Reducing elective surgery waiting times - is more money the answer?

Parliament house flag post

Reducing elective surgery waiting times - is more money the answer?

Posted 21/11/2011 by Rebecca de Boer

Performance of public hospitals is rarely out of the news. Attention is often focussed on elective surgery waiting times or episodes of poor care. Recently there have been reports of ward closures in Victoria and the Tasmanian government has announced cuts to elective surgery in an attempt to balance the budget. Likewise, funding arrangements for hospitals are guaranteed to generate community debate, with more, not less, funding often proposed as the answer.

The most recent COAG Reform Council Progress Report presents a sobering, if not contradictory, view of public hospitals in Australia. This report is a high level examination of implementation of the Government’s reform agenda across a range of measures through COAG and National Partnerships Agreements. For hospitals, the report considered changes to hospital funding arrangements including the implementation of the activity based funding arrangements (ABF) and elective surgery waiting times. It also reflects on whether key reform indicators are being met and if progress is being made on key performance indicators.

For hospital funding arrangements, the report concludes that ‘reforms to funding public hospitals are complete’. This perhaps is premature as one of the key components of hospital reform, the Independent Hospital Pricing Authority (IHPA), has not yet been established. Legislation to establish the IHPA is due to be debated next week. In the meantime, the Government has established an interim IHPA and has appointed an interim CEO.

The IHPA will determine the ‘nationally efficient price’ of public hospital services which will be used to determine the Commonwealth’s contribution to hospital funding. States and Territory governments will not be obliged to pay the efficient price but will negotiate with each Local Hospital Network about the price paid for each procedure. The IHPA will also be responsible for advising Government on which type of funding would be used for hospitals— ABF, block funding or a combination of both. It will also advise on cross-border disputes and regional loadings (see here for further detail about the functions of the IHPA). Work has commenced on the initial determination of efficient pricing and associated payment rules but nothing has yet been publicly released. Funding for public hospitals on the basis of ABF will not commence until 1 July 2012.

One of the key promises of the Rudd Government’s health reform agenda was to reduce waiting times for public hospital emergency departments and elective surgery. In 2008, it committed $600 million to the Elective Surgery Waiting List Reduction Plan (ESWLRP). There were three stages to the plan: stage one focussed on the immediate reduction of patients on waiting lists, stage two provided money for investment in infrastructure to improve elective surgery in the future and stage three was aimed at reducing the number of ‘long wait’ patients and improving overall efficiency of public hospitals. The plan applied up to 2010; the recently agreed National Partnership on Improving Public Hospital Services builds on this.

Results from the ESWLRP are mixed. While the total volume of elective surgery under the plan exceeded expectations (41 584 operations were completed against a target of 25 278), the number of ‘long wait’ patients actually increased over the period 2007–08 to 2009–10. This means that while some patients were seen within clinically recommended times, the number of people who waited for significant periods of time continued to increase. There is insufficient detail in the data to determine why this occurred; and it is likely that there is significant variation across (and within) states and territories and surgical specialities. The data may not also reflect current waiting times - some States (for example WA) have more up-to-date information publicly available.

The COAG Reform Council concluded that apart from additional elective surgery procedures, it was not possible to determine what activities were undertaken by jurisdictions in ‘seeking to achieve the targets under the National Partnership Agreement’. One of the Stage three targets is improved management of elective surgery waiting lists. This is measured by a reduction of ‘long wait’ patients as well as the number of patients who are seen within the clinically recommended time by urgency category and the number of patients who have waited for longer that is clinically necessary.

Under the ESWLRP, states and territories are rewarded for achieving targets under each stage. When the performance payments for Stage three were announced, only three states qualified for the full amount of reward funding (NSW, QLD and VIC). The remaining states received partial payments. Clearly, it will take some time before there is national consistency on the management of elective surgery waiting lists.

The new National Partnership Agreement on Improving Public Hospital Services has two main objectives for elective surgery: increasing the number of patients seen within clinically recommended times and the progressive reduction of long wait patients. Funding of up to $650 million is available with up to $200 million in reward funding. As with the previous Agreement defined targets have been set. Minister Roxon has been clear about improving the accountability of hospital financing and this Agreement goes some way towards ensuring this, despite concerns about the appropriateness of using waiting lists as the sole measure of performance.

Broader questions of health financing and hospital funding remain. As the COAG Reform Council Report has shown, more money doesn’t necessarily solve all the problems. Questions about how much funding is enough and the best way to reduce preventable hospital admissions persist. And how can underperforming states be best supported? Tasmania is likely to face significant challenges in meeting elective surgery targets into the future with its recent ban on elective surgery. Waiting times for public hospitals is a perennial issue and one that is unlikely to go away despite additional investment from the Commonwealth.

Thank you for your comment. If it does not require moderation, it will appear shortly.
Facebook LinkedIn Twitter Add | Email Print


Flagpost is a blog on current issues of interest to members of the Australian Parliament

Parliamentary Library Logo showing Information Analysis & Advice




refugees asylum immigration Parliament Australian foreign policy elections climate change social security women welfare reform Indigenous Australians Australian Defence Force welfare policy school education higher education private health insurance Taxation health financing emissions trading Senate Australian Bureau of Statistics employment people trafficking Asia statistics Middle East illicit drugs gambling health reform federal election 2010 income management Medicare disability Sport United Nations industrial relations constitution transport Australian Public Service politics criminal law Afghanistan health forced labour aged care aid Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget Carbon Pricing Mechanism dental health Fair Work Act voting law enforcement electoral reform public service reform OECD Australian Electoral Commission WADA child protection environment poker machines Australia in the Asian Century steroids National Disability Insurance Scheme detention 43rd Parliament slavery health system regulation domestic violence parliamentary procedure International Women's Day accountability defence capability multiculturalism ASADA Australian Federal Police governance labour force people smuggling debt international relations New Zealand food Australian Crime Commission pharmaceutical benefits scheme Human rights crime China leadership Census election results UK Parliament Papua New Guinea banking corruption pensions children's health Aviation federal election 2013 foreign debt gross debt net debt Senators and Members ALP Newstart Parenting Payment Youth Allowance sea farers violence against women vocational education and training military history by-election political parties High Court skilled migration mental health Federal Court terrorist groups science social media Higher Education Loan Program HECS federal state relations youth paid parental leave same sex relationships coal seam gas customs planning doping health risks Gonski Review of Funding for Schooling sex slavery Special Rapporteur Northern Territory Emergency Response social policy trade unions Foreign affairs election timetable Indigenous royal commission Productivity United Kingdom firearms public policy Population ADRV terrorism transparency research and development welfare ASIO intelligence community Australian Security Intelligence Organisation carbon tax mining employer employee renewable energy regional unemployment fishing European Union family assistance United Nations Security Council Australian economy forestry food labelling Drugs welfare systems Indonesia children Constitutional reform local government codes of conduct terrorist financing homelessness Parliamentary remuneration money laundering Trafficking in Persons Report energy social inclusion paternalism ODA Defence sitting days electoral divisions Southeast Asia administrative law universities TAFE Ireland citizenship asylum seekers early childhood education Canada Financial sector national security fuel disability employment Tasmania integrity standards NATO Australian Secret Intelligence Service sexual abuse World Trade Organization Australia public health housing affordability bulk billing water health policy Governor-General US economy export liquefied natural gas foreign bribery question time speaker superannuation public housing expertise climate Intergovernmental Panel on Climate Change Department of Agriculture Fisheries and Forestry Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets animal health middle class welfare constitutional recognition of local government referendum consumer laws PISA competition policy US politics language education baby bonus Leaders of the Opposition citizen engagement policymaking Australia Greens servitude Trafficking Protocol forced marriage rural and regional alcohol entitlements ministries Hung Parliament social citizenship maritime Iran ANZUS regional students school chaplains federal budget 2011-12 salary Medicare Locals primary care Building the Education Revolution prisons police deaths in custody electoral margins electoral pendulum electoral redistribution redistribution NSW redistribution WA redistribution ACT electoral boundaries ASEAN Sustainable Development Goals Double dissolution Senators safety vehicles MYEFO Pathology tertiary education Taiwan Xi Ma meeting family violence government financial advisers financial planners Financial System Inquiry Murray Inquiry China; Economic policy; Southeast Asia; Africa housing Speaker; House of Representatives; Parliament High Court; Indigenous; Indigenous Australians; Native Title ACT Indigenous education Norfolk Island External Territories emissions reduction fund; climate change child care funding refugees immigration asylum procurement Indigenous health e-voting internet voting nsw state elections 44th Parliament 2015 ABS Age Pension Death penalty capital punishment execution Bali nine Bali bombings Trade EU China soft power education Fiji India Disability Support Pension Antarctica Diplomacy by-elections state and territories Bills anti-corruption fraud bribery corporate ownership whistleblower G20 economic reform innovation Members of Parliament Scottish referendum Middle East; national security; terrorism social services Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 online grooming sexual assault of minors ACT Assembly smoking plain packaging tobacco cigarettes Asia; Japan; international relations Work Health and Safety Migration; asylum seekers; regional processing China; United States; international relations fiscal policy Racial Discrimination Act; social policy; human rights; indigenous Australians Foreign policy Israel Palestine asylum refugees immigration political finance donations foreign aid Economics efficiency human rights; Racial Discrimination Act employment law bullying Animal law; food copyright Australian Law Reform Commission industry peace keeping contracts workplace policies same-sex marriage disorderly conduct retirement Parliament House standing orders prime ministers First speech defence budget submarines workers Somalia GDP world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission limitation period cancer gene patents genetic testing suspension of standing and sessional orders live exports infant mortality honorary citizen railways disciplinary tribunals standard of proof World Health Organisation arts international students skilled graduate visas temporary employment visas apologies roads Italy national heritage NHMRC nutrition anti-dumping Rent Assistance obesity evidence law sacrament of confession US presidential election international days DFAT UN General Assembly deregulation Regulation Impact Statements small business Breaker Morant regional engagement social determinants of health abortion Members suspension workplace health and safety marine reserves hearing Victoria astronomy resources sector YMCA youth parliament Korea rebate Australian Greens presidential nomination Racial Discrimination Act political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing political education Social Inclusion Board early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin sanctions Norway hospitals republic President Barack Obama Presidential visits qantas counselling Korean peninsula Work Choices biosecurity hendra environmental law federalism federation preselection therapeutic goods Therapeutic Goods Administration plebiscites computer games pests suicide nuclear COAG Ministerial Councils floods ADHD stimulant medication advertising electricity extradition conscience votes poverty preventative health rural health coastal erosion Parliamentary Budget Office work-life balance

Show all
Show less
Back to top