Public Health Service

[Julia]

I heard an item on "PM" this evening from Tasmania where elective surgery is to be significantly cut due to budget constraints.

Now I've just come across this article which alleges the numbers in the Queensland Health service are three to one in favour of bureaucrats over clinical staff.
http://www.couriermail.com.au/news/exposed-numbers-shock-our-doctors/story-e6freon6-1226157599605

How about the other States?

What can be done about this clearly unacceptable situation?

 

[Smurf1976]

I don't know the number of bureaucrats versus actual workers, but I've worked in the public service (not health department) and if there's one thing I learnt it's this...

The general public perceives the problem to be "too many chiefs and not enough indians" in terms of the cost of employing all those "chiefs". That is an issue yes, but to be honest it was really only 5 or 10% of the problem.

The real problem relates to the methods of accounting used. To keep it simple, consider that you have 10 "buckets" of money in a particular area.

1. Wages
2. Overtime
3. Vehicles
4. Mobile phones
5. Consultants
6. Stationery
7. Office rent
8. Power, phone etc
9. Cleaning
10. Materials

Now, one of the bureaucrats will come along and insist on a cut and they will specify where that cut must be made even though they know little or nothing about the operation of the area in question. Typically, they'll target items 3 or 4 on that list - vehicles and mobile phones as they are the general items on the Labor hit list (Liberals target item 1 - wages).

OK, so we'll cut $20,000 a year from vehicles by getting rid of two vehicles. And then we'll pay $15,000 in staff overtime and another $$35,000 in consultants in order to maintain work output. And the bureaucrats will be pleased indeed, since we've "saved $20,000" and that's exactly how they look at it.

Follow the math in the above and you'll immediately see the problem. We've spent $50,000 in order to save $20,000. Clearly a dud deal, but the bureaucrats only look at their target money bucket. They'll gladly spend $100,000 or even $500,000 in order to save that $20,000 target on vehicles (or phones or wages etc) if they need to. The cost is irrelevant, as long as it achieves the required cut in the specified area.

Now, I distinctly recall being paid at a ratio of 7 to 1. They paid me an extra $7 for every $1 they were saving. It took years of argument before they finally backed down and let me "win" that one.

I could give you plenty of examples like that. Some large, some trivial. But the bottom line is that it's not the bureaucrat's wages that matter but rather, it's the faulty accounting they use.

The situation is directly comparable to you or I deciding that we're spending too much on bus faresl. So we cut our bus fare budget - by means of getting a taxi to work each day at a far higher price than the cost of the bus. We're spending $30 each way in order to save $3, but so far as the bureaucrats are concerned it's a good deal since we're saving $3. Sadly, I'm not making this up and this is exactly how they think.

It's not front line workers being lazy. In my experience they work just as hard, in many cases harder, than those in the private sector. Nor is it the cost of mobile phones, government vehicles and other things which attract attention. There's the occasional abuser but the majority are doing the right thing (and let's be honest, how much money can anyone really waste making a few private phone calls? I mean really...). No, the real problem is the faulty accounting used by the bureaucrats. The accounting that says that spending $700 to save $100 is a good thing as long as the $700 came out of a different bucket to the $100.

And don't get me started on the fact that anyone who saves money is effectively punished for doing so - that's another story altogether but it's how the system works (there were ways around it if you were clever enough however, but the path of least resistance is certainly to waste).

So as thousands wait for surgery, just remember that somewhere there's a bureaucrat arguing that spending $7 to save $1 is a good thing. And remember also that front line workers and their unions would in most cases stop it if they could, indeed they spend a lot of time trying to do just that.

 

[Boggo]

I am more concerned about the fact that the Aust Govt are spending up to $1.4 million on cigarettes for illegal immigrants while we have people on trolleys in corridors in our hospitals because of lack of funding for beds and staff and meanwhile we have politicians such as Andrew Wilkie running the country with 13000 votes.

 

[Billyb]

Now I've just come across this article which alleges the numbers in the Queensland Health service are three to one in favour of bureaucrats over clinical staff.
http://www.couriermail.com.au/news/exposed-numbers-shock-our-doctors/story-e6freon6-1226157599605

My experience in QLD Health agrees with that very strongly..

The Public Health system is a debarcle, so many different departments and each works with their own blinkers on and forgets the big picture. This is the problem. Smurf summed up some of the problems very well. Is there anything we can do about it? Probably not a lot IMO. it's just how big systems work.

 

[McLovin]

IMO, the biggest reason for the state of the public health system is that it is staddled like no other public service between state and federal. It's all too convenient for state to blame federal and vice versa while nothing gets done.

 

[tothemax6]

What can be done about this clearly unacceptable situation?

Immediate and complete liquidation of all public sector medical assets in a public stock auction.

Shortages and high costs are the norm for anything government controlled. The USSR controlled all aspects of its economy, and people spent hours just queuing for things like bread. Localised control just produces localised shortages (in this case, health care).
Public sector medicine is free of competition, full of bureaucrat leaches instead of doctors, and unable to correctly price its services. The NHS in England is an absolute behemoth, sucks in massive amounts of money, and is also mostly comprised of 'admin' staff instead of actual medical practitioners, and yet all politicians there agree it is a wonderful thing.

In a word, the whole thing is a rort.

Smurf1976, as someone who spent some time working as a contractor to council/utilities, yes this all sounds familiar. The public sector makes me sick to the stomach. No one else there gives two hoots about 'productivity', 'efficiency', 'actually getting things done'. Indeed, all these things are completely irrelevant to them. The spend 95% of their time with their stupid office politics and nonsense, and the other 5% begrudging doing actual things.

 

[McLovin]

Immediate and complete liquidation of all public sector medical assets in a public stock auction.

Shortages and high costs are the norm for anything government controlled. The USSR controlled all aspects of its economy, and people spent hours just queuing for things like bread. Localised control just produces localised shortages (in this case, health care).
Public sector medicine is free of competition, full of bureaucrat leaches instead of doctors, and unable to correctly price its services. The NHS in England is an absolute behemoth, sucks in massive amounts of money, and is also mostly comprised of 'admin' staff instead of actual medical practitioners, and yet all politicians there agree it is a wonderful thing.

In a word, the whole thing is a rort.

Any health system is going to be bloated and inefficient, it's the nature of the service being delivered. I don't see how privatising the system will fix that?

 

[boofhead]

I noticed a job vacancy for a locum doctor, $1700 a day.

I notice nurses (and it happens in some other public sector front line service workers) are very aggressive in pay increase negotiations. Wages often appear to be a major budget allocation.

Public health service has expanded a lot in the last 100 years.

People use the hospital service instead of a GP. Then you have self abuse which eventually has a cost - say alcoholics, ice addicts etc.

No shortage of people suing medical people.

Cases like Jayant Patel have costs. People want things in place to stop employment of such doctors or they are quickly discovered. Who does that work?

Overall public health is consuming more of the federal and state budgets. Sadly the free trade agreement modifies how the PBS works.

As medical advances happen, costs seem to go up. Life expectancy goes up.

In the last 3 years Four Corners had a good story about health systems around the world, USA, UK, Australia, Japan, Germany and a couple of others. Japanese govt did some price controls - like limit MRI machine costs. The makers said it can't be done. Japanese government stood firm. I think it was Toshiba that came to the party and found a way to produce it at a cost acceptable to the Japanese government.