Despite the collective sacrifices of the people of NSW through the pandemic to protect the health system, it is cracking under the pressure of a post pandemic increase in demand for services. While COVID-19 is a large driver of the current crisis, even before the pandemic hit there were concerns that the health system would not be able to deal with the sustained increases in demand for services and rising costs.

As the Commonwealth Government considers the recommendations of the latest review of Medicare there is a risk that the broader system wide drivers of the current crisis will not be addressed. The health system is complex, and responses need to reflect a patient-centred approach rather than artificial silos between primary and acute care, private and public provision, and Commonwealth and state funding.

While state premiers and doctor’s groups call for more resources to meet the additional demand, it is important that any responses reflect that the current crisis is not just about a lack of funding, but is driven by how that funding is being spent.

Australia’s fragmented health system, where responsibilities and funding are split across state-federal and public-private lines means it does not deliver the best outcomes for the money spent. The current system does not incentivise outcomes, rather it incentivises the provision of more health services. This is undermining the delivery of quality, evidence-based and cost effective health care, and means simplistic solutions such as increasing rebates, more GPs and more nurses is not the solution.