LOCAL hospital networks at the heart of the Rudd government's health reform package would be too small to provide comprehensive services and would create substantial administrative costs that were duplicated dozens of times across the state, clinicians said.
A working group of 60 doctors, nurses and academics told the Premier, Kristina Keneally, that an activity-based funding model - which pays hospitals for each patient treated - could encourage local networks to admit more patients to hospital, rather than treat them more cheaply in the community.
The Prime Minister's blueprint sees the conversion of eight state and territory systems into an integrated national system run by more than 150 local networks, each supervising between one and four hospitals.
Ms Keneally said on a population basis, NSW would have about 50 networks.
''There were questions raised about the appropriate size and density that would support a local hospital network, whether a network of one to four hospitals was too small, and whether it was more appropriate to think on a population basis rather than having a [particular] number of hospitals in a network.
''Some clinicians pointed out today that a network of anywhere between one and four hospitals in a rural or regional setting would mean you still have four very small hospitals in a network and they may not be linked to a hospital of significant size or a network that provides a full range of services.''
In announcing his reform package this month, Mr Rudd drew particular attention to the mid-north coast town of Port Macquarie, recalling that health workers there had complained that too many decisions were made in either Sydney or by the North Coast Area Health Service, which serves about 530,000 people and has its headquarters in Lismore, 370 kilometres north.
Yesterday, Mr Rudd questioned the effectiveness of having one area health service, Greater Southern, to cover an area spanning over 160,000 square kilometres. ''Surely we should start thinking about why a local hospital network in this area doesn't bring together hospitals in Canberra, in Queanbeyan, in Yass and Cooma and to make some sensible, local, community-of-interest decisions for the future.''
Yet Professor Stephen Leeder, the director of the Menzies Centre for Health Policy and who was at the seminar, said that Mr Rudd was being ''naive''.
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