It’s very kind of the media to allow Minister Tony Abbott to keep the election focus on the perennial problems of public hospitals. This not only gives him an easy shot at the states, but also helps distract public attention from areas where the health buck stops firmly at his government’s feet.

One of the reasons that public hospitals are so stretched is because our patchy primary care system means that too many people end up sick in hospitals with problems that could have been prevented or better managed in the community.

As well, too many people get stuck in hospitals because of the shortage of aged care beds. These are areas where the Feds have a direct role in contributing to the strain on public hospitals.

At the same time as reducing its share of funding to public hospitals, the Federal Government is subsidising the private health insurance sector to the tune of about $3 billion a year. The Government’s justification for this subsidy was that it would take the pressure off public hospitals, but it’s an excuse that looks increasingly lame.

If anything, many argue that subsidising the private sector so heavily is only making it more difficult for the public sector to attract and retain the increasingly scarce resource of staff. And it’s done very little to boost services in rural and remote areas, where there are few profits for private hospital operators.

So that’s a few quick reasons why the Minister is so keen to talk about the problems with public hospital management. As for his reported plan – to introduce local boards to run each of the nation’s 750 public hospitals – he can’t be serious.

Health services need to be better integrated – not less. In an ideal world, hospitals would be managed as part of broader health and community services, which is one of the reasons why there was a move away from local hospital boards. Abbott’s plan would reinforce the dominance of hospitals in the health system, and divert the focus from where it is most needed, in building a more effective and accessible primary care system. 

Prue Power, Executive Director of the Australian Hospitals and Healthcare Association, is speaking sense when she says Abbott’s plan “would be going back a couple of decades in our attempts to create an integrated system”.

Of course, there is a need for local accountability, but that’s not only true of hospitals. Of course, local communities’ needs and concerns should be represented in health service planning and delivery. But again, not just for hospitals.

It’s likely that setting up 750 hospital boards competing for staff and resources would only worsen the current inequities in the health system, as those in wealthier areas would be more likely to attract funds and staff. It would make it even more difficult to ensure scarce resources are distributed fairly, rationally and in a way that promotes quality and safety of care.

Then again, the Government hasn’t shown concern for any such notions in its recent Mersey hospital buyout. The Minister’s latest proposal looks like another example of a Government putting politics before health.

Tomorrow: Why the Feds don’t care about fairness in health.