear where the buck stopped. his funding "carrots" and when means the extra costs don't hit Was it with the Commonwealth and how he would wield his the commonwealth budget bot- (the majority hospitalsfunder) or reserve power "stick".

Copyright Agency Limited (CAL) licenced copy Ref: 65641610 Sydney Morning Herald 04-Mar-2010 Page: 7 General News By: Mark Metherell Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 49.29 sq.cms Frequency: MTWTFS- PLAN FOR UMPIRE AND NETWORKS

THE Rudd government's plans for its health reforms rest largely on the establishment of two new struc- tures: an "independent umpire" to determine public hospital costs and "local hospital networks". The umpire, who is likely to be appointed under a state-federal agreement, and be separate from health departments, will have to settle on hospital cost figures that vary widely. Hospital costs can differ by as much as $1000 per single patient case depend- ing on location in Australia. According to the latest available figures, Victoria in 2006-07 had the lowest cost per admission of about $3400 per case, compared with NSW at about $3700. The government has still to complete appointment arrangements for the umpire and is expecting to work with the states on it. The Local Hospital Net- works will preside over the hospital groupings to be paid directly by the federal government, but appointed under state laws. Mark Metherell

Copyright Agency Limited (CAL) licenced copy Ref: 65641622 Sydney Morning Herald 04-Mar-2010 Page: 17 General News By: Stephen Leeder Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 297.66 sq.cms Frequency: MTWTFS- Finance is just the start tofix health

interest. more to be done. In many instances, Another positive element is ridding say of the treatment of trauma and the system of the blame game and cancer, the benefits continue to justi- incentives for cost shifting due to dif- fy increased spending. STEPHEN ferent governments paying for differ- But in other fields, high-tech does LEEDER ent parts of the system. Yet the role of not hold the answer. Failing to bal- states and territories in hospitals ance community and hospital ser- would change substantially and the vices for those with chronic illness is a details need careful clarification. glaring example. We need better I anyone doubted Kevin Rudd's Vested interests of professional research on caring for the chronically determination to honour his groups, managers, politicians and ill, and then political will to allocate election promise to attend to patients have varying degrees of resources accordingly. the nation's ailing health ser- legitimacy and power but the At present, not nearly enough is vices- even if it involved a Common- reformer ignores them at his or her spent on community care and too wealth takeover -yesterday fixed that. peril. Byleaving a third of public many people end up in hospital inap- His announcement of an Australian hospital funding with the states and propriately as a last resort. If one adds, Health and Hospitals Network, with territories, Rudd sees a continuing as Rudd did, how we should best federal funding of up to 60 per cent of role for their in management and provide mental health care - a desper- costs in public hospitals, constitutes delivery of care. ate defect of our current system- and serious reform. He spoke of enfranchising clini- dental care, then it's easy to foresee a It is a step in the right direction but cians in managing local hospital net- reform agenda stretching for a decade. there is no single magic bullet. It is works which, he hoped, would be Making direct payments to hospit- important to be realistic about what better integrated with community als for services provided would be a his plan might achieve. services, including general practice. good prelude to paying for services we On the positive side, he seems to By ensuring all community services know are good value for money. have acknowledged the need for more are centrally funded, there would be We may hope that, though the early local flexibility and control in health- less incentive to move patients pre- agenda will be heavily hospital- care, balanced by leadership from a maturely from hospital to home to focused, prevention may come to the higher level of government. reduce costs to states, or from home fore again because of what it offers in Under Rudd's plan, the network to hospital to avoid costs to the many fields - indigenous, mental and would distribute the billions the Commonwealth. dental health among them. Commonwealth currently provides But the network will need to focus And while the Prime Minster directly for public hospital services on areas beyond finance to make real referred to his commitment to work- (35 per cent of total costs) and add to improvements to the health system. force development, the broader this enough GST clawed back from Much remains to be done in stand- matters of education and research the states, which now receive it all, to ards and quality of care. Establishing crucial to future health care and lift the Commonwealth share to national standards forwaiting times, medical science are yet to come. 65 per cent. for example, is no easy task yet is crit- Nevertheless, yesterday's proposals This would enable the first substan- ical. Caring for chronic problems are a good beginning to ensuring we tial service change - to bring public already consumes about 75 per cent have a health system attuned to the hospitals together in local networks of the budget, so the search for effi- special needs and opportunities of with a high level of autonomy and the ciency is essential. the future. capacity to respond with greater agil- The national system has done ity to local need. The motto is "Fun- much to improve how efficiently Stephen Leeder isa professor of ded nationally; run locally". healthcare is provided but we have public health and community The commitment to meet 60 per not measured the health gains it medicine at the University of Sydney cent of capital and infrastructure achieves. So discussion is limited to and director of the Menzies Centre funding for health facilities is wel- the efficiency of the process of care for Health Policy. come. It gives the Commonwealth a rather than the outcome. controlling but not monopolistic Modern technology allows much

Copyright Agency Limited (CAL) licenced copy Ref: 65641785 Hobart Mercury 04-Mar-2010 Page: 2 General News By: Michael Stedman Region: Hobart Circulation: 45210 Type: Capital City Daily Size: 114.97 sq.cms Frequency: MTWTFS- State welcomes funding plan MICHAEL STEDMAN "I am very confident the "All the bad things. such as Political reporter package Kevin Rudd outlinedovercrowded emergency today will be good for Tas-wards,insufficient bedsin PREMIER David Bartlettis mania," Mr Bartlett said. public hospitals and long elec- confident the Federal Govern- "It will eliminate cost shift-tivesurgery waitinglists, ment's plan to seize control of ing between the states and theshould improve under this 60 per cent of public health Commonwealth and will leadsystem," Dr Middleton said. funding will not adversely im- to more Commonwealth injec- "One would hope the num- pact the State Budget. tion [of funds] into hospitals. ber of bureaucrats and non- In Tasmania, it's likely more "It means we can spend moreclinical staff could be reduced than $530 million from Tas- WIN WIN: David Bartlett of that net gain on other thingsby this arrangement." mania's GST revenues every like preventive health and pub- Australian Nursing Feder- year will go into the proposed Mr Bartlett indicated Tas-lic transport." ation statesecretary Neroli new health system. mania would not stand in the AMA Tasmanian presidentElliswarned hospitalnet- The state AMA has wel-way of the proposal. Chris Middleton said thereworks shouldn't completely re- coined the plan as a means of Rather than sapping revenuewas still a lot of detail to cone,place state-level management. ending the funding blamefrom the State Budget lie saidincluding determining how to "ANF believes therestill game between the federal andthe plan would result in a "netreduce the size of the stateneedstosome overallco- state governments. financial gain" for the state. medical bureaucracy. ordination of health." she said.

Copyright Agency Limited (CAL) licenced copy Ref: 65641803 Northern Territory News 04-Mar-2010 Page: 2 General News By: Nigel Adlam Region: Darwin Circulation: 20553 Type: Capital City Daily Size: 144.39 sq.cms Frequency: MTWTFS Hospital plan bodes ill for NT

By NIGEL ADLAM But Mr Rudd said lie would payNT faced greater challenges than for the increase by cutting GSTany other jurisdiction. THE Federal Government's hos-funding to states and territories by "Running a hospital in Darwin or pital funding deal seems disas-one third. Alice Springs is not the same as trous for the NT at first sight. If that cut were applied across therunning a hospital in Woden in the But Chief Minister Paulboard, the Territory would loseACT," Mr Henderson said. Henderson said yesterday he had$800 million a year. Mr Rudd saidifstates and been assured personally by Prime Mr Rudd promised last week thatterritories did not agree to his Minister Kevin Rudd that thehospitals would be funded on thehealth shake-up, lie would call a Territory's special needs - thenumber of patients they treat. national referendum. large indigenous population and the Health professionals interpreted He said hospitals would still be tyranny of distance - would bethat as meaning much more moneyrun locally, probably by regional taken into account. for Royal Darwin. which in proport-health authorities. Canberra will increase its contrib-ion to population isthe busiest For the first time, eight state-run ution to the cost of hospitals from 40hospital in Australia. systems would become part of one per cent to 60 per cent. Mr Henderson received a callnational network," lie said. That would give the NT Govern-from the Prime Minister about the inentabout $135 million morehealth reforms yesterday morning. each year. He said Mr Rudd accepted that the

Copyright Agency Limited (CAL) licenced copy Ref: 65643314 Herald Sun 04-Mar-2010 Page: 5 General News By: Ben Packham Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 71.48 sq.cms Frequency: MTWTFS- HOW IT WILL NOW WORN IF you're waiting for hip surgery, Kevin Rudd says he'll get you your operation faster. The pledge hinges on his plan to make hospitals more efficient. Under his health reform blueprint, the Federal Government would boost its share of hospital funding from 35 per cent to 60 per cent. The money would be paid directly to local hospital networks, but they'd be paid only for the "efficient" cost of each procedure, as set by an independent umpire. The other element of the system involves a 100 per cent financial takeover of out of hospital services by the Federal Government. The PM says the financial arrangement will ease pressure on hospitals, letting them treat more patients. The proposed system is a version of Victoria's "Casemix" funding model, leading the State Government to ask "what's in it for us?" But the Federal Government says efficient hospitals will be paid the set rate for a procedure and be able to pocket any savings. There is no new money for the states for the first four years. But by guaranteeing 60 per cent of hospital costs into the future-which are rising much faster than GST revenues -the states would benefit in the long run. - Ben Peckham

Copyright Agency Limited (CAL) licenced copy Ref: 65642380 Age 04-Mar-2010 Page: 18 Editorials Region: Melbourne Circulation: 202100 Type: Capital City Daily Size: 246.83 sq.cms Frequency: MTWTFS- THE AGE ESTABLISHED IN 1854 Rudd prescribes huge dose of change in health The principle is good. The challenge is in the details and politics. ALMOST everyone sees pies are hospital beds occupied dimension of bureaucracy". in Victoria, an independently the need for a shake- by elderly patients who should The spectre of a vast, detennined "efficient national up of healthcare, be in nursing lionies and emer- remote bureaucracy was the price" will be paid for each which Prime Minister gency departments filled with opposition's first line of attack, health service. Of the GST Kevin Rudd said yesterday was people who need to see a GP. but one would hope for a more money, $18.7 billion will go to "a total mess". In 2006, as The report of the govern- constructive contribution than the neglected area of primary health minister, Tony Abbott ment's National Health and opportunistic lines such as this and preventative healthcare. A said: "Nowadays, no one Hospitals Reform Commission from Mr Abbott: "Do you trust national fund worth $90 billion designing a health system from summed up the potential gains the bureaucrats who have given over the first five years is to be scratch would propose the in one line:It is estimated that you the Pink Batts disaster to set up for hospital investments. present division of responsibil- the productivity gap between give you a functioning public It almost goes without say- ities between different levels of current and optimal efficiency hospital system?" Mr Rudd said ing that there must be no government." As early as 2004, in the hospitals sub-sector a National Health and Hospit- federal sleight of hand in the the current opposition leader might be in the order of 20 to als Network would fund groups funding shake-up. The Com- mooted a federal takeover of 25 per cent." Estimates of sav- of one to four public hospitals monwealth must be held to its hospitals, but thought it ings from eliminating federal- nun by local networks, with "a commitment to fund 60 per impossible to get all states to state duplication in healthcare new level of local control" cent of the cost of public health agree. That is Mr Rudd's range from $2 billion to entrusted to health profession- services, of recurrent spending challenge. $8 billion a year. als. Mr Abbott has proposed on research and training and of The changes proposed yes- Victoria preceded Mr Rudd's local hospital boards, and capital expenditure. terday would be, as Mr Rudd announcement by asking for an greater community input does Mr Rudd says no state or said, the biggest health reform extra $1 billion to restore the have popular appeal. The Rudd territory will be worse off finan- since Medicare. If the states federal-state funding balance to government will also take on cially, but their power will be resist, he reaffirmed his 2007 50:50. Instead, Mr Rudd said full responsibility for primary diminished. As he concedes, promise to call a referendum, states were no longer capable healthcare, where the NHHRC there is a "way to go" to secure and should. Outside govern- of coping with the rising costs found better funding and man- agreement next month from ment, there is wide support for of healthcare. The system not agement could reduce hospital the Council of Australian Gov- a single funding source for only requires more money, but admissions by 700,000 a year. ernments. Yet anyone who health, to eliminate duplication more funding transparency and The likely sticking point is resists systemic reform needs and end cost-shifting and accountability for service costs, the transfer of a third of GST to offer a better alternative. No buck-passing that goes with the efficiency and quality. The revenue over four years, one should seriously seek to split in state-federal responsib- NHHRC saw a single health $50 billion, from the states and defend the current mess. ilities between hospitals and funding pool as desirable, but territories to a federal health general practice, allied services said a central service provider fund. Under an activity-based and aged care. Classic exam- would add "an unnecessary funding model, of the sort used

Copyright Agency Limited (CAL) licenced copy Ref: 65639579 Northern Territory News 04-Mar-2010 Page: 12 Editorials Region: Darwin Circulation: 20553 Type: Capital City Daily Size: 111.15 sq.cms Frequency: MTWTFS

MARCH 4.2010

Health funds bigconcern K EVIN Rudd seems determined to push ahead with his health reforms. Territorians wil I be wary of supporting him after the release of a few details yesterday of what is proposed. NT hospitals are of a very high standard, despite what the knockers say, but their funding is a terrible strain on the Territory's limited budget. About one dollar in every four in the NT goes on health care, much of that to the five hospitals. The Prime Minister wants to end the patchy funding throughout Australia by taking hospital administration away from state and territory governments and handing it over to local regional health authorities. He would increase the federal contribution to the cost of running hospitals from 40 per cent to 60 per cent. But the money would be recovered by cutting GST money by one third, surely a case of giving with one hand and taking back with the other. The Territory would lose badly on such a funding formula. But Chief Minister Paul Henderson says Mr Rudd accepts that the Territory has special needs because of the tyranny of distance and large indigenous population. Territorians will want an absolute assurance that the reforms will lead to more money for our hospitals - not less - before they back this revolution in health care.

Copyright Agency Limited (CAL) licenced copy Ref: 65642607 Daily Telegraph 04-Mar-2010 Page: 36 Editorials Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 154.14 sq.cms Frequency: MTWTFS-

Di1y Te1egraph A healthy intervention HEN-Labor leader Kevin Rudd sometimes be impossible to find. went to the 2007 federal election Rudd's reforms also recognise that the I with a massive proposal for the states - certainly NSW - cannot be nation's hospitals. trusted to properly outlay GST revenue. Aware of widespread (and Bear in mind that the new scheme deserved) concern about the quality of doesn't actually increase health spending; it health care provided by our hospitals, Ruddjust redirects available funds, which the pledged to deliver what amounted to a Federal Government (probably rightly) federal takeover. understands to be sufficient. This message was particularly well- The Daily Telegraph supports the Rudd received in NSW, where the hospital systemplan as outlined. It is the best of all models needs a hospital of its own. proposed for reform of our hospitals and Having promised to intervene, we are appears to carry enough safeguards that any now seeing the detail of Rudd's proposal. flaws will be identified and dealt with. It is necessarily complex, for this is a This last element is important. Public complex area, but at its core is a relatively faith in the Government's ability to deliver simple and apparently workable structure on its plans is understandably low following based around the reclaiming of state GST the disastrous insulation scheme. revenue to fund fully 60 per cent of hospital Here, then, is a chance for redemption. costs Australia-wide. The quest for hospital reform is vastly more Crucially, under the proposal there wouldcomplicated than the Government's be clear lines of responsibility for the insulation scheme, but, by the same token, running of certain hospital networks. the Government seems far better prepared. This would remove the excruciating Kevin Rudd's hospital plan deserves a present situation where, in the case of chance. The time for talk is over. underperformance, a responsible party can

Copyright Agency Limited (CAL) licenced copy Ref: 65639961 Courier Mail 04-Mar-2010 Page: 42 Editorials Region: Brisbane Circulation: 211230 Type: Capital City Daily Size: 221.62 sq.cms Frequency: MTWTFS- eau icr lail Reform vital to heal a sick system THE starting point of any discussion about public good outcomes in a set-vice delivery area that has health and hospital policy in Australia is that the proved intractable in recent years. existing system does not work effectively or The other key to success is the radical redesign of efficiently and is unsustainable into the future. health and hospital funding. It is, as Mr Rudd says, Prime Minister Kevin Rudd outlined the essential the biggest proposed shake-up of Australia's public fact that makes comprehensive reform imperative: health system since the introduction of Medicare 28 on a no-change basis, by 2045-46 spending on years ago. Not only is the Commonwealth health and hospitals would consume the entire suggesting funding for most health services - GP revenue raised by state governments. The existing services and 60 per cent of all hospital funding - be administrative and funding model cannot run fast borne by Canberra, this would also be achieved by enough to stay in the unsatisfactory place it is, let redrawing the rules for carving up the revenue for alone make progress. Any reform proposals need tothe GST. The states will lose access to one third of combine a national approach to funding - to end their GST payments and the Commonwealth will decades of cost-shifting and finger pointing - with make up the shortfall. Given that GST revenue is local administration and response to patient needs.increasing by about 6 per cent annually while Mr Rudd's long-awaited health and hospitals policyhealth costs are rising by 11 per cent, this kind of is as big and bold and as comprehensive and financial shake-up is advisable. This proposed coherent as the problem requires. Its appeal is as reform would also represent the biggest rebalancing much based on what Mr Rudd has not done as it is of the vertical fiscal mix in Australia since the states on what he is doing. It is not a Commonwealth gave away taxing powers at the beginning of World takeover of our public hospitals and we need to War II. While it is, probably inevitably, skewed to hold Mr Rudd to his statement that his system the Commonwealth, any shift in this imbalance is would be "funded nationally, run locally". welcome. And if Mr Rudd is not successful in the According to Mr Rudd, his scheme is not a green short-term he can take his plan to the people later light for a new bureaucratic army - he pledges thatthis year. there will not be any net increase in the overall Mr Rudd's plan deserves a chance, as key business health bureaucracy. Given the bloated groups and sector bodies, like the Australian bureaucracies that run the state health systems - Medical Association, said yesterday. We do need especially in Queensland and NSW -we would more detail which will emerge during the hope that any real reform would cut the number ofnegotiations with the states, and proposals for bureaucrats and increase the front line of doctors prevention and health promotion also need to be and nurses. developed. A healthy and productive population is The local administration of Mr Rudd's plan is key to as important to our future as any macro-economic its practical success. It is not unlike the proposal settings the Federal Government might make. Mr from Opposition Leader Tony Abbott for hospitalsRudd's reform plan points to a key factor in our run by local community boards but the differencesnation's future. Australians need to be healthy and will be tested in the debate to come. If Mr Rudd's have ready access to affordable health care. It is the plan can place local hospitals at the centre of their key to living a full life and being a productive communities and patients are treated as people Australian. requiring care rather than just numbers on CResponsibility David by41 clipboards, the Prime Minister will win general mll owen election Qld4006.Printedandpublished approval. Mr Rudd will need to push his own Queensland Newspapers Pty. Ltd. (ACN 009 661 778) Afull list of our editors, with contact details, is available at Government and,byextension, the states to delivernews.com.au/couriermail/ourstaff.

Copyright Agency Limited (CAL) licenced copy Ref: 65640067 Adelaide Advertiser 04-Mar-2010 Page: 20 Editorials Region: Adelaide Circulation: 180853 Type: Capital City Daily Size: 180.95 sq.cms Frequency: MTWTFS- TheAdvertiser Questions still onFederal health plan ONE thing above all else is clear about thefaceless bureaucrats sitting in Canberra run- Australian health and hospital system. Itning the system. needs fixing. Commonwealth Treasury has predicted Which is not to say it is a bad system bythat by 2045, the entire revenue stream of international standards. Merely that our 762every state government would be taken up public hospitals are hampered by an increas-paying for health alone. Thus, it makes sense ingly out-dated federal structure, and besetfor the Commonwealth to step in now. The with chronic under-funding. promise of significant new funds for hospi- It is beyond argument that existing prob-tals is also positive. lems are set to worsen if major surgery is But the devil, especially in such a massive not undertaken soon. In that context, Primeand complex reform, is always in the detail. Minister Kevin Rudd's plan for a radical re-Patient accountability will be enhanced by casting of responsibilitiesisa welcomegreater hospital responsiveness from local contribution. boards and by what appears to be a planned In its main elements, it appears worthy ofhospital version of the successful My School consideration. Doctors and other health pro-website. fessionals appear to have responded favour- But political accountability in our system ably to its central ideas of a partial nationalof governance must be to the people via the take-over, more responsive localised man-Parliament. Itis unclear how that would agement, and activity funding in place ofoperate under the proposed system. If the block grants. state minister for health is not to blame, The Opposition has predictably attackedwhen something goes wrong, who is? the plan suggesting thata Government In an era when ministers claim they are responsible for the calamitous $2.45 billionnot responsible for errors in programs di- home insulation debacle, is in no shape torectly under their control, how accountable assume responsibility for the national healthwould a federal health minister be if removed system. by several layers of management and thou- This is an easy and obvious jibe but is notsands of kilometres? to be taken seriously because while the It is also unclear exactly how Mr Rudd Commonwealth would assume the majorityintends to get the changes through given that funding burden - reversing the 40/60 splitstate approval is needed to claw back GST with the states to become the 60 per centrevenue and some states will resist. funder - it would cede direct control of the There are many unanswered questions but hospitals to local boards. In other words, thejumping to immediate rejection is not a Commonwealth will not have thousands ofreasonable response.

CHANGE: Kevin Rudd.

Copyright Agency Limited (CAL) licenced copy Ref: 65640314 Canberra Times 04-Mar-2010 Page: 1 General News By: Danielle Cronin Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 332.21 sq.cms Frequency: MTWTFS- Ruddpromisesto deliver By Danielle Cronin Political Correspondent

Prime Minister Kevin Rudd is head-tation of the new system was due toresponse. "1 think a rational analysis ing for a showdown with the states -begin on July 1, with the full systemfrom a state's point of view may point and a possible referendum - over histo be tip and running one year later.you in the direction of working with plan to rebuild the health system. As well as getting the states andits, rather than against its. But we'll Central to the plan is the states andterritories on side, Mr Rudd must getsee which way they jump." territories giving tip $90 billion overthe plan through a hostile Senate that The FederalOpposition con- five years - $50 billion over the firsthas killed off some other governmentdemned the plan, saying it would three - in GST revenue sotheproposals such asthe emissions"pour petrol on the blame game" Commonwealth can become the ma-trading scheme. and bloat the public service. jor fonder of public hospitals, cover- "It'll be very hard ... it'll be one of Opposition Leader Tony Abbott ing 60 per cent of thebillsforthe hardest things this Governmentsuspected Mr Rudd's plan was a "fix infrastructure, research and training.does," Mr Rudd conceded last night.for an election campaign not a fix for In exchange, the states will save State and territory leaders alreadythe public hospitals system". $15 billion in the five years to 2020have concerns, with ACT Health "There'll be big promises but the and potentially tens of billions moreMinister Katy Gallagher unconvincedbigpromises won'tactuallybe after that. that the changes would benefit Can-delivered upon until after the elec- The Commomvealth would alsoberrans and a hostile response com-tion and he'd basically be saying to fund up to100 per cent of theing from Western Australia and Vic-people `trust me, I've got a plan, I "efficient price" for hospital out-to ria. want to get it right'," Mr Abbott said. patientservices and assumefull Ms Gallagher wanting guarantees "But that the plan will be about policy and funding responsibility forthat ACT would benefit from themore bureaucrats, it won't be about GP and primary health-care services.reforms. more doctors and more nurses." The states would be excluded from This isn't additional resourcing The plan was widely welcomed by managing public hospitals, with thefor health it's the Commonwealthgroups representing patients, hospi- task going to new Local Hospitaltelling us how we should allocate ourtals, nurses and doctors including Networks - run by specialistsinmoney and our priorities within ourAustralian Medical Association presi- health, finance and management -budget," she said. dent Andrew Pesce. that would be responsible for small "We will need to be very much "There's a lot to digest but it's very groups of hospitals. guaranteed that the ACT will begratifying to see a government and a The Commonwealth would alsobetter off under this arrangementprime minister standingtipand developnationalstandardsforthan the status quo. And you know,taking responsibility for major health patient care and publish perform-our recent experience in dealing withreform and major reform is needed, ance statistics for hospitals. national outcomes is that the ACT isnot just tinkering around the edges," Activity-based funding for hospi-often the forgotten territory. Dr Pesce said. tals would also be introduced from "Under this proposal as it stands Mr Rudd saidfurther reforms July 2012. we'll be asked to essentially carve offwould be "embraced" in the future Hospitals will be paid a set amounta third of our budget and put it underto deal with the lack of hospital beds, - determined by an independentthe control of the local hospitalshortage of doctors, nurses and other umpire - per treatment. If it costsnetwork and thatthe Common-health professionals, the inadequacy them more to deliver, the relevantwealth will fund that directly. It stillof electronic health records and state will have to pay the difference.has the state government carrying, Ichallenges in preventive health care, The states have until April 11 tothink, a lot of the risks with quite a lotaged care, mental health and dental decide and if they don't come onless say about how that service is toservices. "Australia has a choice. We board, Mr Rudd has promised abe run." can continue blaming others when referendum so the public can vote on Mr Rudd started talks with pre-things go wrong or we can take the the issue directly. miers and chief ministers yesterdayhard road of reform," Mr Rudd said. Mr Rudd calledthe plan themorning. "Building a new health and hospi- biggest change to health care since "Some of them were monosyl-tals network is fundamental to build- Medicare and said the implemen-labic," he saidof the premiers'ing a stronger and fairer Australia."

Copyright Agency Limited (CAL) licenced copy Ref: 65645096 Canberra Times 04-Mar-2010 Page: 4 General News By: Philip Dorling Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 304.74 sq.cms Frequency: MTWTFS- Reform has implications for operation of federal system ANALYSIS By Philip Dorling National Affairs Editor

Prime Minister Kevin Rttdd's hospi-Health and Ageing ptiblislied a reportwon't have time to sort through this tals and health policy announcementrecommending further expansion ofhugely complex detail by the Council yesterday has been widely billed asthe federal role in health policy andof Australian Governments meeting the biggest reform to the nation'shospital funding. Newly elected Mrscheduled for the second week in health-care system since MedicareRudd adopted the report's title as hisApril. Two jurisdictions, South Aust- was introduced by the Hawke gov-otvii at his first media conference asralia and Tasmania, will have only emtnent. leader and used health policy as anjust emerged from the caretaker While much of the debateiseffective demonstration of the needconventions of their respective elec- inevitably and rightly focused on thefor new national leadership. tion campaigns. implications for Australia's hospitals Three yearslater Mr Rttddis On balance it seems likely that the and their patients, the implicationsproposing that the Commonwealthstates and territories will give agree- for Australia's federal system of gov-directly fund 60 per cent of the pricement in principle to Mr Rtidd propo- ernment should not be neglected. of every public hospital service. Tosals,whilecontinuingtohaggle If implemented, and that's still adeliver the changes, the Rudd Gov-intensely on the details including the big if, Mr Rudd's proposals will alsoernment wants toestablishlocalextent of the transfer of administrat- be the biggest shift in Australia'shospital networks - small groups ofive and regulatory functions to the federal balance since the the GST.hospitals that will work together toCommonwealth and the relative con- and arguably since the Common-deliver services and achieve econom-trol of both levels of government over wealth grabbed control of income taxies through bulk purchasing. the proposed local hospital networks. collection during World War II. Not too dissimilar proposals were The further expansion of Coin- Mr Rudd described the proposedrecommended to but rejected by themonwealth control may take longer changes as a "$50 billion takeover offormer Howard Government. Thethan Mr Rtidd hopes, bttt noneth- funding responsibility for hospitalsauthor of those proposals, formereless appears inevitable. from the states and territories". senior public servant Andrew Podger However, in the longer term, if a "These changes will end the blameyesterday welcomed Mr Rudd's pro-genuine federal system is to con- game, eliminate waste and shoulderposed scheme as a "great oppor-tinue, serious reinvestment in the the burden of fundingto meettunity" and a "substantial movepolicy responsibilities, administrat- rapidly rising health costs," he said.forward". ive capacity and financial autonomy Federalism and"statesrights" But as Mr Podger says "the devil isof the states appears essential. What aren't vote winners in today's agein the detail". The effectiveness ofare democratically elected and local- and "ending the blame game" hasthe proposed new arrangements willly networked governments should been a frequent refrain from Mrdepend critically on new cooperativenot be reduced to political and policy Rudd ever since became federalarrangements between the Com-husks, a state of affairs unlikely to Labor leader in November 2007. monwealth and the states which insupport good governance across the On theday before Mr RuddMr Rudd's words are to "keep somenation. defeated Kim Beazley, the House ofskin in the game". Representatives Committee on The premiers and chief ministers

ALL CHANGE: Health Minister Nicola Roxon and Prince Minister Kevin Rudd Copyright Agency Limited (CAL) licenced copy Ref: 65645518 Canberra Times 04-Mar-2010 Page: 4 General News By: Natasha Rudra Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 228.24 sq.cms Frequency: MTWTFS- Doctor welcomes plan to beat the run-around MEDICAL OPINION By Natasha Rudra

In her Isabella Plains practice, Rash-Dr Sharma said. right royal waste of time," Dr Sharma mi Sharma sees first hand how the "It became reallyconfusing,said. health-care system can give patientsbecause people went to see doctors "It's trying to cost shift. They talk and doctors the nin-around. in other areas and you had one set ofabout the blame game but it's also Dr Sharma, who is president of therules in one place and another set ofabout trying to maximise income by ACT Division of General Practice,rules in another." some othersources,but inthe welcomed the proposed hospital re- But she warned the Governmentmiddle is the poor patient who's forms and said patients needed aneeded to work with doctors andpushed from pillartopost and more streamlined health system. nurses at the coal face. wasting GPs' time. We really need to "You'vegot GPs paid by the "You don't want it too centralisedbe seeing patients who are sick and Commonwealth through Medicare,because obviouslytheinsulationdelivering health care." you've got having to deal with otherthing didn't work. If you don't realise But like many other health-care primary health-carethingslikewhat's really needed in Canberraprofessionals, Dr Sharma said she physio [or] dieticians, that are run byyou're not going to deliver the care,wanted tosee thedetailin the another organisation. So care canyou really need to work with peopleFederal Government's plan. become quite fragmented," she said.on the ground." "There's been a lot of talk about The Federal Government's move Dr Sharma said the split in fundingtheeffect of primary health-care to take more control over the hos-between state and Commonwealthorganisations and what they're going pital and primary care system wouldcreated situations where patient andto be like and it would be really nice help do away with artificial barriersdoctor time was wasted. to get a bit more detail rather than to care. "We have these artificial state "We see issues where, for example,just the motherhood statements," and territory boundaries - a greatthey'll send patients back so they canshe said. example is when we had the wholeclaim a referral from Medicare when swineflubreak-outlastyear,"they go to see them and it's just a

V -R-" SNWf

THE COAL FACE: ACT Division of General Practice president Rashnti Shariua Copyright Agency Limited (CAL) licenced copy Ref: 65645521 Australian 04-Mar-2010 Page: 4 General News By: Palge Taylor Region: Australia Circulation: 131246 Type: Australian National Size: 40.77 sq.cms Frequency: MTWTF Sniff-proof petrol for Goldfields

OPAL fuel, which provides no "high" when sniffed, is being rolled out in the West Australian Goldfields area following regular outbreaks in petrol sniffing among indigenous youths in the past year. Indigenous Affairs Minister Jenny Macklin said the Rudd government would spend $2.3 million on Opal subsidies for nine outlets in six communities, help establish a bulk storage facility for Opal fuel in the Gold- fields city of Kalgoorlie- Boulder and pay for bowser upgrades. "Over the years petrol sniffing has wrecked too many young In- digenous lives," Ms Macklin said. "We have seen positive results from the rollout of Opal fuel in regional and remote areas of Australia, and we want to see this extended to the Goldfields." There are 122 sites receiving or registered to receive Opal fuel. PAIGE TAYLOR

Copyright Agency Limited (CAL) licenced copy Ref: 65637653 Herald Sun 04-Mar-2010 Page: 34 Editorials By: Herald Sun Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 142.42 sq.cms Frequency: MTWTFS- Herald Sun Rudd cure-all must deliver TAKING over responsibility for hospital funding across the nation will cure Aus- tralia's healthcare problems only if federal control proves to be better than the states in delivering services to patients. This will be the real test of what Prime Minister Kevin Rudd hopes will be the universal panacea for the problems he promised his Government would fix. The states and territories will be asked to agree to a transfer of powers in April. But an indication of just how much the Gov- ernment is counting on the restructure to restore its electoral fortunes is reflected in the response to its scheme by Opposition Leader Tony Abbott. Mr Abbott, who is steadily gaining on Mr Rudd in the polls, asks whether a Government that could not implement a home insulation scheme can successfully oversee a reorganisation of the healthcare system. Public hospital spending last year took $30 billion of the more than $100 billion spent on health care in Australia. Mr Rudd says the takeover will end the "blame game", which sees premiers and chief ministers go cap in hand to Canberra each year for funding. But health care is no game, and what the new arrangement must achieve is better outcomes for patients, especially those on long waiting lists for surgery. If the takeover is rejected, Mr Rudd says he will take his plan to a referendum or the election for a second opinion. The diagnosis will be made by those who fall ill and find the system is still sick.

Copyright Agency Limited (CAL) licenced copy Ref: 65641200 Australian 04-Mar-2010 Page: 7 General News By: Stephen Lun Region: Australia Circulation: 131246 Type: Australian National Size: 172.84 sq.cms Frequency: MTWTF Network plan will increase red tape elective procedure yesterday at SII:I111E.\I.[ \\ the Alfred Hospital in Melbourne, a steroid injection in the ankle to THE father of "case-mix" hospitaltreat chronic arthritis. funding in Australia says its pro- "I come in here a bit for another posed national rollout under condition I have, about once every Kevin Rudd's new health reform three weeks or so," Ms Nalder said. package is crucial to the future "I've never felt like they're rush- viability of the health system. ing me out here. It's more the other But health economist Stephenway. They won't let me leave until Duckett, who oversaw the intro- everything is completely finalised. duction of activity-based hospital I'm the one trying to get out." funding in Victoria 17 years ago, is Case-mix funding has also been concerned the Prime Minister'sintroduced in South Australia, plan focuses on acute hospital care Queensland and, to a degree, in at the expense of areas such as re- NSW, but the Rudd plan envisages habilitation and mental health. "a nationally consistent patient- And he fears the mooted move level costing and pricing regime". to Local Hospital Networks, which "Currently, the Australian gov- would cover just a few hospitalsernment provides block hospital each, could lead to expensive funding to states, who then deter- duplication in bureaucracies. mine how and where this money is "Case mix has withstood the spent," Mr Rudd said yesterday in test of politics in Victoria, havinglaunching the plan. "This is like been brought in by a Liberal gov- providing a blank cheque. ernment and used by a Labor gov- "In the past, neither the Austra- ernment for the last 10 years," Drlian taxpayer nor the Australian Duckett, now chief executive ofgovernment had any idea where Alberta Health Services in Can- the money went. Or even if it all ada, told The Australian. went to hospitals. This must stop. "Both sides recognised it was a "Under the new arrangements, rational way of funding services, each Local Hospital Network will and that it was just the right thing be funded for every service they to do." provide to a patient." In 1993, under the Kennett gov- Dr Duckett said while the move ernment, Dr Duckett introducedto Local Health Networks was a the "case-mix" system of govern-promising idea, his recent Can- ment funding for Victoria's public adian experience had revealed hospitals, a complex calculation they may be too local. based on the full needs of a patient "Alberta now has one board for from presenting through to re- a province of 3.5 million people. habilitation and aftercare. We moved from 12 boards to one, It put relative values on the and this meant moving from 12 HR complexity of procedures and the departments doing much the same hospital resources required. If athing to one, from 12 payroll de- hospital could treat a patient more partments to one," he said. efficiently, it freed up money un- "In splitting things up, you must der its budget for other needs, be careful not to increase by hun- though checks and balances en- dreds the bureaucrats involved. sured treatment was not rushed "The Prime Minister might and quality was maintained. have to be careful about this; he Beauty therapy student Kath-may have underestimated the erine Nalder, 21, was having ancomplexities."

Copyright Agency Limited (CAL) licenced copy Ref: 65637951 Australian Page 1 of 2 04-Mar-2010 Page: 14 General News By: Katie Lahey Region: Australia Circulation: 131246 Type: Australian National Size: 332.06 sq.cms Frequency: MTWTF PATIENT-CENTRED HEALTH REFORM

It's not who pays that's important, it's about gettingmorevalue andbetter service

K,1 1 1 1,L IIl_Y AS we assess the federal govern- is seen as one of the best in the crating or providing appropriate ment's policy response to the world. care have been slow to evolve in a challenges facing our health sys- Over the past 30 years our life systemic sense. tem it is worth considering firstexpectancy on average has in- Some have suggested that at what are the objectives of health creased significantly and the least 15 per cent of present re- reform. number of preventable deaths sources could be released, to ad- Too much of the present de-has fallen. We have managed dress unmet demand or taken as bate about healthcare reformthese outcomes with expendi- savings. focuses on the burgeoning cost oftures that rank in the middle of But this cannot be achieved health care and concerns aboutthe OECD field. But as many through blunt cost-cutting mea- thesustainabilityofever- have argued, "good" is the enemy sures or budget limits. increasing public contributions. of "great". The effects of such measures in Originating in Intergenerational We can do better and will need the past have left us with a legacy Reports that linked the cost in- to do better if we are to maintain of skills shortages and over- creases to population ageing jux-the advances we have achieved crowded, understaffed and stres- taposed against a shrinking tax and spread them to those groups sed public hospitals. base, the debate is only now turn- in Australia that have not shared What we need is a systemic ing to the real issue: how to get in them. and systematic view of reform for better health outcomes and bet- It is not just that we will run out health care. ter value for the dollars we all pay of money to fund a universal The approach must take ac- in taxes or fees. healthcare system. count of the changing patterns of But what does "better value" It is more that the system is not disease and best-practice treat- mean in health system reformwell suited to the changing pat- ment models,adopt more and why is it the objective wetern of disease, and staffing short- business-like administrative sys- should be most focused on? The ages alone will dictate that we do tems and harness the advances in answer lies in delivering better things differently. information and communication outcomes, increasing greater ac- The demand for health care technologies to those needs. countability, reducing risk, andwill continue to rise but the re- The battle for scarce resources ultimately improving the effec- sources to supply the requisite means that all assets, people, in- tiveness of the health sector by services are finite, in terms of dol- formation and capital, need to be shifting the focus to patientlars and people. used as efficiently and effectively needs. Since 2009, the Business as possible so that unnecessary The Prime Minister's an-Council of Australia has ident- duplication is eradicated. All of nouncement yesterday is an im- ified healthcare reform as one of these are likely to be achieved if portant step in shaping a betterthe essential areas of micro- services are designed around the system to meet Australians' heal-economic reform to be tackled by needs of the patient. thcare needs into the future. This Australian governments as part A simple contrast: when a is a major piece of the health re- of their productivity agenda. Im- guest checks into a hotel, they are form puzzle. proving the health status of Aus- provided with one "file" and ac- tralians and the cost- count. All departments of the It must now form the basis for a effectiveness the value prop- hotel enter their information and broader reform agenda that sup- osition for citizens and patients services on to that one file. ports better governance of the en- alike of the healthcare sector When you check out you get a tire health sector. Health must be are integral to improving Austra- single bill that incorporates every seen asa critical area for lia's productivity and achievingservice and product you have pur- microeconomic reform alongside the economic and social pros-chased during your stay. But if other areas such as regulation perity we all seek. you "check in" to a hospital today, and infrastructure. The micro-economic reformyou receive multiple bills from Part of the challenge for agendas of past decades have left your hospital stay. Patients face would-be health reformers is that this sector relatively untouched. the risk of injury or incon- the Australian healthcare system Not surprisingly, new ways of op-

Copyright Agency Limited (CAL) licenced copy Ref: 65638180 Australian Page 2 of 2 04-Mar-2010 Page: 14 General News By: Katie Lahey Region: Australia Circulation: 131246 Type: Australian National Size: 332.06 sq.cms Frequency: MTWTF venience as information miimr 5ehours means that on present pro-their potential. TI passed through multip!L 1, .ii t-jections and treatment models,maximise our ecor ments and professionals b, lorethere will be insufficient people toat prosperity. treatment is provided. From astaff the system as it is currently business and administrative per-configured. Mounting stress inKatie I,uhev is chief' executive of spective alone, there is ample op- arts of the system is exacerbat-the Business Council of'Austratia. portunity to improve the experi- turnover rates. The issues are ence of patients and reduce wastelinked. and risk. The lessons learned The real implication of the In- Checking out of from many other sectors stand tolergenerational Report is not provide some guideposts. about rising expenditures on the hospital should be Most importantly, we need tofederal budget. It is much more like checking out of recognise that the health work-about how we will optimise. our a hotel, with a force itself is ageing. Despite thehuman resources as the compo- patient getting only recent increases in training num-sition of our population changes, bers and international recruit-and how we ensure that all can one bill ment, the offsetting reduction inparticipate and contribute to

Copyright Agency Limited (CAL) licenced copy Ref: 65638180 Australian 04-Mar-2010 Page: 14 General News By: SinclairDavidson Region: Australia Circulation: 131246 Type: Australian National Size: 294.86 sq.cms Frequency: MTWTF GST SURE TO RISE UNDER RUDD'S HEALTH TAKEOVER Do we really want some Canberra bureaucrat determining how much should be spent on our wellbeing? SI CLAIR DAVIDSON

WHILE Kevin Rudd acknow- "divide and conquer". It is cold It is true that the healthcare costs ledged the "long-suffering Austra- comfort that an "independent um- are expected to grow rapidly in fu- lian taxpayer" in his healthcarepire" will determine "efficient It is true that the ture and that the states have poor healthcare costs are policy announcement at the Na- prices" for procedures. fiscal bases to meet those costs. It expected to grow tional Press Club in Canberra yes- Do we really want some Can- is not clear that greater centralis- rapidly and the terday, there was much more to berra bureaucrat (note the "no net ation is the solution to this prob- states have poor dislike than like in his speech. increase in bureaucrats" promise) lem. Itis especially unclear fiscal bases to meet He is proposing that the com- determining how much should be whether Canberra is up to the thosecosts.It is not monwealth provide dominant spent on our health? Do we really challenge. The home insulation clear that greater funding of the health system, in- want to have health spending allo- program was a locally managed, centralisation is creasing its share from 35 per cent cated on the same basis that the centrally funded program and the solution of the cost to 60 per cent. The devil Commonwealth Grants Commis- that just didn't go well. is in that detail. sion divvies up the GST? The solution to high vertical There are, of course, aspects of This policy is to be financed by fiscal imbalance is not stripping thepolicy that are good. Published one-third of the GST revenue. authority and funding from the performance standards should be People may think that to be sen- states but ensuring that the states welcomed. Ideally they would be sible, but hang on to your wallets. have a sound fiscal basis for ser- at a sufficient level of detail so Rudd promised further ostensible vice delivery. That means the league tables can be established, reform. He identified that the gap commonwealth needs to collect something yet to happen in edu- between expected GST revenue less revenue and the states more cation. The pledge of "no net in- and demands on the health sys- revenue. It looks like the Henry crease in bureaucracy" also should tem is expected to increase. tax review won't be making that be welcomed, although I cannot That's code for a future in- recommendation. see this being met. crease in the GST rate. No doubt, Effective service delivery re- At the least federal and state through time the commonwealth quires that decision-making and governments will have to estab- will find that it needs to spend funding be localised as much as lish a hospital inspectorate and more and more on health. "GST possible. That means greaterpow- auditors to ensure the national up" will become the new perennial ers to the states and less to the standards are being met. Other- budget headline. commonwealth. wise doctors and nurses will spend Unlike many other countries Rudd also spoke of directly more time filling out forms for with a GST-type consumptionfunding regional areas and by- Canberra than treating patients. tax, the 10 per cent rate has been passing the states. That is a recipe Just look at the administrivia very stable. The long-sufferingfor a huge boondoggle. He will drowning universities. Australian taxpayer has been also need a constitutional amend- The financing and governance fairly confident that the rate ment to do so. Hopefully the states aspects of the announcement are wouldn't escalate to very high will refuse to co-operate and force troubling; on that basis it is poor levels. That was the genius of the a referendum. policy.Separatingdecision- Howard government's implemen- This will be the largest health- making and financing creates tation. The commonwealth bore care reform in Australian history. what economists call "agency all the political costs of the GST The electorate deserves an oppor- costs". In this policy, decision- while deriving none of the benefit. tunity to express an opinion of this making is far removed from Once the commonwealth reform separately and over and financing. starts to derive benefit from the above considerations that come Rudd tells us that his plan will bundled up at elections. This pol- GST, we can expect the rate to es- icy isn't only about health; it is eliminate waste and duplication, calate fairly quickly to European but greater agency costs imply Union-type levels. In the context about taxation and about the greater waste and duplication, not of revenue-neutral tax cuts else- nature of our federation. less. It is difficult to see how clini- where in the system, that may be a Sinclair Davidson is a professor cal decisions will drive the system valid policy choice. Rudd, how- in the school of economics, when the dominant fonder will be ever, has spending plans. finance and marketing at dealing with a large number of Rudd points to Australia's high RMIT University. small hospital networks. This is vertical fiscal imbalance as being the typical Canberra strategy of part of the problem in health care.

Copyright Agency Limited (CAL) licenced copy Ref: 65638181 Summaries - Australian Financial ReviewPage 1 of 2 04-Mar-2010 Page: 1 General News By: David Crowe with John Breusch and AAP Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: PM’s $90bn health gamble

AUTHOR: David Crowe with John Breusch and AAP

Prime Minister Kevin Rudd has released a blueprint on a $90 billion offer to overhaul the health system by drawing on some annual GST revenue to transfer power to a network of local hospital authorities. But states including Western Australia and Victoria objected to the plan late yesterday saying there would be no net increase in total funding for at least four years. Opposition Leader Tony Abbott also rejected the new plan. Such restructuring of the health system poses as a gamble for the Rudd government as any one state can veto amendments to GST arrangements and other federal-state partnership agreements. If no agreement is reached on the reform at a Council of Australian Governments meeting in Canberra after Easter, Mr Rudd could be forced to take it to a referendum. Reaction from the business and health-care sector was mixed, with chief executive Christopher Rex at Ramsay Health Care commenting the plan as benign for the private hospital sector. Mr Rudd believes the restructuring amounts to the largest single healthcare reform since the introduction of Medicare. Yesterday, Mr Rudd communicated with premiers on the reform and they indicated their concerns about redirecting GST revenue, but “the premiers said other things as well”, he quipped after a speech delivered to the National Press Club. Ernst & Young believes states should be attracted to the plan because “the real incentive for the states is they’ve got an unsustainable financial position going forward”. However, Family First’s Steve Fielding said in a statement “The PM said he would take over the ailing health system at the last election, yet when it comes time for action he’s shirked away from his responsibility, coming up with some half-baked hybrid idea”. The Doctors Reform Society pointed out the changes could cut waiting lists, while Aged Care Association Australia said the reform agenda does not address the issues of aged care. Chairman of the Australian Health Care Reform Alliance commented that the Prime Minister’s reform proposal is a “solid down-payment on a more consistent and sustainable health system for Australia”. © Media Monitors Pty Ltd 2010

This summary may not be provided to any third party for any purpose without the express permission of Media Monitors Pty Limited ABN 11 002 533 851. Summary may be subject to error or omission. Subscribers should refer to the original article before making any financial decisions or forming any opinions.

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Ref: 65646690 Summaries - Australian Financial ReviewPage 2 of 2 04-Mar-2010 Page: 1 General News By: David Crowe with John Breusch and AAP Region: Australia Circulation: 77470 Frequency: MTWTFS-

MENTIONS: Council of Australian Governments, Ernst & Young, Medicare, Ramsay Health, Kevin Rudd

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Ref: 65646690 Sydney Morning Herald 04-Mar-2010 Page: 6 General News Region: Sydney Circulation: 211066 Type: Capital City Daily Size: 246.41 sq.cms Frequency: MTWTFS-

A HEALTHY WORD IN YOUR EAR

The Health Minister, Nicola Roxon, with the Prime Minister, Kevin Rudd, at yesterday's launch of the hospitals plan. Photo: Andrew Sheargold 'At the moment the critics of the plan do not appear to have any better ideas. In the absence of a convincing alternative vision the government's reform process should be allowed to unroll.' EDITORIAL, PAGE 16

Finance is just the start to fix health. OPINION. PAGE 17 Copyright Agency Limited (CAL) licenced copy Ref: 65641611 Canberra Times 04-Mar-2010 Page: 18 Editorials Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 263.17 sq.cms Frequency: MTWTFS- nt (anltrra ar#mt8 TO SERVE THE NATIONAL CITY AND THROUGH IT THE NATION Health changesa long time coming The Rudd Government is renowned more for its Mr Rudd has factored a largish stick (masquerading as a timorousness than its fervour in translating carrot) into his calculations by proposing to grant other election promises into action, so it is a relief to see elements of the reform package - such as extra money for some action, finally, on health. Concrete progress GPs and allied health services - to those states which agree on implementing the significant changes outlined by Kevin to the new funding mechanism for public hospitals. If a Rudd yesterday is unlikely before the next federal election, majority refuse this blandishment and decline to sign up to but firm undertakings have been given (and a schedule set) the reforms, Mr Rudd has said he will try to win a specific for what the Prime Minister describes as "the most mandate for change at the election "along with a significant reform ofAttstralia's health and hospitals referendum by or at that same election to give the system since the introduction of Medicare almost three Australian Government all the power it needs to reform the decades ago". health system". The assumption bythe Commonwealth of direct If by this he means a referendum to amend the responsibility for the funding of the public hospital system Constitution (which give the states and territories (the administration of which will be undertaken by local responsibility for community health), then the chances of hospital networks rather than state bureaucracies, as is the success would appear remote. Virtually no referendum on case now) is the cornerstone of Mr Rudd's ambitious constitutional change in Australia has succeeded when reform plan. Equally far-reaching are Mr Rudd's proposals opposed by significant political forces or groupings, so the for minimising waste and maximising efficiencies through federal Coalition's response will be significant. Even before the establishment of activity-based funding arrangements Mr Rudd provided details, the Liberals were questioning for hospitals, the setting of national standards for patient the ability of the Labor Government to deliver on health care, and the publication of performance statistics for after having failed so spectacularly in the delivery of the hospitals. home insulation scheme. A new National Hospitals Fund will be created to finance This is a specious argument, of course, but not recurrent and capital expenditure on hospitals, with the unexpected given Opposition Leader Tony Abbott's states and territories being invited to forfeit a portion of predilection for mischief-making and opposing for their GST revenues for direct placement in the fund. As opposition's sake. In light of their previous enthusiasm for well, the Commonwealth will take over funding local boards to take control of hospitals in Tasmania, the responsibility for the provision of primary health care. With Liberals ought to be keen advocates of these reforms, but the Commonwealth's own share of the total health spend Mr Rudd won't be counting on them. Instead, he will rely forecast to rise to about 60 per cent, Mr Rudd says the on the strength of public feeling about dysfunctional Federal Government will become the undisputed main hospitals, long waiting lists and the inability of some state player in the financial provision of health care, ending the governments to fix the problems to back his arguments for blame-shifting, and the tunderftinding and change. Certainly, there is a strong and widespread feeling mismanagement of hospitals that has been an all-too- that some states have deliberately hidden the extent of frequent occurrence over the past two decades. their mismanagement or blamed the Commonwealth for Given that the basis of Mr Rudd's proposals are funding shortfalls when they have been guilty of doing the recommendations made by the National Health and same themselves. The viability of Mr Rudd's proposals Hospitals Commission and the National Preventative would also be boosted by a positive reception from the Health Taskforce, there is every reason to suppose they will likes of the Australian Medical Association. usher in a new era of health care. But two significant It is the potential of these reforms to substantially hurdles - the likely opposition of some of the states and the increase efficiencies (and there are estimates that savings Federal Opposition - remain to be cleared before any of tip to $2 billion a year will be possible) that is their most implementation can begin. winning feature. This is because efficiencies are the key to a health system that is affordable, sustainable and, most importantly, fair. It's unfortunate that Mr Rudd delayed his plans as long as he did (and there are suspicions that his timing was dictated by a desire for maximum political impact), but at least voters now have an idea of what can be achieved if common sense prevails and the states cooperate.

Copyright Agency Limited (CAL) licenced copy Ref: 65647193 Summaries - Australian Financial Review 04-Mar-2010 Page: 71 General News By: Ken Baxter Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: A good idea, now for some careful handling

AUTHOR: Ken Baxter

Prime Minister Kevin Rudd's proposed health reform plans, which were announced at the National Press Club, involves reducing state Goods and Services Tax revenues in order to fund Australian public hospitals. Not long after the Australian Labor Party won the 2007 federal election, it set up the National Health and Hospitals Review. The National Health and Hospitals Reform Commission Report was presented to the Government last year. The intergenerational reports of the federal Treasury clearly show that health-care costs will continue to rise. Many not-for-profit hospitals are now operated by the Catholic Church. If the Government does not manage to implement the health plan well, then the arising problems may be more severe than those recently seen with the emissions trading scheme and home insulation scheme. Mr Rudd will soon take his plan to the Council of Australian Governments. The Department of the Prime Minister and Cabinet is more likely to succeed at devising and executing the plan than the federal Health Department. Ken Baxter is a director of TFG International. © Media Monitors Pty Ltd 2010

MENTIONS: Council of Australian Governments, Kevin Rudd

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Ref: 65651428 Daily Telegraph Page 1 of 2 04-Mar-2010 Page: 2 Edition Changes - AM Metro (23-30 edition) By: Simon Benson and Sue Dunlevy Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 1078.98 sq.cms Frequency: MTWTFS- PM's health revolution A death knell for small hospitals Reforms to hurt rural and regional Australia

Simon Benson and Sue Dunlevy

NSW Health officials warned that asstateswith money toruntheirvice health advisory chair Dr Steve many as 100 smaller communityhospitals, instead he will directly fundFleckhoe fears for the future of 44 hospitals may becomefinanciallythe local hospital networks, boostinghospitals in his western NSW region. unviable under a new payment-per-theCommonwealth'ssharefrom "I am absolutely sure that the small service model unveiledinPrime35 per cent to 60 per cent. hospitals ... could not possibly fit into MinisterKevinRudd'shospital The new funding system will re-a casemixed model," he said. "It reform plan yesterday. move the current caps placed onworries the heck out of me. The worry Professor Bob Farnsworth, chair ofhospital budgets. A price will be set forwas always that an efficiency model the Sydney Illawarra Area Healtheach service, with the Federal Gov-would be applied that didn't take into Service's health advisory council, saidernment paying 60 per cent of that. account other circumstances." Mr Rudd's reforms were "appalling" This price will cover the "efficient" Mr Rudd's office said the reforms and "potentially a disaster" for NSW.cost of hospital services and stateswould not force any hospitals to close. Itis taking healthcare in NSWsuch as NSW, which provide inef- His office guaranteed that medical back 20 years," said Professor Farns-ficient services, will have to subsidiseservices to regional hospitals in NSW worth, who is also the director ofthose extra costs from state budgets. would be retained and assessed by the surgery at Prince of Wales Hospital. "TheAustralianGovernment'sproposed new independent umpire. "This was a great opportunity todecision to take on the dominant "There will be loadings to recog- come up with a logical, efficient andfunding role for the entire publicnise the needs of people in regional effectivesingle-finding system forhospital system is designed to end theAustralia," a spokesman said. healthcare. Some of our hospitals willblame game, to eliminate waste and to Mr Rudd will also move to take struggle to operate under casemixshoulder the funding burden of theover from the states' primary care funding. All our small regional hos-rapidlyrising healthcostsof theservices, such as community health pitals are very much at risk." future," Mr Rudd said yesterday. centres, mother and baby clinics, drug Senior NSW Government sources Senior NSW Government sourcesand alcohol services and community said as many as 100 regional and ruralsaid the plan would not put any morebased mental health services. hospitals could become unviable. money into the health system. The changes will start to be intro- Under what Mr Rudd described as They said the 100 hospitals acrossduced in 2011 but voters will have to thebiggestchange toAustralianregional and rural NSW would bere-elect Mr Rudd twice before the healthcare since Medicare, the Fed-financially unviable under the case-new system takes full effect in 2013-14. eral Government will become themix system, which allocated funding "There is a lot in these proposals major funder of hospitalservices,on a per-procedure basis, because thethat has the potential to significantly which will be run by local managers. volume of medical proceduresinimprove our hospital services," said The Commonwealth will take $90small hospitals was too low. Australian Medical Association presi- billion over five years $50 billion "The State Government will havedent Andrew Pesce, but he said NSW over the first three in GST revenueto make a decision as to whether ithospitals might lose if the payment- from the states to fund a new Nationalcan continue to subsidise these hos-per-service system did not take into Health and Hospital network. pitals or close them," they said. account care and training costs. Mr Rudd will no longer provide Greater Western Area Health Ser-

Copyright Agency Limited (CAL) licenced copy Ref: 65651835 Daily Telegraph Page 2 of 2 04-Mar-2010 Page: 2 Edition Changes - AM Metro (23-30 edition) By: Simon Benson and Sue Dunlevy Region: Sydney Circulation: 359171 Type: Capital City Daily Size: 1078.98 sq.cms Frequency: MTWTFS-

The cost of your health care Why an operation in NSW costs so much more JUST some of the $200,000 needed to pay for a basic operation in a NSW hospital. From Aiyesthetbt $1.80 for a scalpel and $700 for an average Theatre Hot rohtw $60/hr theatre staff to $2.10 for each glove and $50,000 ...... $100,000 for a ventilator, the cost soon adds up. Yet south of the border in Victoria, the Sail" same operation is 10 per cent cheaper. $1.60/litre same nperatlon Is 10 per cent cheaper. Surye.ns spe lallst $180/hr $200/hr lotr.oeaces puny plus stmd $6000

Gloves $2.10 Ipe,pperson)

Ventllater $100,000

Theatre had $10,000

Copyright Agency Limited (CAL) licenced copy Ref: 65651835 Summaries - Australian Financial Review 04-Mar-2010 Page: 70 Editorials Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Health reform all about detail

AUTHOR: none

Reform of health is the most difficult area a Federal Government can become involved in, and Prime Minister Kevin Rudd's proposals, which follow the report of the National Health and Hospitals Reform Commission and were announced yesterday, deserve serious consideration. Although they contain worthy first steps towards proper reform, there remain many gaps, and there are also concerns that the reforms are being foisted on the states by the Prime Minister rather than seen as a joint venture through the Council of Australian Governments. © Media Monitors Pty Ltd 2010

MENTIONS: Council of Australian Governments, Kevin Rudd

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Ref: 65651991 Northern Territory News 04-Mar-2010 Page: 15 General News Region: Darwin Circulation: 20553 Type: Capital City Daily Size: 185.65 sq.cms Frequency: MTWTFS Rudd pitches health plan CANBERRA: Kevin Rudd And the Prime Minister sig- difference any time soon," lie has told Australians he'll nalled he would take on the said yesterday. make it easier for them to states and territories,if "This is really a fix for the necessary, to get his way. election,it'snot a fixfor see a GP or get into hospital public hospitals." - but it'll be two elections But the states are unlikely to In a move described as the before they find out if they be his only obstacle. biggest reform since Medicare, can take him at his word. The seismic shift in hospital the Rudd Government will In a pitch to voters that puts funding arrangements will re- snatch back $50 billion in GST health at the centre of the next quire legislative approval and federalelection,the Rudd theCoalitionisshowing revenue from the states to Government is promising to no signs of being willing to redirect to the National Health fix the shambles that is the play ball. and Hospital Network. current state-run public hos- Opposition Leader Tony In return,theconmmon- pital system. Abbott warned all Labor wealth will fund 60 per cent of "Starting today, the Austral- was offering was a fix for hospital services - up from 35 ian Government will build a the election. per cent - and take over full new National Health and Hos- "I don't think any patients financial and policy responsib- pital Network to deliver better ility for general practice and are going to notice any differ- primary care. health and better hospitals to ence any time soon and I don't allAustralians," Mr Rudd Mr Rudd said the current (pictured) said yesterday. think any of the doctors or arrangements werelikea nurses are going to notice any blank cheque to the states.

Copyright Agency Limited (CAL) licenced copy Ref: 65643453 Summaries - Australian Financial Review 04-Mar-2010 Page: 13 General News By: John Kehoe Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Emphasis on stronger federal tax bases

AUTHOR: John Kehoe

Prime Minister Kevin Rudd is positioning his plan to fund the health system by a carve-up the goods and services tax as a serious micro-economic reform. Additionally, the Ken Henry-chaired review of taxation is expected to recommend a number of state taxes be axed and replaced with other sources for revenue. Last year, Dr Henry said such a position was closely aligned with a National Health and Hospitals Reform Commission report. © Media Monitors Pty Ltd 2010

MENTIONS: Kevin Rudd, Ken Henry, National Health and Hospitals Reform Commission

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Ref: 65652726 Canberra Times Page 1 of 2 04-Mar-2010 Page: 1 General News By: Ross Peake Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 554.58 sq.cms Frequency: MTWTFS-

Copyright Agency Limited (CAL) licenced copy Ref: 65645101 Canberra Times Page 2 of 2 04-Mar-2010 Page: 1 General News By: Ross Peake Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 554.58 sq.cms Frequency: MTWTFS-

Copyright Agency Limited (CAL) licenced copy Ref: 65645101 Canberra Times 04-Mar-2010 Page: 1 General News By: Danielle Cronin Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 132.16 sq.cms Frequency: MTWTFS- Rushing in where patients lust wanta bed

Analysis Danielle Cronin

Prime Minister Kevin Rudd explain- address to the National Press Club as times, satety and follow-up care. the ed his reform agenda by asking he shared plans for the "most signifi- Prime Minister's plan unveiled yes- Australians to tap into their imagin- cant reform"tothe health andterday only sets the framework for atLo n. hospital system since the introduc- addressing these issues rather than He cited the circumstances of a tion of Medicare about 30 years ago. tackling them. 67-year-old man who is retired, lives Itis a bold plan involving the This work is still to come. Mr Rudd in the outskirts of a major city andCommonwealth shouldering most of stressed "further initiatives must also needs a hip replacement. He will livethe financial responsibility for public be embraced in the future". with "pain, poor mobility and having hospitals that will be run by local There is the lack of hospital beds to rely on his wife to get around" as hospital networks - code for boards. that can trigger a blow-otit in waiting he spends 12 months on the waiting Statesandterritorieswillbe times for emergency treatment and list for surgery. sidelined in the decision-making and elective surgery. He compared this man's predica- the day-to-day running of hospitals. There are to be further reforms to ment with the plight of a 45-year-old It'sa radical departure from the expand primary care, deal with the woman - in another capital city - existing system. shortage of doctors and nurses, roll- who needs the same operation but Butthe67-year-old man andout electronic health records and on will only wait five weeks. 45-year-old woman, who need hipdental care, mental health services, "Two different people, both inreplacements, are unlikely to care aged care and preventive health care. capital cities - but very different who funds and runs hospitals. Tackling these challenges can ease standards of care," Mr Rudd said in They are concerned about waitingthe strain on public hospitals.

Copyright Agency Limited (CAL) licenced copy Ref: 65645102 Canberra Times 04-Mar-2010 Page: 4 General News Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 93.62 sq.cms Frequency: MTWTFS- t_.nanges mean new role for GST

FUNDING CHALLENGE

Prune Minister Kevin Rudd has labelled it the biggest shake-up in the health system in three decades. Butitalsomarks thebiggest change in the 10-year history of the GST. Mr Rudd plans from 2013-14 to redirect a third of GST revenue - about $15 billion under current annual assumptions - directly into his National Health and Hospital Net- work announced yesterday. "This is a comprehensive package thatIwill put to the states and territories at COAG [Council of Aust- ralian Governments] on April 11," Mr Rudd said yesterday. It will be an interesting meeting. Currently all GST revenue is collected by the Commonwealth and distributed tothe states and territories, and it is up to the separate entities how they spend the money - on health or otherwise. Under Mr Rudd's plan, the states would effectively get the same GST money, but a third would go directly into health. The independent Commonwealth GrantsCommission recommends how the GST revenue pie is sliced up among the states. The 10 per cent consumption tax, introduced in July 2000, was created to replace wholesale and certain state taxes. The rate of GST has not changed since then, needing the go-ahead of all states and territories under an inter-governmental agreement, and a change of law at the federal level. But the same rule applies to any change to how the GST is distributed, unless of course Mr Rudd decides to takethepoliticallyunpalatable approach of bypassing the states, but such action would probably face a hostile Senate. AAP

Copyright Agency Limited (CAL) licenced copy Ref: 65645519 Canberra Times Page 1 of 2 04-Mar-2010 Page: 4 General News By: Natasha Rudra Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 682.24 sq.cms Frequency: MTWTFS- Groups wait for `devil in the detail' REACTION

By Natasha Rudra ACT Health Minister Katy Gallagher responsibility for 60 per cent soundswork now shifts to the states, and the isunconvinced theterritorywill good on the surface and then youclinical leaders who'll be expected to benefit from extra funding under thelook at that's just a reallocation oftake responsibility for implementing Federal Government's hospital re- existing money that's already coiningthe reforms," lie said. forms. tothe ACT," shesaid. "So my AustralianMedicalAssociation The $30.9 billion package has been immediate concern is that it's notpresident Andrew Pesce said the mostly welcomed by doctors' groups any additional resources for healthchanges would helpreducethe and the health-care lobby, whichwhich is certainly something which blame game over health care. have asked for more detail on thewe think is needed. Now I'm not ''[Bttt]itwill be importantto plans. saying that you shouldn't go downensure that the end result of the full Ms Gallagher accepted that natio- that path or that it's not the right waypackage of reforms leads to more nal reform was needed and the togo,but I'msaying thattheoverall resources in the health sys- growing need for health-care fundingjurisdictions will have to look at verytem and that hospital funding is had a big impact on the ACT budget. closely before they say `No worries'."unrestrained by artificial caps." "It's already at 30 per cent, it won't Former federalhealthminister The Australian Nursing Federation take long to get Neal Blewett, who helped introducesaid the reforms would snake the to 40 per cent Medicare, said he had argued for ahealth system more responsive and and then it will similar system 10 years ago. accountable. But business groups get to 50 per cent "Of course with all these things thewarned that the reforms should not and you know devil is in the details. One of the biglead to increases in tax. thatisunsu- issues remains in a sense how far you Australian Chamber of Commerce stainable,"she have a single central fonder. As Iand Industry chief executive Peter said. understand from what he said it'sAnderson said raising tax to fund But shesaid stilla 60-40 division on hospital services would damage the economy. the ACT Govern- costs. And Fin not sure therefore one "We should looktofiend our ment currently has got away from the buck-passing, current and future health needs funded70per CAUTIOUS: ACT state-Commonwealth conflict," Drthrough revenues from a growing cent of hospital Health Minister Blewett said. economy, through incentives for pri- costs while the Katy Gallagher. The director of the Menzies Centre vate coverage and through efficien- Commonwealth for Health Policy, health-care expertcies in service delivery and reduced paid for 30 per cent, up from aRobert Wells,said the plan was duplication in the public and private previous 50-50 split in funding. positive. systems." "The fact thatthey'lltake on "The onus for making the reform

Copyright Agency Limited (CAL) licenced copy Ref: 65645524 Canberra Times Page 2 of 2 04-Mar-2010 Page: 4 General News By: Natasha Rudra Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 682.24 sq.cms Frequency: MTWTFS- THE NATIONAL HEALTH AND HOSPITALS NETWORK INVOLVES SEVEN MAJOR REFORMS ...... Federal Government's hospital funding will almost double from 35 per cent to 60 per cent - an extra $11 billion annually from next year. It will permanently fund 60 per cent of the "efficient price" of every public hospital service, 60 per cent of on-going bill for research and training in public hospitals and 60 per cent of capital expenditure. Eventually, Commonwealth will pay up to 100 per cent of the "efficient price" of primary care...... 2 The Federal Government will take full funding responsibility for all GP services provided outside hospitals...... One-third of GST revenue will flow directly into a new National Hospitals Fund. These funds - about $90 billion over the first five years - will be quarantined for investment in hospitals. Likely to cost federal budget extra $15 billion over a decade, a bill otherwise paid by states and territories...... 4 The Federal Government will develop national standards for patient care and publish performance statistics for the nation's hospitals - using its financial clout to improve care. There will be nationally consistent standards for emergency departments and elective surgery. Australians will also access to information about how hospitals and health providers are performing - the hospital equivalent of the My Schools website...... Local Hospitals Networks established and 5be run byhealth, financial and managerial experts rather than bureaucrats. Each network will be in charge of a small group of hospitals, managing the budgets, delivering coordinated patient care and being accountable for performance. Local Hospital Networks will have Governing Council. 6 Commonwealth directly pays Local Hospital Networks for each service provided to patients rather than providing block funding to the states and territories...... Federal Government will take the dominant 7role in funding future growth in the system and plans to outline core initiatives on such issues as hospital bed numbers, elective surgery and sub-acute care as well as doctor shortages.

Copyright Agency Limited (CAL) licenced copy Ref: 65645524 Summaries - Australian Financial Review 04-Mar-2010 Page: 12 General News By: Laura Tingle Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Scheme is high risk, high reward

AUTHOR: Laura Tingle

It appears hard to fault the politics of Kevin Rudd’s health and hospital reform plan. The offer to the states has an irresistible quality and a ruthless edge to the way it focuses on the devolution of hospital management to a local level that affects the chances Tony Abbott has on product differentiation over health. If everything goes the Prime Minister’s way on this reform in the next month or so, his proposed reforms would represent a profound reform to the efficiency of the health system, and a micro-economic benefit in the economy. This would lay the groundwork for Labor to dominate an election on the comfortable ground of health. However, to get the plan into place needs an amendment of federal GST legislation with potential further consequences and reforms need a re-writing of the current intergovernmental agreement on the GST and the commonwealth-state health agreement. The government has to beat off charges by the opposition that it is simply another level of bureaucracy. And all needs to be achieved quickly within months in an election year. It also requires agreement in principle when the states and territories meet at the Council of Australian Governments next month. © Media Monitors Pty Ltd 2010

MENTIONS: Council of Australian Governments, Kevin Rudd

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Ref: 65653007 West Australian 04-Mar-2010 Page: 1 General News By: Andrew Probyn Region: Perth Circulation: 188211 Type: Capital City Daily Size: 243.21 sq.cms Frequency: MTWTFS- Rudd's huge health gamble

ANDREW PROBYN

Kevin Rudd has staked his politicaltals Networks would be authorities es-insisted the requirement for the States future on the biggest change to thetablished under State law, they wouldto give up one-third of its GST reve- health system since the introductionbe funded directly by the Federalnue for a national funding pool was of Medicare, promising to give everyGovernment and be charged withflawed. Australian faster and better medicalmeeting national standards on emer- "That's a sleight of hand - this is treatment. gency department and elective sur-State funds to achieve a Common- But the Prime Minister's ambitiousgery waiting times, infection rates andwealth objective," he said. plan to take majority funding respon-patient care. Without every Premier's consent, sibility for the nation's 750 public hos- Australians would be able to seethe Commonwealth cannot change the pitals will face fierce resistance fromhow their local hospital measures up,1999 agreement that sees all GST rev- the States, which will have to surren-with performance statistics to be pub-enue flowingtotheStates and der one-third of their GST revenue. lished on a website similar to the pop-Territories. The PM said if he could not con-ular My School site. The Australian Medical Association vince Premiers to back the idea he Mr Rudd intends starting the tran-offeredin-principlesupportand would take it to the people via a refe-sition to the new hospital funding sys-urged the States to carefully consider rendum at the next election. tem next year, meaning he not onlyit. "The 60-40 funding split and the Under the proposal, the Federalneeds agreement from each State butCommonwealth's 100 per cent fund- Government would pay 60 per cent ofmust negotiate passage of legislationing responsibility for outpatients and public hospital costs - up from thethrough a potentially hostile Senate. primary care has the potential to min- existing 35 per cent - and 100 per Premiers have been summoned toimise the opportunities for blame and cent of GP services and primary care.Canberra for a meeting on April 11 tocost-shifting," AMA president State health bureaucracies would bediscuss his plan but there are alreadyAndrew Pesce said. collapsed, with local doctors, nursessigns of significant State disquiet. Shadow health minister Peter but- and financial experts put in charge of WA Premier Colin Barnett said heton said the plan was a mere "election running groups of hospitals. was prepared to consider the changesfix", not a fix for hospitals, and would While these so-called Local Hospi-if they improved patient care butonly entrench a new bureaucracy.

Copyright Agency Limited (CAL) licenced copy Ref: 65645535 Summaries - Australian Financial Review 04-Mar-2010 Page: 13 General News By: Khia Mercer Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Costs worry private providers

AUTHOR: Khia Mercer

Listed hospital operators have said the Federal Government’s plan for the creation of a national hospital network would not affect the number of patients in private hospitals, while private insurers have expressed concerns over cost pressures. Healthscope’s Bruce Dixon said the plan would not reduce hospital waiting lists, while NIB’s Mark Fitzgibbon said it was a shame that the government did not have a better look at the option of Medicare Select given the positive evidence from countries such as the Netherlands. Elsewhere, Ramsay Health Care’s Christopher Rex said Prime Minister Kevin Rudd’s next challenge would be convincing the states to forego GST revenue, while iSOFT’s Gary Cohen said IT providers were disappointed at the government’s lack of vision and drive for an electronic health strategy. © Media Monitors Pty Ltd 2010

MENTIONS: Federal Government, Healthscope, NIB, Medicare Select, Ramsay Health Care, iSOFT

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Ref: 65653093 West Australian Page 1 of 2 04-Mar-2010 Page: 6 General News By: CATHY O LEARY and DANIEL EMERSON Region: Perth Circulation: 188211 Type: Capital City Daily Size: 426.57 sq.cms Frequency: MTWTFS- Mixed reaction to health plan

CATHY O'LEARY and DANIEL EMERSON

The health reform blueprint has beenvered locally, and doctors will hewhether the proposed changes were labelled a "sleight of hand" by theinvolved, so on the face of it there willgood for patients in public hospitals State Government as it faces the pros-be less bureaucracy." and was quick to accuse the Common- pect of a smaller share of GST revenue CurtinUniversityprofessorofwealth of taking money from the but several interest groups in WA havehealth policy Mike Daube said theStates to prop up its reforms. given it cautious support. plan had an ambitious time line and Health Minister Kim Hames said While many argue the devil will bewas likely to see the WA Healthhe backed the plan's "activity-based in the detail, a proposal for local hos-Department's headquarters shrink. funding" provision, whereby the pool pital networks has already curried "This looks like a very carefullyof funds would be used to pay for indi- favour with critics such as the Austra-crafted package to address the com-vidual procedures rather than fund- lian Medical Association, which hadmunity's concerns and it will meaning being distributed in big blocks. previously raised concerns the Ruddmajor changes to the way our health "We are prepared to go through the plans would see the country's hospitalsystems are overseen," he said. detail, we are prepared to co-operate system run from Canberra. "There will clearly be importantprovided the outcome for WA is AMA WA president Gary Geelhoedissues to address for a State like WA,improved healthcare," he said. Oppo- said the plan went a long way to pro-where the main hospitals are so closesition Leader Eric Ripper said the viding a single funding provider whileand there are special rural and remoteplan should be examined closely. having regional boards that providedneeds, so the format for local health some community input, and togethernetworks may need to be different they could improve how hospitalsfrom that in other States." were run. Health Consumers Council execu- "There is still a place for the State,tive director Michele Kosky said she and the success of it will be to try towelcomed plans for local hospital net- negotiate a balance between State andworks and said the reforms could help Federal responsibilities so we don'tto integrate primary health care with have the bunfights of the past,"hospital services in a way Australia Professor Geelhoed said. had not seen before. "But we like the fact it will be deli- But Premier Colin Barnett said the Government would have to weigh up

THE PLAN

Federal Government to assume - will be established to run Hospitals will be rewarded for 60 per cent funding of public hospitals efficiency and meeting targets hospitals Networks will be paid for each Commonwealth to take full This will cost an extra $30.9 service or procedure they funding responsibility for GP billion over four years which will perform and primary care, helping take be stripped from the States' If a network cannot find a bed, pressure off hospitals GST revenue it will pay to have patients No overall increase in Local Hospital Networks - treated at private hospitals bureaucracy groups of up to four hospitals

Copyright Agency Limited (CAL) licenced copy Ref: 65645780 West Australian Page 2 of 2 04-Mar-2010 Page: 6 General News By: CATHY O LEARY and DANIEL EMERSON Region: Perth Circulation: 188211 Type: Capital City Daily Size: 426.57 sq.cms Frequency: MTWTFS-

i i% I ad l I 9 1

Cautioussupport:WA AMA president Gary Geelhoed, right, with vice-president DavidMountain. Picture: Nic Ellis

Copyright Agency Limited (CAL) licenced copy Ref: 65645780 West Australian 04-Mar-2010 Page: 6 General News By: Andrew Probyn Region: Perth Circulation: 188211 Type: Capital City Daily Size: 164.04 sq.cms Frequency: MTWTFS- Rudd must push grand idea to dicky knee brigade

ANDREW PRORYN CAL EDITOR CUM viENT

From the perspective of a bloke from Gosnells with a dicky knee awaiting elective surgery, Kevin Rudd's public hospitals plan would be welcome. He Big plans: Kevin Rudd just might get faster and more efficient treatment. there is definitely merit in Mr Rudd's But for the States, the Prime Minis- proposal from the States' perspective. ter's plan is a threat to their autonomy Health costs are growing by 9 to 10 and dilutes their powers. per cent a year but GST revenues by only It would wrest away one-third of the 6 per cent, meaning hospital costs will States' untied GST grants and could, if take more and more of the States' entire accepted, establish a blueprint for fur- revenue base over the coming 35 years, ther Federal incursions on the funding of until it is 100 per cent by 2045. education and other State-run services. By giving the Commonwealth more Premiers, Labor and Liberal, would exposure to the health costs, the States understandably be very cautious before could maintain a presence in healthcare signing an agreement to diminish their much longer without being so vulnera- financial clout permanently. ble to the exploding health dollar. Mr Rudd must harness public support So will these reforms end the blame for his plan from people such as the game in health? Will the buck really stop bloke in Gosnells to counter resistance with Mr Rudd on hospitals, as he has from the States - a sales pitch he could long insisted? not musterforhisthrice-defeated Most probably not. emissions trading scheme. At best, Mr Rudd would only assume The PM has started a hundred con- 60 per cent of the blame with the versations in the past 21/-,years but premiers and State-run local networks finished none of them. This reform, to be apportioned the rest. gigantic as it is, must be a conversation The blame game would undoubtedly he sees to the end. continue but at least the lines of respon- And despite all their chest beating, sibility would be a bit clearer.

Copyright Agency Limited (CAL) licenced copy Ref: 65645781 Canberra Times 04-Mar-2010 Page: 19 General News By: Stephen Leeder Region: Canberra Circulation: 33511 Type: Capital City Daily Size: 299.34 sq.cms Frequency: MTWTFS- Answering hard health questions After years of inquiries and reports it's time for action, STEPHEN LEEDER writes Since the last federal election was on hospitals that he this does not come down to a in 2007, there has been lively concentrated yesterday. It would be referendum: memories of the failed debate about the shape of churlish to expect him to say republic haunt me. By allowing the our future health service. anything mach about prevention states and territories a continuing Kevin Rudd came to power and the promotion of health one third share in the financing of promising that hospitals would be yesterday: his focus was correct. public hospitals, Rudd has played a different. But as Barack Obatna has However, in the next instalment of clever card that may pave the way to discovered, health is the carrier of the health reform agenda, we might peaceful negotiations. the most complicated of all political well ask for more details on these Second, a huge amount of work- freight, a "strife of interests important topics as well. perhaps as judged from other masquerading as a contest of Rudd also proposed the countries that have reformed their principles" to use US satirist formation of small local hospital health systems - we are in for a Ambrose Bierce's definition of networks. I have mixed views about decade of change and the politics in general. these as they stand, while believing discomfort that goes with it. A Since the election, beginning with firmly that we should always change of government in the middle the gala days of the 2020 Summit devolve to the smallest effective of it may prove to be problematic, (where health was one among 10 administrative unit that can and there are serious risks that we principal agenda items) , health has respond to the comnrtinity. But should take into account. By been subjected to more from my experience in NSW, I fear committing himself to a change, in pummelling, interrogation, Rudd's networks maybe too small. his terms, as large as Medicare, diagnostic tests, and general In NSW, the previous (not the Rudd has stepped back from working over than a patient with ill- current) Area Health Services incremental shifts. Reflect on the defined abdominal pain. The provided care for about 500,000 history of Medibank, then of National Health and Hospitals people. They included hospitals and Medicare, to see how long Reform Commission and the to an extent community, though not revolutionary change in health care Preventative Health Taskforce, set general practice which was a great takes to stabilise. Of course, Rudd tip by the Prime Minister, both defect of the split in funding may be engaging in rhetoric and reported last year, providing between Commonwealth and state. perhaps the noise of clashing comprehensive analyses of the Each was served by a board, some tectonic plates is simply for effect. hospital, community and working better than others, but But in any case, an era of change has prevention elements of the health where the voice of the health been signalled, the battle for better system. These were attended with professionals and local community health care joined. wide consultation. We do not lack could be heard. They were large Third, real efficiency gains, of any longer for diagnostics. The enough not to become concerned which we are in desperate need in question is now what do we do? with details of the parish pump. The the health system will come only Yesterday, Kevin Rudd reinstitution of single hospital when we start abandoning forms of announced the first steps, in boards, as advocated by some, care that have no or even negative governance and finance, of a would be serious regression in lily yield in life expectancy and quality. reformed national system of opinion. The Rudd hospital We must begin measuring the publicly funded health care. He networks hover perilously close to outcome of what we do and not proposed that the Commonwealth those hospital boards. After all we simply measuring its quantity. increase its current contribution of are talking these days, loudly and Reimbursement of activity in health one-third of the costs of public clearly, about the need for system makes sense if, and only if, hospitals to two-thirds, giving it integrated hospital and community what is being reimbursed works well more say in how they are run, and care. There are large and small and is good value. proposed the formation of networks hospitals and many types of We need much more detail from of public hospitals, linked to community services, and linking Rudd on how lie will achieve real community services. these together is no trivial logistic efficiency gains in his reformed The formation of an Australian challenge. health system. Health and Hospital Network, What might we look for from this which would oversee the dispersal point? First, there will be much Professor Leeder is director of Menzies of funds, including a third of GST diplomatic horse-trading to Twin Centre for Health Policy, a joint venture clawed back from the states and agreement from the states and between The Australian National territories, was the centrepiece of territories to the concept of the University and the University of Sydney. his proposal. His pre-election Australian Health and Hospital promise was to fix hospitals and it Network. I would sincerely hope

Copyright Agency Limited (CAL) licenced copy Ref: 65645810 West Australian 04-Mar-2010 Page: 7 General News By: Andrew Tillett Region: Perth Circulation: 188211 Type: Capital City Daily Size: 206.13 sq.cms BenchmarksFrequency: MTWTFS- and price umpire key tosuccess

ANDREW TILLETT the rest of the bill, giving them incentive to cut waste. The Commonwealth would also use Kevin Rudd's fix for public hospitals its added funding clout to establish revolves around asix-pointplan safety and performance benchmarks aimed at relieving the States of their for hospitals to meet such as reducing ballooning health costs while driving infection rates and adverse events, and down the bill for medical care. cutting emergency department and Mr Rudd wants to strip $30.9 bil- surgerywaitingtimes.Hospitals lion from the States' GST collection which did well would get extra cash - about a third of GST revenue - while poor performers could face and put that money into new local penalties and see managers sacked. hospital networks, lifting the Federal With the State health departments share of hospital funding to 60 per bypassed, Mr Rudd plans to direct the cent. Federal cash into local hospital net- Under the plan, the Common- works, made up of a major hospital wealth will fund 60 per cent of the such as Sir Charles Gairdner and two "efficient price" for every public hos- or three neighbouring suburban hospital service or treatment, as well as pitals such as Osborne Park. Each net- up to 100 per cent of the cost of some work's hospitals would co-ordinate outpatient treatments. and plan care, instead of competing As an extra sweetener for the States for resources and duplicating servic- to back the deal, the Commonwealth es. If a bed was unavailable, the net- will pick up 60 per cent of hospitals' work would pay for the patient to go infrastructure costs, as well as spend- to a private hospital. ing on research and training. Shifting Another way the Commonwealth to activity-based funding means pay- wants to cut spending is to take over ing hospitals per treatment, instead of responsibility for GP and primary doling out cash to States and then health care services, which would cost expecting them to resource hospitals the States another $18.7 billion in properly. GST. An independent umpire would set The Governmentbelievesthis the national efficient prices, taking would keep people out of hospital by into account factors such as remote- better co-ordinating care between ness and complexity of patients' different health professionals. needs. Under such a pricing regime, Mr Rudd said one in 10 hospital for example, the Federal payment for admissions - 441,000 last year - a knee replacement in Perth would be could have been avoided by enhancing the same for Sydney. States would foot care in the community.

Copyright Agency Limited (CAL) licenced copy Ref: 65645820 Summaries - Australian Financial Review 04-Mar-2010 Page: 14 General News By: Lisa Murray, Mark Ludlow, Mathew Dunckley and Jona Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Wary of 'diabolically clever' money grab

AUTHOR: Lisa Murray, Mark Ludlow, Mathew Dunckley and Jonathan Barrett

Prime Minister Kevin Rudd yesterday said that he held some dynamic talks with state counterparts over the Federal Government's proposal to withhold 33 percent of Goods and Services Tax revenue, to boost the Commonwealth's share of public hospital funding from 35 to 60 percent. New South Wales Deputy Premier Carmel Tebbutt says that her state will seek reassurance on the extra funding. Victorian Health Minister Daniel Andrews says that health reforms need to be about more money. West Australia's Liberal Premier, Colin Barnett, says the concept of a national pool has some merit, while WA Treasurer Troy Buswell this week ruled out co-operation. NSW currently has eight Area Health Services, but under Mr Rudd's plan the bodies would be replaced by more local hospital networks. Queensland Health Minister Paul Lucas says that he is worried about specialist out-patent care. South Australian Premier Mike Rann says he is willing to strongly support the reforms. Discussions will be held over the proposal at the April Council of Australian Governments meeting. © Media Monitors Pty Ltd 2010

MENTIONS: Council of Australian Governments, Kevin Rudd

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Ref: 65653551 Summaries - Australian Financial Review 04-Mar-2010 Page: 13 General News By: John Breusch Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: First steps on longer route to reform

AUTHOR: John Breusch

Prime Minister Kevin Rudd’s proposal to devolve the management of public hospital to the local level has been welcomed by health experts, although they warn that further reforms are needed for the improvement of co-ordination with primary care. PricewaterhouseCoopers’ Mary Foley has warned of networks becoming too big leading to an overly bureaucratic structure, while the Australian General Practice’s Emil Djakic said for reform to be implemented correctly, there needed to be a more equitable relationship between the primary health care sector and the hospital sector. Elsewhere, Ernst & Young’s Jim Birch said: “if the pricing signals support hospitals more than community-based care, you don’t achieve the outcome of the reforms.” © Media Monitors Pty Ltd 2010

MENTIONS: Kevin Rudd, PricewaterhouseCoopers, Australian General Practice, Ernst & Young

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Ref: 65653651 West Australian 04-Mar-2010 Page: 22 Editorials Region: Perth Circulation: 188211 Type: Capital City Daily Size: 191.01 sq.cms Frequency: MTWTFS- Good reason to bewaryof Rudd health reform West Australians would do well tocarve-up issue, there will be suspicion that more treat Kevin Rudd's plan for a revenue generated in WA will be siphoned off to Federal takeover of hospital prop up States with less capacity to generate an funding warily. This State has aincome. history of financial raw deals Of course, the States could well be happy to from Canberra, the latest episode coming just handpass to the Federal Government some of the last week when changes to the way GST fundingheavy burden of their spiralling health budgets, is carved up cost WA $223 million. which are growing at 9-10 per cent a year. WA is Premier Colin Barnett's cautious response to a prime example of how health spending takes on the Prime Minister's plan yesterday suggests thisa life of its own, with a blowout of $250 million concern was foremost in his mind. Mr Barnett in its budget this financial year. doesn't need us to remind him not to trust There is merit in the idea of a central pool of Canberra. But he is sensible to take a conciliatoryfunding to be handed directly to local hospital approach in this case and to consider the management but not if we end up with another proposal carefully. layer of unwieldy health bureaucracy as a result. Mr Rudd promised yesterday that no State In fact, for the Rudd plan to work, State health would be worse off in the short term and that alldepartments will need to be cut because part of would benefit in the medium term under his their work will be done in Canberra. plan to take control of funding 60 per cent of all Ultimately, the decision on overhauling the services in public hospitals. Canberra would clawhealth system must be made on the basis of what back one-third of GST revenue from the States is best for patients, not for the political interests to put into a new national hospital fund. of any State or Federal government. Mr Rudd needs the support of all States and Although there is still considerable doubt Territories to put his proposal into effect. about the proposition, if hospital services can be WA, in particular, will need solid guarantees delivered cheaper and more effectively from that its revenue will not be affected by a shift to aCanberra, it makes sense for the States to cede more centralised system. In the light of the GSTcontrol.

Copyright Agency Limited (CAL) licenced copy Ref: 65647323 Summaries - Australian Financial Review 04-Mar-2010 Page: 12 General News By: John Breusch Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Reform will take the heat off Canberra

AUTHOR: John Breusch

While Prime Minister Kevin Rudd’s health reform blueprint is not likely to end the blame game, it will redirect responsibility in a way that benefits the commonwealth and not anyone else. The commonwealth currently helps fund public hospitals by giving money to the states that is worth around 40 percent of the cost of running those facilities through an agreement that is negotiated every five years. The states operate the hospitals and pay the bills if the commonwealth’s contribution ends up being too small. Under the plan outlined by Mr Rudd, the commonwealth will hold back on about one third of GST revenue and use the money to increase its share of hospital funding to 60 percent of what is called the ‘efficient cost’ of a particular service, while the states pick up the balance. The money goes straight to regional networks comprising between one and four hospitals. If the inevitable scandal hits a hospital it will be the local health network, the board and the CEO that will take the flak, perhaps deflecting some attention away from state health ministers, with Canberra able to argue it is only fulfilling its funding obligations. © Media Monitors Pty Ltd 2010

MENTIONS: Kevin Rudd

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Ref: 65653788 Herald Sun Page 1 of 4 04-Mar-2010 Page: 4 General News By: Stephen McMahon Region: Melbourne Circulation: 514000 Type: Capital City Daily Size: 1266.76 sq.cms Frequency: MTWTFS- health plan Show us the money, Victoria tells PM The benefit to Victoria's healthRoyal Children's Hospital -would budget would gradually grow toit be funded as it was, or would it $1.2billion,but not for a decade. have to compete against children's Stephen McMahon hospitals across Australia?" Mr Andrews said that if the AMA Victoria president Dr state politics editor Commonwealth provided an extra $1 billion a yearnow,VictoriaHarry Hemley said the federal STATE Health Minister Danielcould almost double its capacityplan took with one hand and gave Andrews says the federal health for elective surgery and build twoback with the other. reform plan short-changes "In Victoria alone, we need Victorian patients. hospitals in regional and outeranother 600 hospital beds; we also The proposal was all aboutsuburban areas every year. need another 187 each year to administrativereform,but he said "Our test has always been moremanage population growth. That "health reforms need to be about money to treat more patients andneeds extra funding now," he said. more money" so more patientsto treat themfaster,"he said. "Other stateswillsee more were able to receive the necessary "And we will continue to fightchanges. We already have case- treatment more quickly. to get that." mix; we already have local boards. Victoria remained $1 billion a He said the data showed Vic- "We need to ensure that we year out of pocket since the blow-toria had the best-performingprotect existing innovation in out in the 50-50 split in state andhealth system, and only extraVictoria and drive reform." Commonwealth funding, he said. cash would improve hospitals. Dr Hemley also questioned Under theplan,the FederalBut the state might lose outwhether patients would be better Government would contribute under a federal model. off in the long run. 60 per cent of all costs, up from "I wouldn't want to see (us) "Doctors were hoping that its current 35 per cent. But Mrunder a national scheme withhealth reform might involve Andrews said there'd be no moreVictoria's capital works programpatient care, rather than just having to compete against those governments'funding arrange- money for Victorian patientsof other states," Mr Andrews said. until2014,and even then it ments." he said. would be less than $200 million. "For instance, the $1 billion

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ji l l ' 1 fill Imil FEDERAL GOVERNMENT WILL: ED MANAGE local health networks, WHAT'S IN IT FOR PATIENTS? determining the volume and mix of ED INCREASE its share of public hospital services provided ED THE plan, which is yet to be fully running costs from 35 to 60 per cent revealed, will aim to keep people out of 0 HAVE to agree to change the GST iD PAY 60 per cent of public hospital agreement with the Commonwealth hospital by keeping them healthy and infrastructure costs treating them at GPs and community ED PAY 100 per cent of out-of-hospital health services health services, including GPs, WHERE WILL THE MONEY GO? outpatient services, community health, ED PEOPLE who need an operation or ID IN the first three years the Federal emergency treatment should get it faster allied health, alcohol and drug, and Government will claw back $50 billion in mental health services GST revenue because hospitals will be better funded and have shorter waiting lists ID REWRITE the GST agreement, ED THE money will go to public hospitals withholding 33 per cent of GST revenue ($30.9 billion) and out-of-hospitals from the states services ($18.7 billion) KEY HEALTH FACTS: ID PAY local hospital networks directly ED THERE will be no net financial gain based on "efficient" per-patient costs for the states until 2013-14. That's when C PUBLIC hospital spending is rising by for each service the Federal Government starts paying about 10 per cent a year ED HAVE a referendum if the states the lion's share of rising health costs, refuse to agree to the plan which are increasing much faster than 0 ABOUT 23 per cent of Australians will their GST revenue stream be aged over 65 by 2050 - up from 14 0 THE states will get an extra per cent today STATE GOVERNMENTS WILL: $15 billion towards health services ED ONE-in-six elective surgery patients PAY 40 per cent of hospital costs over a decade and one-in-three emergency patients ENSURE services are delivered ED VICTORIA will reap an extra have to wait longer than recommended efficiently, or they will pay 100 per cent $100 million from 2014-15, rising to of the cost blow-out about $1.2 billion in 2019-20

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Joan Maple, 84 of Mount Martha. Has been waiting for a knee replacement for two years.

"I HAVE been waiting at least two years to see a doctor and have had problems for three or four years, but my knee just gets worse. I don't know who you blame- it is not the hospital's fault, it is not the doctor's fault, I think it is just the bureaucracy. There are too many bosses and not enough workers, and I don't think they can see the little people for the trees. And I don't know if the Federal Government takeover is good or bad. I think the new plan is right, but I doubt they are capable of delivering it the way they are going at the moment. Frankston Hospital is trying to do a wonderful job, but they just can't handle all the people who need handling. I need a new knee. I have had an assessment from the physiotherapist and every three months I have to fill out a questionnaire to let them know about my condition, but I still haven't even been able to see a doctor. I have just joined a health insurance fund because I just can't wait any longer. I have to wait 12 months before I can have the operation, but I still think it will come around quicker than waiting in the public system."

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Dr Joseph Sgroi, 34, Sunshine Hospital obstetric registrar.

"VICTORIA already has funding being directed to the local hospitals and the Federal Government is going to adopt our model in other states, so I don't think we are going to see much change out of this reform. The concern is that there actually is no additional funding being offered to the states, so we are not going to see any major improvement in the number of beds. We are already short 600 beds in the state. We still have long waits in emergency departments and that won't change as a result of this. The Federal Government is taking control of the money with an aim of providing primary preventive care to prevent people ending up in hospital, and that is a very sound argument. Victorian hospitals in general outperform their counterparts interstate. If performance indicators are put on hospitals and Victorian services are penalised by budget cuts because they overperform, that is when there will be real concerns."

Copyright Agency Limited (CAL) licenced copy Ref: 65648302 Summaries - Australian Financial Review 04-Mar-2010 Page: 14 General News By: Louise Dodson Region: Australia Circulation: 77470 Frequency: MTWTFS-

HEADLINE: Labor hardens spine for health reform

AUTHOR: Louise Dodson

Prime Minister's $90 billion health care system reform is expected to be the largest challenge in Labor's reform agenda since Medicare was introduced 30 years ago. State governments will discuss the proposal at the next Council of Australian Governments meeting in April. Former departmental heads involved in the reforms, Michael Keating and Andrew Podger, say the detail of the reforms will be critical to achieving a successful outcome. There still needs to be an agreement over how Goods and Services Tax funds will be distributed to the states. COAG has explored ways to introduce a single health- funding model since 1995, when Paul Keating was the prime minister. During the 1996 COAG meeting, after John Howard became prime minister, a proposed model was eventually dropped. Mr Rudd appointed Terry Moran as the Victorian head of the Prime Minister's department. © Media Monitors Pty Ltd 2010

MENTIONS: Council of Australian Governments, Medicare

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Ref: 65654273 West Australian 04-Mar-2010 Page: 1 Edition Changes By: Andrew Probyn Region: Perth Circulation: 188211 Type: Capital City Daily Size: 246.76 sq.cms Frequency: MTWTFS- Rudd's huge health gamble

ANDREW PROBYN FLL]LI AL F"ULI I IL:AL t.u!IUI CANBERRA

Kevin Rudd has staked his political networks would be authorities estab- WA Premier Colin Barnett said he future on the biggest change to the lished under State law, they would be was prepared to consider the changes health system since the introduction fundeddirectlybytheFederal if they improved patient care but of Medicare, promising to give every Government and be charged with insisted the requirement for the States Australian faster and better medical meeting national standards on emer- to give up one-third of their GST reve- treatment. gency department and elective sur- nue for a national pool was flawed. But the Prime Minister's ambitious gery waiting times, infection rates and "That's a sleight of hand - this is plan to take majority funding respon- patient care. State funds to achieve a Common- sibility for the nation's 750 public hos- Australians would be able to see wealth objective," he said. pitals will face fierce resistance from how their local hospital measures up, Without every Premier's consent, the States, which will have to surren- with performance statistics to be pub- the Commonwealth cannot change the der one-third of their GST revenue. lished on a website similar to the pop- 1999 agreement that sees all GST rev- The PM said if he could not con- ular My School site. enue flow to the States and Territories. vince Premiers to back the idea he Mr Rudd intends starting the tran- The Australian Medical Association would take it to the people via a refe- sition to the new hospital funding sys- offeredin-principlesupportand rendum at the next election. tem next year, meaning he not only urged the States to consider it care- Under the proposal, the Federal needs agreement from each State but fully. "The 60-40 funding split and the Government would pay 60 per cent of must negotiate passage of legislation Commonwealth's 100 per cent fund- public hospital costs - up from the through a potentially hostile Senate. ing responsibility for outpatients and existing 35 per cent - and 100 per He said yesterday that the current primary care has the potential to min- cent of GP services and primary care. system was a total mess, with too imise the opportunities for blame and State health bureaucracies would much duplication, overlap and waste. cost-shifting," AMA president shrink, with local doctors, nurses and Premiers have been summoned to Andrew Pesce said. financial experts put in charge of run- Canberra for a meeting on April 11 to Shadow health minister Peter but- ning groups of hospitals. discuss his plan but there are already ton said the plan would only entrench While these so-called local hospital signs of significant State disquiet. a new bureaucracy.

Copyright Agency Limited (CAL) licenced copy Ref: 65654534 West Australian Page 1 of 2 04-Mar-2010 Page: 6 Edition Changes By: Cathy O’Leary And Daniel Emerson Region: Perth Circulation: 188211 Type: Capital City Daily Size: 421.20 sq.cms Frequency: MTWTFS- Mixed reaction to health plan

CATHY O'LEARY and DANIEL EMERSON

The health reform blueprint has beenFederal responsibilities so we don'tGovernment would have to weigh up labelled a "sleight of hand" by thehave the bunfights of the past," hewhether the proposed changes were State Government as it faces the pros-said. "But we like the fact it will begood for patients in public hospitals pect of a smaller share of GST revenuedelivered locally and doctors will beand he was quick to accuse the Com- but several interest groups in WA haveinvolved, so on the face of it there willmonwealth of taking money from the given it cautious support. be less bureaucracy." States to prop up its reforms. While many argue the devil will be CurtinUniversityprofessorof Health Minister Kim Hames said in the detail, a proposal for local hos-health policy Mike Daube said thehe backed the plan's "activity-based pital networks has already curriedplan had an ambitious time line andfunding" provision, whereby the pool favour with critics such as the Austra-was likely to see the WA Healthof funds would be used to pay for indi- lian Medical Association, which hadDepartment's headquarters shrink. vidual procedures. previously raised concerns the Rudd "This looks like a very carefully "We are prepared to go through the plans would see the country's hospitalcrafted package to address the com-detail, we are prepared to co-operate system run from Canberra. munity's concerns and it will meanprovided the outcome for WA is AMA WA president Gary Geelhoedmajor changes to the way our healthimproved healthcare," he said. said the plan went a long way to pro-systems are overseen," he said. Opposition Leader Eric Ripper viding a single funding provider while Health Consumers Council execu-said the plan should be examined having regional boards that providedtive director Michele Kosky said sheclosely. some community input, and togetherwelcomed plans for local hospital net- The Victorian Government strong- they could improve how hospitalsworks and said the reforms could helply opposed the plan but most other were run. to integrate primary health care withStates said they would keep an open "There is still a place for the State,hospital services in a way Australiamind, notably the biggest health trou- and the success of it will be to try tohad not seen before. ble spots of NSW and Queensland. negotiate a balance between State and But Premier Colin Barnett said the

Cautioussupport:WA AMA vice-president David Mountain with president GaryGeelhoed. Picture: Nic Ellis

Copyright Agency Limited (CAL) licenced copy Ref: 65654537 West Australian Page 2 of 2 04-Mar-2010 Page: 6 Edition Changes By: Cathy O’Leary And Daniel Emerson Region: Perth Circulation: 188211 Type: Capital City Daily Size: 421.20 sq.cms Frequency: MTWTFS- THE PROPOSAL Federal Government to assume 60 per cent funding of public hospitals This will cost an extra $30.9 billion over four years which will be stripped from the States' GST revenue Local hospital networks - groups of up to four hospitals - will be established to run hospitals Networks will be paid for each service or procedure they perform If a network cannot find a bed, it will pay to have patients treated at private hospitals Hospitals will be rewarded for efficiency and meeting targets Commonwealth to take full funding responsibility for GP and primary care, helping take pressure off hospitals No overall increase in bureaucracy

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HEADLINE: Unions worry about possible job cuts

AUTHOR: Steven Scott

Prime Minister Kevin Rudd, who leads the Rudd government, says he would like to see workers relocated from departmental headquarters, such as New South Wales Health, to regional areas that are closer to hospitals. Community and Public Sector Union joint national secretary David Kerry says the Government's proposal to bypass state bureaucracies could bring job losses. Health Services Unions fears that the reforms will be undermined by job losses. NSW Nurses Association secretary Brett Holmes says that his union will lobby the NSW Government to oppose any job cuts or forced relocations. Australian Nursing Federation secretary Ged Kearney, on the other hand, welcomed the reforms. Federal Treasurer Wayne Swan told Brisbane Radio 4BC that he would examine the reform's implementation on a "network by network" basis. © Media Monitors Pty Ltd 2010

MENTIONS: Nurses Association, Wayne Swan, Kevin Rudd

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Ref: 65654741 Australian 04-Mar-2010 Page: 6 Edition Changes - All-round Metro Region: Australia Circulation: 131246 Type: Australian National Size: 123.03 sq.cms Frequency: MTWTF Less bureaucracy, but 200 new organisations

KEVIN Rudd's pledge to ensure creating the likelihood there planned "Local Hospital would be at least 200 such bodies Networks" will not create more nationwide, each as a state bureaucracy is in question after it statutory body with its own chief emerged that more than 200 of executive and governing council. the new organisations are likely to Health Minister Nicola Roxon spring up nationwide. said last night the government The networks, announced as was committed to appointing no part of the government's proposed extra bureaucrats to the networks, reforms to hospital funding and but some city-based health governance, have been sold as an officials would need to be moved attempt to ensure health services to regional areas. are run locally instead of by Asked yesterday about the impersonal state bureaucrats. potential forjob losses in existing Detailing the proposals in his state bureaucracies, Mr Rudd National Press Club address in accepted this was likely, saying if Canberra yesterday, Mr Rudd said "it means shifting a position from the networks would ensure that if the main street of Sydney to, a patient could not be admitted at frankly, a Local Hospital Network their local hospital, "then the in downtown Port Macquarie, I'll Local Hospital Network will find tell you where I'll be supporting that person a bed at another that's downtown local Port hospital within the networkor Macquarie, and the same right with a private hospital if one can't across the country". readily be found". The network But several health experts would also be more likely to remained concerned at the approve new ways of treating potential for duplication and patients that made sense in a local uncertainty over how decisions area, he said. But experts say the would be made over which proposal raises many troubling hospitals would be singled out to questions, and may even need to receive specialist treatment be rethought, because of the sheer centres that were not cost- number that will be created and a effective at every hospital. The perceived lack of clarity over vital policy document revealed state policy and planning issues. governments would retain some Each network would comprise central planning functions. between one and four hospitals ADAM CRESS`VELL

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KEVIN Rudd has set up a federal would move for a referendum for a trade union officials. election campaign dominated by takeover. Health Minister Nicola Roxon health, unveiling plans to strip the Yesterday, eight months after said last night the health plan states of 30 per cent of their GST the expiry of his self-imposedwould "absolutely" mean no extra receipts to fund a federal takeover deadline, the Prime Minister pro- bureaucrats, although some city- of state-run public hospitals. duced a watered-down proposal based health officials would have The Prime Minister also plans under which the commonwealthto move to the regions to be closer to sideline the states on hospital would fund 60 per cent of the costto local hospitals. administration, instead doling outof public hospital services up The plan also involves the com- tied grants to new local boards from 35 per cent currently. monwealth taking full control of which would deliver services in "People across Australia are fed all aspects of general practitioner accordance with strict require- up with the blame game," Mr Rudd and primary care services conduc- ments set in Canberra. told the National Press Club. ted outside hospitals. The aim is to And Mr Rudd has created the "They are fed up with waste in deliver better out-of-hospital care mechanism to campaign on the the system. They want to see that to ease demand for hospital beds. issue in this year's election, threat- fundamentally so we can get on Mr Rudd said under current ar- ening a referendum if states do not with the business of delivering rangements the commonwealth hand over 30 per cent of their GST better health and better hospitals provided block hospital funding to revenues to bankroll his plan. for all Australians." states, which determined how and The health blueprint, unveiled Under the proposals, the fed- where money was spent. in Canberra yesterday, sparked eral government would bankroll "That is like providing a blank immediate political sparring, with its extra responsibility by seizing cheque," the Prime Minister said. the West Australian Liberal gov- the GST receipts from the states, "Neither the Australian tax- ernment of Colin Barnett ruling which would be left to handlepayer nor the Australian govern- out a handover of GST revenues. 40 per cent of hospital fundingment had any idea where the And while state Labor govern- with their administrative respons- money went or if it went to hospi- ments offered heavily qualified ibility limited to long-term policy tals. This must stop." support, Tony Abbott savaged the and system-wide contracts. He promised any new jobs on plan as a cynical election fix which Mr Rudd said the boards would the Local Hospital Networks would not take full effect until be called Local Hospital Networks would have to be matched by job 2012-13. and would include no more than reductions within state health "I don't think many patients arefour hospitals. They would havebureaucracies. going to notice any difference any chief executives and would be Mr Abbott said Mr Rudd's pro- time soon,"the Opposition Leader based within hospitals. posals were light on detail. said. They would be paid by the com- "The timing of the rollout of this There was also doubt about the monwealth on a per-procedureproposal also raises suspicions prospects for any referendum,basis, with bonuses for efficientthat this is a fix for an election with legal experts telling The Aus- administration which would, over campaign, not a fix for the public tralianthe commonwealth'stime, extract productivity gains hospitals system," said Mr Abbott, botched $2.45 billion homethat would spread the health who had previously proposed local insulation scheme would provide dollar further. boards to run individual hospitals. opponents with potent messages Mr Rudd has guaranteed he will "He (Mr Rudd) needs to cobble to fuel a scare campaign. not allow state governments to something together to take to the Mr Rudd made his push to "end stack boards governing proposed election and this is it. But in the the blame game" on public hospi- new Local Hospital Networks end, it's not an answer. It's a plea: tals a central plank of his 2007with politically friendly ap- trust me." election campaign. He promised pointees. And he vowed his gov- Continued on Page 6 that if states did not improve hos- ernment would not intervene to pital services by June last year he stack boards with Labor mates or

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Key details

FUNDING. The commonwealth will strip $50bn from the states, one third of their GST revenue, to fund its health takeover.

HOSPITALS. The commonwealth will lift its share of public hospital funding from 35 to 60 per cent. It will fund 100 per cent of GP and primary care ' !r 66 There is no way that in a short time a high level of expertise in management will be able to be developed embracing; services outside hospitals. all of Australia's 762 public hospitals, even if grouped into loc l area networks. Inevitably. there will be two levels of bureaucracy directly involved with the public hospitals, and a new layer of BOARDS. Local Hospital management at the local network level ... IL is hard to sec that this will deliver better services, to address the need to Networks of one to four o early improve Lhc interface herween hospitals and primary care, rationalise duplica Lion between hospitals, or salve the hospitals will be tun by continuing problem of elderly patients occupying inappropri ate beds in high-cost acute hospitals. 99 Professor David Peninglon health and finance experts. Senior fellow at the Grattan Institute, an independent Melbourne-hared think tank, and a former They will be paid for each vice-chancellor of Melbourne University service they provide.

STATES. If the states do not agree to the deal on April 11, it will go to a referendum.

"It's a bit like looking at a sketch for a new "This doesn't produce any more money for kitchen - it all looks good and the colours the hospitals, so it won't solve the waiting are nice, but the question is does the stove list problems immediately." work and does it all hang together?" Stephen Leeder John Deeble Director, Menzies Centre for Health Policy Health economist and one of the architects of Medicare

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Continued from Page 1 distracting and draining for a government and doomed to fail if Its also a process-driven solution it does not have bipartisan support that depends on solving currently and the backing of the states. intractable problems such as There is also the issue of doctor shortages by managerial priorities for the next election, incentives and isn't what the with health overtaking climate public thought Rudd had change, which Labor has promised in 2007 when he said suggested could form the basis of a he'd take over public health. double- dissolution election and Like the emissions trading an effective "referendum" onthe scheme to address climate "greatest economic and moral change, this proposal has the challenge of our time". potential to offer great hope that Hospital reform is something can nevertheless sink when that has been necessary for ages people begin questioning how it and strikes a deeply responsive could directly and positively affect nerve with the public. It is also their wellbeing. something the Prime Minister put It also carries with it the threat at the middle of Labor's last of a referendum on federal powers election pitch in 2007. over health, to be held at the same Voters took him at his word last time as the election. time and he's asking them to do so A referendum battle is again at his peril.

Copyright Agency Limited (CAL) licenced copy Ref: 65651817 Australian Page 1 of 3 04-Mar-2010 Page: 6 Edition Changes - All-round Metro By: Paige Taylor Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 1041.01 sq.cms Frequency: MTWTF WAsays no,other states give cautious support

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WESTERN Australia's Liberal agreement. Handing back a third cially unviable" under the system. government yesterday warned of GST was not the way to go. "We Queensland Premier Anna Kevin Rudd it would not surren- will not tolerate a situation where, Bligh gave qualified support, say- der 30 per cent of its GST takings from Canberra, all the decisions ing the offer of "growth funds" was and allow health decisions to be relating to our hospitals and most welcome news. She said it would made in Canberra. of the healthcare decisions aretake several weeks to digest the Even the Labor states gave made," he said. Victorian Healthpackage ahead of the Council of cautious support to the Prime Minister Daniel Andrews said the Australian Governments meeting Minister's health reform blueprint. priority was to get more money to next month. But she warned she Premier Colin Barnett said theprovide more patients with the would not allow Queensland to be commonwealth's proposal to in- treatment they needed faster. But short-changed. South Australian crease its contribution to healthby Mr Rudd's new model provided no Premier Mike Rann in the mid- taking money from the states was new money for at least the nextdle of an election campaign a "sleight of hand", "very unsatis-four years. "That doesn't meet thewelcomed the "partnership" with factory" and unachievable without test we have put down, that is, Canberra as a way of putting more the co-operation of the states. more money now to provide more money into the state's hospitals. Mr Rudd announced yesterday care to patients and their families," Tasmanian Premier David Bar- the commonwealth would take 30 he said. tlett, also on the hustings, said the per cent of the states' GST revenue NSW Health Minister Carmel plan would result in a net gain to in return for guaranteeing 60 per Tebbutt said the key to getting her the state over 10 years and end the cent funding of public hospitals. state's support would be whether "blame game" over hospitals. Asked about the premiers' reac- new federal funding was directed Northern Territory Chief Minister tion, Mr Rudd said he had received to hospitals. A senior NSW gov- Paul Henderson said the plan "monosyllabic answers" duringernment source said: "It is clearly would have his support as long as it phone calls with them yesterday. the Prime Minister's strategy to met the needs of remotely located Mr Barnett said he would con- pick a fight with the states but and indigenous Australians. sider a pooling of federal and state we're not going to give him one." ADDITIONAL REPORTING: funds if benefits for patients could However NSW health sources MICHAEL McKENNA be shown, but states should con- also told The Daily Telegraph up to MATTHEW DENHOLM tribute to a common fund by 100 state hospitals could be "finan- MICHAEL OWEN AND WIRES Ms Bligh warned she would not allow OCost of running public hospitals is increasing Queensland to be by nearly 10 per cent per year and by 2045 will short-changed exceed all of the revenue collected by state and local governments OWith an ageing and growing population health costs will account for two-thirds of the increase in total commonwealth spending up to 2050 OProductivity Commisson estimates some public hospitals are wasting up to 20 per cent of their budgets

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Kevin Rudd announces the policy in Canberra yesterday

Copyright Agency Limited (CAL) licenced copy Ref: 65651826 Australian Page 3 of 3 04-Mar-2010 Page: 6 Edition Changes - All-round Metro By: Paige Taylor Sid Maher Region: Australia Circulation: 131246 Type: Australian National Size: 1041.01 sq.cms Frequency: MTWTF 1M11` I IIL NATION AI. i i [AI I II R1:1:()11M FLAN 1'1'[11. LI 11'1'{)RK

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