It is difficult to explain the history of healthcare systems, and the interpretation of contemporaneous events is even more challenging. It involves extrapolating past and present trends, anticipating coming events and painting a cogent picture for posterity. Many people have failed miserably for various reasons. He expresses views with which many would agree. The hospital sector has emerged in response to a wide range of policies and practices, many of which are no longer relevant.
Some recent trends seem destined to continue.
These include further compression of length of stay, increased outsourcing and privatisation, renewed efforts to manage quality of care, and greater use of care options such as ambulatory care, day-only hospitalisation and home care. However, mere extrapolation is an insufficient basis for prediction given the many changes in clinical practice that could hardly have been anticipated. Further, in view of the lack of strategic vision of most Australian governments, there is no coherent framework for these trends. Moreover, the trends have been influenced by unfortunate constraints. For example, we have maintained the illogical splits in healthcare financing between the Commonwealth and the States despite 50 years of expert opinion that this system is counterproductive.