Recently there has been a revival of age-old discussions about the role of government and non-government organisations in the delivery of aged care.
There have been some suggestions that governments would be better off running aged care directly or that privately owned operators should be banned from the industry.
The spark for the most recent discussion of these issues is a report prepared for the aged care royal commission that finds government operators have the strongest performance in relation to quality followed by not-for-profit organisations and then for-profit businesses.
To start with, it’s important to realise that the quoted report isn’t really trying to measure quality; it is trying to measure productivity and the cost of care.
Doing that requires a way of adjusting for the quality of output, so the researchers put together a quality index from the available data. At the same time, they say explicitly that data limitations in relation to quality are one of the key constraints of their report.
Leaving aside the latest report, there is some evidence internationally and in Australia to suggest that government-run and not-for-profit organisations have higher average performance across a number of quality measures.
However, there could be a number of things going on in the background.
Firstly, in Australia at least, for-profit organisations tend to look after residents with higher needs. Various analyses attempt to take this into account but it is likely that they fail to fully analyse this when measuring quality.
Secondly, it’s important to realise that for-profit organisations actually receive less funding, relative to need, to deliver care than their counterparts in the government and the not-for-profit sector.
This is a result of state governments providing additional support to the aged care services that they operate, over and above the support that Federal Government give to all providers. Non-profit organisations, meanwhile, have the benefit of tax concessions such as payroll tax and fringe benefits, which means they can be better resourced.
We should have a level playing field where all organisations receive the same level of resources to deliver care.
Is not fair to older Australians that the ownership of the provider they choose affects the level of funding received for their care.
At the end of the day, we want policy to be laser-focused on quality but blind to ownership.
Even if government and not-for-profit operators have higher average quality performance, there will still be many above average for-profit organisations as well as below average not-for-profit and government run providers.
What matters is the quality that an individual service delivers and whether they can do this in a way that makes best use of the available resources. We don’t need a policy on for-profit, not-for-profit and government providers.
Human services in Australia – including hospitals, schools, child care and disability services – are provided by a diverse range of privately owned, not-for-profit, faith-based and government operated services.
Regardless of their ownership, none of these services can continue to operate and deliver their vital services if there is consistently more money expended than money received.
It is no different in aged care.
What we need – as another paper commissioned by the royal commission found recently – is to rigorously measure quality and make it the foundation of everything we do in aged care.
Organisations that cannot meet the required level of quality should either lift their game or leave the industry regardless of who owns them.
Funding should be based on the typical cost of services that meet these quality benchmarks.
We don’t need to restart old political wars. We need to see intelligent modern policies that target what matters directly.
The care of older generations is too important to settle for anything less.