So, the ACT has one of the highest rate of car theft in the land and the most costly delivery of health care.
This, and a myriad of other measurements came out this week courtesy of the fifth Productivity Commission report on government services.
This year the report showed that the ACT has among the shortest wait for public housing, the least spent on traffic enforcement, the best ambulance response times, the longest wait for aged care places, the most expensive child care and so on.
The report goes into searching detail to answer questions on how much, how many and how quickly. But it does not answer the question why the differences occur or what should be done about them. The report is quite open about that. Those are matters for the state and territory governments to deal with.
The car-theft statistic is a case in point. When we have such comparitively low levels of crime in general, why is car theft high? And what should be done about it? Mandatory life sentences for car theft, surely.
Thinking a little more deeply, what is peculiar about Canberra that might make car theft more prevalent. Well, Canberra has a rule against fron fences. It makes cars in driveways more exposed. It might be the price we pay for our beautiful suburbs.
Or we can do what the Productivity Commission hopes will arise from its report – look at the experience of other jurisdictions and find out what has worked and what has not and what might work here. There is no need to reinvent the wheel.
Western Australia, which has the highest rate of car theft, has begun to require all cars to be fitted with immobilisers before they can be registered or ownership transferred. Car theft is plummeting. We can learn.
Hospital costs is another sore thumb. We have the highest. There is no disputing it, but we must ask why, in an intelligent and impartial way. We should not just go on an ideological crusade saying it is all those greedy doctors or all the union-induced wasteful work practices of nurses. There may be some element of those, but Canberra’s main hospital has a unique feature. All other state capital hospitals have a huge hinterland of people from their own state. Ours has a hinterland from another state. And we have no lower-cost small or medium hospitals in small and medium size towns. The result is we take a lot of heavy-cost heart, cancer and complex accident cases from hinterland NSW which push our average hospital costs up. And no small low-wage hospitals doing cheap sore toes in country towns. So let’s not cut the health budget as a knee-jerk reaction.
A lot of people are deeply suspicious of the tools used by the Productivity Commission: benchmarking, user-provider models, competition between the states and the like. But the problem is not the gathering of the comparative information. The problem is what you do with it.
The report warns about governments just looking at the bottom line. It says they should aim at overall community efficient. It cites the example of a Government contracting the provision of a service to a charity, making its bottom line better, but maybe costing the community as a whole more because the charity consumes more community asset (including services it might provide elsewhere) to provide the service.
Aged care is another example of different results for different reasons. The ACT performs fairly dismally. That is measured fact. It is important to ask why. Quite likely, it is because the ACT had a huge spurt of immigration from Melbourne, Sydney and other places from about 1958 to 1975. The immigrants were mainly working age public servants who left their parents (their children’s grandparents) behind. The aged simply did not have a big presence in Canberra. Out of sight out of mind. People thought their aged parents would go into a home or hostel in their home city or town, so their was no need to worry in Canberra. But we have too many schools and too many playgrounds.
The importance of the Productivity Commission report is that it rings warning bells on things like aged care.
The trouble is: will governments listen, or will they misuse the data?
We have the best ambulance response times because we have the best roads, surely. Do we know if ambulance crews get from the station to the road in the best time? We have the most expensive cost per prisoner because we do not have a prison and NSW charges what it can get away with to house our prisoners, all of whom are at the expensive end of prisoner because we only send the most serious cases to jail.
One of the dangers in the Productivity Commission’s report is that the people of the ACT might get a sense of being utterly different from other Australians because so many ACT statistics stick out when measured against the other seven jurisdictions.
This is a false impression. As the referendum showed, people in the ACT had a very similar outlook as counterparts in Sydney and Melbourne with a similar age and income demographic. Indeed, if the commission reported on only Sydney, Melbourne, Perth and Adelaide, we would be closer to average. Age and education are the critical differences because of the earlier public service influx. The former we can do nothing about but wait, and the latter should be a cause for celebration.
There is a lot to be gained from the commission’s report, but its message should be to pick out some eyes of best practice and not let it be a catalyst for aspiring to the average.
BLOB. Last week’s column wrongly stated that the health insurance rebate was still means-tested. The means test was removed in January 1999. If anything, though, this supports the central argument of the column that the rebate was misdirected government money going to people who would keep their insurance anyway instead of being put directly into health, particularly the public hospital system. Unmeans-tested, higher income people are even more likely to keep their insurance anyway and even more liklely to spend their rebate on frivolity rather than health. Alas, this undotted i and a uncrossed t has enabled people to swoop down to condemn the whole column. It is one of the hazards of a profession where all one’s work and mistakes are vetted publicly while doctors can bury theirs and lawyers charge for them.