Tasmania has an opportunity, based on its success in minimising the exposure of its people to Covid 19, to capitalise on its reputation as a “safe place” both from future pandemics and in the face of ongoing climate change – to attract more migrants from both other parts of Australia and from other countries to live here.
However, as explained in the third of this series of articles, families with children are going to be hesitant about making their future in Tasmania if they have reason to fear – as, unfortunately, they do – that they may be taking risks with their children’s education by doing so. That’s one reason – though far from the only one – why “fixing” Tasmania’s under-performing education system is so important.
Equally, both families with children and people approaching, or already in, their retirement years – another cohort that might potentially be more interested in moving to Tasmania in larger numbers – may be understandably reluctant to do so if they think they might be compromising their access to the health care.
And well they might think that, because Tasmania’s health system, like its education system, has for a long time also been falling short of what Tasmanians are entitled to expect.
Tasmanians are, on average, older than other Australians. Partly – but not only – for that reason, they are also, on average, sicker than other Australians (with the conspicuous exception of indigenous Australians).
Despite being older on average, Tasmanians have shorter lives (by an average of almost 1½ years) than other Australians. Those of us under the age of 75 are more than 28 per cent more likely to die of “potentially avoidable” causes.
Tasmanians have a higher incidence of lung and bowel cancer than people in any other state except Queensland. Tasmanian women have a higher incidence of cervical cancer than their sisters in any other state. Tasmanians are 7 per cent more likely to experience heart attacks, and are more likely to be living with long-term chronic conditions such as asthma, arthritis, hypertensive or kidney disease.
More of us are overweight, or obese, more of us are daily smokers than people in any other state or territory except the Northern Territory, and we exceed the national average in consumption of “excessive” amounts of alcohol.
Those outcomes are, in part, the result of lifestyle choices which people make, because of the circumstances into which they were born and in which they grew up – but also because of the education which they received or, more to the point, didn’t receive.
International evidence clearly shows that there’s a clear link between levels of education and life expectancy for people aged 25 and over: which strongly suggests that improving the outcomes of Tasmania’s education system will also contribute, eventually, to improved health outcomes for Tasmanians.
But Tasmania’s health system doesn’t provide the same standard of care as those of other states and territories.
According to figures published by the Productivity Commission in its latest annual Report on Government Services, only 65 per cent of patients presenting to the emergency departments of Tasmania’s public hospitals in 2019-20 were seen “on time” – 9 percentage points below the national average. The median waiting time for elective surgery at Tasmania’s public hospitals in 2019-20 was 52 days, by far the highest of any state or territory, and 20 days more than the national average. The last 10 per cent of patients had to wait an average of 358 days – 120 days more than the national average.
Tasmanian hospitals have more frequent “adverse events” than those in any other state or territory. And Tasmanians are anywhere between 15 per cent and 93 per cent more likely to experience unplanned re-admissions to hospital (because of complications arising from surgery) than the national average.
Ambulances take longer to respond to call-outs in Tasmania than in any other state or territory, by on average almost 60 per cent more than across Australia as a whole.
Tasmanians have greater difficulty accessing GPs than people in any other state or territory; 8.25 per cent of Tasmanians report that they have delayed seeing, or haven’t seen, a GP due to concerns about costs, more than double the national average; and almost 24 per cent of Tasmanians (a higher proportion than in any other state or territory, and 5 percentage points above the national average) say that they waited longer than they felt “acceptable” to get an appointment with a GP. In 2019020, 37 per cent of Tasmanians seeking an “urgent” appointment with a GP waited more than 24 hours, 7 percentage points more than the national average.
None of these shortcomings in the delivery of health services in Tasmania appear to be due to inadequate staffing. Tasmania’s public hospitals have more staff per 1,000 population than any other part of Australia except the Northern Territory – roughly 17.5 per cent more than the national average – although it also has about 10 per cent fewer GPs per 1,000 population than the national average (which probably explains at least some of the difficulty that Tasmanians seem to have accessing GP services).
But there is evidence that Tasmania is spending less than it should on health services.
According to assessments made by the Commonwealth Grants Commission as part of its latest assessment of how the revenue from the GST should be carved up among the states and territories, Tasmania has spent about $160 million per annum (or about 9.5 per cent) less, over the past five years, than it needed to in order to provide the same standard of health services as the average of all states and territories.
That’s after making allowances for differences among the states and territories in the relative need for health services (for example, as a result of Tasmania’s population being older and sicker than that of other states) and of differences in the cost of providing them (for example, although Newcastle and Tasmania have roughly the same population, it’s cheaper for the New South Wales Government to provide health services to the people of Newcastle than it is for the Tasmanian Government to provide the same services to its population because Tasmania’s population is more widely dispersed).
But it’s probably not simply a matter of spending more money. Tasmania also needs to spend what it spends in different ways – more efficiently and more effectively.
That almost certainly includes major improvements in the clinical systems that doctors and nurses use to record the treatments that patients have received and the results of tests that they have undergone. It probably includes a re-think of the way in which beds are configured in hospitals, and of the allocation of hospital resources between public and private patients.
And, as recommended in a report to the State Government by a team lead by Professor Kathy Eagar, of the Australian Health Services Research Institute, it will likely require a “substantial investment and re-investment in subacute care” – that is, rehabilitation, geriatric evaluation and management, palliative care and psychogeriatric care – in order to take some of the pressure off Tasmania’s acute care hospitals.
If Tasmania can’t substantially improve the performance of its health system over the next four years, it will have missed an opportunity to capitalise on its relatively successful management of the Covid 19 pandemic, and the appeal which that would otherwise provide for people currently living in other parts of Australia, and beyond, to consider making Tasmania their home.
It would also, of course, be letting down those who already live here.
Saul Eslake came to Tasmania with his parents as an eight-year old. He went to primary school in Smithton, and high school and university in Hobart (graduating with a First Class Honours degree in Economics from UTas). Like so many in that era, he went to the mainland for work, initially at the Treasury in Canberra, before spending almost 32 years in Melbourne, working as (among other things) chief economist of the ANZ Bank for 14 years and chief economist (Australia & New Zealand) for Bank of America Merrill Lynch for 3½ years. In 2015 he came home to establish his own business, Corinna Economic Advisory. Saul Eslake is a Vice-Chancellor’s Fellow at UTas, and a non-executive director of the Macquarie Point Development Corporation.
Click here to read more from Saul Eslake.