1. A new public-private partnership in health Introductory comments Professor David Hayward

2. Our mixed health economy From its European foundations in the 1840s and 1850s, our health system has never been wholly private nor public –It’s always been a mixed economy Central institutions, activities and workforces will always require government regulation and provision Some combination of public and private funding will always be needed The tricky bit: getting the balance right David Hayward RMIT 2

3. Paying the bill In 2011/12, health expenditure: –$140.2b (9.5% of GDP cf 6.8% in 1986/7) –Of which – $53.5b (38%): public hospitals –$50.6b : (36%) primary care Funded by: –Government: 75% –Non-Government: 25% –(source: Australian Institute for Health and Welfare (2014), Australia’s Health, 2014 (accessed at http://www.aihw.gov.au/australias-health/2014/health- system/#t2 on August 20, 2014). http://www.aihw.gov.au/australias-health/2014/health- system/#t2 David Hayward RMIT 3

4. How do we compare (2012)? AustraliaOECD Health expenditure % of GDP (government in brackets) 9.1% (6.2%)9.3% (6.7%) Annual Growth rate total expenditure 2000-2012 (government in brackets) 4.2% (4.4%)3.9% (4.1%) Public as % of total75.9%72.3% Households out of pocket expenses as % of total 18.3%19% Physicians per 1,000 pop.2.53.2 Hospital beds per 1,000 pop3.84.8 Average length of stay5.87.4 Source: OECD accessed at http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm on 20 August 2014 http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm David Hayward RMIT 4

5. Where to from here? No proposal to go wholly private or wholly public Debate is about –Extent of funding growth –Federal/state share of public health spending –Household share of health spending News Ltd has reminded us that first is settled: most of budget is done. Many of the cuts are legislated and will take effect. May be true, but in health more than half the cuts are currently unfunded David Hayward RMIT 5

6. Budgeted Health Savings ($m) 2014/152015/162016/172017/18 Change in health expenses -$86.2-$1,899.3-$2,030.7$-2,121,6 Public hospitals-$217.3-$260.5-$133.4-$1,162 Co- payment$8.8-1,130.2-$1,153-$1,200.8 David Hayward RMIT 6

7. Where to from here cont. What will happen to the co-payment? Maybe bigger question is our health industry in a globalising world? –Global market for health talent –Global market for health patients –And a post-mining-boom economy That’s the real challenge for a new public private partnership in what is our health industry David Hayward RMIT 7

8. RMIT University©2010 Global Studies, Social Science and Planning 8 National Centre for Policy Analysis accessed at http://www.ncpa.org/pub/st304?pg=3 on 20 August 2014http://www.ncpa.org/pub/st304?pg=3