Australian health care, as in a lot of activities administered by Government, is managed under the auspice of subsidiarity – the idea that the decisions that affect people should be made as close to them as possible. The previous labour government entrenched this even further with the establishment of Medicare Locals (for primary care). In the acute care hospital sector in New South Wales we have Local Health Districts. These have gone by different names in the past (areas, networks, etc) and have fluctuated in size. Similar divisions are observed in the other States.

At many levels local health care delivery is entirely logical, after all, until we actually get a National Broadband Network, a decent system of telemedicine, changes to regulation of prescribing and more nurse practitioners a system that allows individuals to manage their own health care at home won’t really exist.

But there is a problem, not the least because in addition to the presence of local systems we have State and Federal government health care management organisations. Because of these tiers of government and the emphasis on local delivery of health care there is very little harmonisation across the health care system.

The problems this causes are numerous. There is an impact on quality and safety, for example, different hospitals manage DVT/PTE prophylaxis differently. Standards for medication management vary from hospital to hospital. There is also an impact on cost efficiency. It would be sensible for our relatively small population base to tender for goods and services at a State or Federal level e.g. why can’t we buy expensive machines like CT scanners or anaesthetic machines through such a process. A lot of money could be saved if we did things in the same way but at this stage we don’t even have a common identifier for individuals properly implemented.

Many quality, safety and efficiency measures could be improved we we stopped thinking, re-inventing and paying locally.