Public+Hospital+Policies+-+The+Difference+Between+Rudd+and+Gillard

Name: Aleisha Chanas Tutor: Colleen Niland

Australian freelance political cartoonist, Peter Nicholson, famous for his creation of the “Rubbery Figures” in 1995 drew this cartoon in early 2011 to accompany a website article on Australia’s hospital reform (Kenny, 2011). This cartoon pictures an overdramatised Julia Gillard at a table with six cups representing each states hospital funding with the Council of Australian Governments’ (COAG) health reform agreement in hand. This cartoon includes the quote, “We’re ending the Blame Game - It was all Kevin’s fault”, referring to her predecessor, Kevin Rudd.
 * Artefact **** Presentation **

Hospital funding and reform has consistently been a hot topic for discussion between Australia’s leading parties, the Australian Labor Party and the Liberal Party of Australia, as it has and always will greatly affect the Australian population as a macro factor to the population’s health and wellbeing. Although the two leading political parties have significantly different opinions on the effectiveness of policies for public hospitals, even different leaders of the same party, Kevin Rudd and Julia Gillard for example, have very different views on what would and wouldn’t improve Australia’s public hospitals. These varying viewpoints of these Australian Prime Ministers and their fellow party members are illustrated in their health reforms.
 * Public Health Issue **

Haycock, Stanley, Edwards and Nicholls (1999) state that any substantial change in public hospitals can be a difficult and time consuming process. Australia’s government has however, continued to advance their policies for public hospitals and care to accommodate our increasing population. Although the main aims of both Kevin Rudd and Julia Gillard’s policies for public hospitals remain similar, such as reduce waiting times for elective surgery and emergency departments and increase the number of beds in hospitals, there are still substantial differences between the two leaders’ policies.
 * Literature Review **

Hospital funding has always been a significant topic for country’s governments but obstacles created by the country’s population can become significant barriers to the successful implementation of public hospital reforms. Haycock et al. (1999) describe the main obstacles to achieving required changes in public hospitals are opposition from stake holders, funding, the process of change and the absence of a shared understanding of policy direction. All the factors described in this article interact with each other, therefore to achieve change all these obstacles must be considered when creating a policy. The funding of a policy provides a conundrum for many governments as the reason behind new policies is the aim to save money by implementing cost-effective plans but to implement them significant and immediate funding is often required (Haycock et al., 1999). The community also commonly disapproves of expensive public hospital reforms, particularly if their aims are purely financial (Haycock et al., 1999).

This information was found in an article by Haycock et al. that based their information on evidence of interviews with people who have been responsible for substantial change in public hospitals in certain English cities. Information in this article was also provided from research of obstacles that have prevented previous policies being successfully implemented. The limited sources of information were due to an apparent lack of research concerning obstacles aiming to improve public hospitals at that time. This led to the methodology used by Haycock et al. lacking validation for their research. By interviewing individuals responsible for significant changes in public hospitals, instead of the parties that implemented the policies, Haycock et al. may have overlooked other critical factors that affect the implementation of policies.

Arguably, the most controversial move by Kevin Rudd during his time in office was his health reform. This reform included a policy for the Federal Government to be the major funds provider for public hospitals, transferring funds directly from the Commonwealth to regional hospital networks (Bahnisch, 2010). These funds would be allocated in accordance to services provided by those hospitals instead of the original block grants the State government provided. This plan involved increasing federal funding from forty per cent up to sixty per cent ( Kevin Rudd outlines radical health care reform, 2010) through the retention of a third of all states GST revenue (Kelton, 2010). Along with this funding strategy, the reform also included a plan to establish local hospital networks to improve services through bulk purchasing and setting a four hour cap on emergency department waiting times. Rudd’s health reform also included reducing the pressure on public hospitals by fully funding treatment of patients by outer hospital services ( Kevin Rudd outlines radical health care reform, 2010) such as private hospitals.

During Rudd’s release of his government’s health policy he quoted that this health reform will “end the blame game” ( Kevin Rudd outlines radical health care reform, 2010). Kevin Rudd’s mention of “the blame game” refers to the Australian people blaming different levels of government. This reform was to give the federal government the greatest amount of responsibility of public hospital funding, while the local hospital networks were given the flexibility of distributing those funds to required areas (Bahnisch, 2010). A poll of 1,400 voters revealed that seventy-nine per cent of Australians supported the Commonwealth taking greater responsibility of public hospital funding (Coorey, 2010). This popularity lead this reform to be passed through parliament despite criticisms from Coalition Leader, Tony Abbott claiming the health reform would be “ineffective and overly-bureaucratic”.

Julia Gillard’s new health reform encompasses a majority of the same basic policies for public hospitals that Kevin Rudd’s government introduced in their health reform. Aims to cap emergency department waiting times to four hours, greater local control of hospitals through the formed regional hospital networks and service-based funding remained important policies included in the Gillard’s government’s health reform (Health Reform, 2011). Early in her term in office however, Julia Gillard reverted to the originally federal funding position of providing only forty per cent of public hospital funds, no longer retaining a third of the GST revenue from States (Parnell & Shanahan, 2011). This movement was supported by States such as Victoria and Western Australia that didn’t immediately agree with Kevin Rudd’s health reform due to the considerable retention of the State’s GST revenue (Parnell & Shanahan, 2011).

Instead of allowing the Federal Government to be the major funds provider, the new health reform involves gradually increasing the percentage of funds provided by the federal government, increasing it to forty-five per cent by 2014-2015 and eventually reaching an equal funding partnership with the state governments by 2017-2018. This method of funding provides equal responsibility between the federal and state governments and has been described as “the biggest change to public hospital financing since the introduction of Medibank and its successor Medicare” (Health Reform, 2011).The new health reforms has also introduced the National Health Performance Authority (NHPA) which documents the performance of all public hospitals and makes them available for public access on a government website, MyHospitals.com (Health Reform, 2011).

Australia’s current health care system focuses on efficiency, calculability, profitability and control. This strategy is used in many other aspects of society to sustain the expanding population and is known as economic rationalization which was theorized by German sociologist, Max Weber but has inherited the term McDonaldisation by George Ritzer after the fast food chain, based on their rationalized strategies for fast and effective production and service (What is McDonaldization?, 2000). McDonaldisation is described as “the process by which the principles of the fast-food restaurant are coming to dominate more and more sectors of American society as well as the rest of the world” (Ritzer, 2011, p. 1). Although public health may seem impermeable to the affects of rationalism, even in Australia’s public health system a focus on efficiency, calculability and control are demonstrated by public hospital physicians.
 * Cultural and Social Analysis **

An example of efficiency in public hospitals include day surgery, where the patient is given a consultation, operated on and allowed to recover before being sent home before the day is out. Control an be seen in public hospitals with the strategy of implementing “pathways” into general medical practice (Ritzer, 2011, p. 122) which standardizes responses to commonly encountered symptoms. Calculability is demonstrated in Australia’s public hospitals by determining the amount of money required for a certain procedure. Recent policies for public hospital funding use these calculations and a record of the number of these services to determine a particular hospital’s funding.

Public hospitals’ strategy of increasing efficiency through day surgeries removes a sense of personal attendance to the patient, creating an “assembly-line” for surgeries. Implementing pathways to improve control removes the need for physicians to make decisions based on their knowledge, creating a greater uniformity amongst physicians but is likely to affect negatively on physicians capabilities to make independent decisions when required (Ritzer, 2011, p. 123). The government’s funding strategy restricts physicians’ flexibility in providing additional services for their patient if they may deem the service required but not necessarily following a pathway created by the hospital.

Policies aimed at improving public hospital systems and services such as those developed by both Rudd’s and Gillard’s government’s health reforms are developed to considerably benefit those that cannot afford private health cover and require access to effective, timely and free health services. These populations groups include lower socioeconomic families, the elderly or pensioners and Aboriginal and Torres Strait islander people.

These population groups would be seen to benefit greatly from the strategies of creating greater efficiency, calculability and control of the public hospitals. These strategies, however remove a majority of the important decision making process by the individual physicians and limits the personal attention to patients which can lead to physicians failing to recognize or correctly treat a symptom that is unfamiliar to a particular pathway. Public hospital systems focus their practices on economic rationalization strategies of efficiency, calculability, profitability and control to sustain an increasing Australian population and improve the use of government funding but in the process will likely adversely affect the hospital physicians and organization of public hospitals.

The political cartoon was used to represent the difference between public hospital policies between Kevin Rudd’s government and Julia Gillard’s government. The quote included in this cartoon is “We’re ending the blame game – it was all Kevin’s fault” referring to Julia Gillard’s predecessor, Kevin Rudd. The mention of the “blame game” is referring to Australians placing the blame on different levels of government for the lack of appropriate funding of public hospitals. This cartoon represents the current government’s stance on public hospital funding with cups on the table representing each state’s hospital funding, as the government allocates a certain amount of funding for public hospitals based on the services they provide.
 * Analysis of Artefact and Reflections **

Cartoons are often used to accompany political articles as they are eye-catching, provide basic information on the issue whilst also using humour to interest the reader. This cartoon has achieved these aims by providing a small amount of information on the government’s stance on the issue while also using humour by using the two contradictory quotes in the cartoon. This implies that although the government is attempting to end the “blame game”, they continue to blame the previous prime minister, revealing the government and prime minister’s supposed lack of consistency.

This cartoon by itself provided me with information on this issue that I wasn’t previously aware of. Having no particular interest in politics, I considered myself relatively uninformed of important policies that involve our public hospital systems and how they may affect individuals and families. Research involving economic rationalization and also reading Ritzer’s “McDonaldization of Society” opened my eyes to how modern society has changed even during my own lifetime and how the strategies of improving efficiency, calculability, profitability and control have come to dominate many seemingly impervious institutions and regions of the world. After this assignment is finished I will continue to study economic rationalization and how it affects different institutions and become more aware of the strategies used within areas of my own life, such as work and study.

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Baer, H.A., (2007). Why is the Australian government interested in complementary medicine? A case study of economic rationalism.(Report). //Complementary Health Practice Review, 12//(3), 167-177. doi: 10.1177/1533210107306134

 [|Bahnisch], M. (2010). Rudd’s health policy. Retrieved October 24th, 2011 from: []

Coorey, P. (2010). Voter’s Warm to Rudd’s Health Plan. Retrieved from: http://www.smh.com.au/national/voters-warm-to-rudds-health-plan-20100307-pqlj.html

Haycock J., Stanley A., Edwards N., Nicholls R. (1999). Changing hospitals. British medical journal (International ed.), 319(7219), 1262-1264. Retrieved from: []

Health Reform. (2011). alp.org.au. Retrieved from: []

Kelton, G.(2010). Kevin Rudd's historic health reform deal finalised after negotiations with Premiers. Retrieved from: [] Kenny, M. (2011). Hospital reform: Your questions answered. Retrieved from: []

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<span style="font-family: 'Times New Roman',Times,serif;">Parnell, S., and Shanahan, D., (2011). Julia Gillard to junk Kevin Rudd health reform. Retrieved from: <span style="font-family: 'Times New Roman',Times,serif;">http://www.theaustralian.com.au/national-affairs/julia-gillard-to-junk-kevin-rudd-health -reform/story-fn59niix-1226000488507

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