The coronavirus pandemic has led to many judgements based on very limited data, often inescapable uncertainty, among which have been judgements of the comparative performance of different institutions, both political and market.
One that has emerged recently from the Victorian experience, and which has been championed by the ABC’s Norman Swan, is the comparative performance of private and public aged care homes. Private homes (among which he counts ‘for profit’ and ‘non-government’ institutions) appear to have much higher rates of Covid infection, something which surely is a Bad Thing.
While Swan’s Coronacast has been admirable for its clarity and near-complete disregard of the excesses of political tribalism, the Health Report, which he has presented for decades, has toyed with selective data-interpretation that flatters Swan’s avowedly social-democratic and anti-market prejudices, previously manifested in opposition to private pharmaceutical business, support for the centralised Pharmaceutical Benefits Scheme and scepticism toward private practice by the medical profession. Swan it will be recalled first came to justified attention by revealing the poor scientific practices of William McBride, so it is regrettable when he uses his platform to jump to convenient conclusions.
Yesterday’s Health Report covered the apparently poorer performance of (mostly urban) private aged care homes compared to the (often rural) public homes.
In Swan’s hands, this is a matter of the absence of continual supervision by people holding occupational licenses – Registered Nurses – echoing a long-standing campaign by the nurses union to require the (expensive) employment of its members; as well as disparagement of the training and care delivered by casually employed lay staff, all sacrificed either to ‘lack of funding’ or the ever-evil profit motive. (Swan appears to have forgotten the damning findings of the Royal Commission into South Australia’s government-run Oakden Older Persons Mental Health Service). A link is here.
While the differences between institutions may be a contributor to their performance – there are reasons to be sceptical about the performance of both for-profit and ‘not for profit’ operators in the Australian aged care ‘market’, which features numerous policies designed to prevent entry, competition and choice by patients and their families – it is folly to jump to conclusions about comparative performance without considering context.
Here, a paper linked on Marginal Revolution provides some insight: a chief mode for transmission is the employment of staff in multiple homes.
Presumably this occurs more readily in private homes in urban rather than rural labour markets, where opportunities will be fewer; and among the less unionised carer groups. If so, that’s a useful, and perhaps foreseeable, insight – but not something that flows inherently from the profit motive or the governance of the operator. It is something one would expect could be managed by the personnel offices of each organisation. It’s a problem that might well arise in the public sector, if staff were allowed to move between state operated homes.
By focusing on whether homes are state or independent, Swan likely misses the cause of the problem, and champions an illusory solution.