The Australian, 12 February 2023

The Health Services Union is calling for a royal commission into the “chronic misallocation of resources and warped priorities” in the NSW health system, in a thinly veiled attack on doctors and other “special interest” groups.

The HSU claims the state’s $33bn health system is “at breaking point”, suggesting the crisis is not about a lack of funding but is caused by chronic over-servicing through unnecessary procedures and treatments, driven by reliance on fee-for-service funding models.

That includes rates of caesarean section that have reached 50 per cent in the private hospital system, more than three times the levels recommended by the World Health Organisation and costing the health system $350m a year, according to a report prepared for the union by consultants Impact Economics and Policy.

In a rebuke of recent campaigns by doctors’ groups, the union – which represents 47,000 health workers, paramedics, cleaners and others - says “simplistic solutions such as increasing rebates, more GPs and more nurses is not the solution”.

Health Services Union NSW secretary Gerard Hayes said there had been more than 20 major reports into the health system over 40 years without substantial action, making the case for a royal commission “overwhelming”.

“Special interests in the health system will squeal. We should be prepared for that. But they should explain why funding is based on fees rather than outcomes,” Mr Hayes said.

“Highly paid providers are often incentivised to provide expensive procedures that boost their earnings but don’t relieve pressure for the wider community.

“At the same time, investment in preventive health is woeful.

“The system is completely out of whack. We can identify billions of dollars’ worth of spending that needs to be properly scrutinised and probably redirected to have more impact.”

The report says people in western Sydney don’t struggle to see a GP because there are not enough GPs trained in Australia but because they are disproportionally located in high income areas where there are lower health needs but greater financial rewards.

Wealthier areas like Woollahra, in Sydney’s eastern suburbs have twice the number of GPs per 1000 people of low socio-economic areas such as Liverpool, in Sydney’s west, the report said.

The union says the federal government’s Strengthening Medicare review focuses only on primary healthcare and fails to encompass 67 per cent of the health system. Among the key findings of the report:

• 1000 hospital beds in NSW are occupied by people who should be in aged-care facilities or are NDIS participants, costing $500m a year;
• More than 50 per cent of NDIS patients have delayed discharges from hospital, with an average stay of 100 days;
• Patient complaints about healthcare services have increased by 144 per cent since 2011-12.