ABSTRACT
Hospitals are without doubt the key institutions of the health sector, accounting for over one-third of total health expenditure. The public often frames health care in terms of hospital care, and the images of the hospital operating theatre and hospital emergency department are regularly used as images of health care generally. However, the nature of acute health care services is changing. Patients are increasingly being maintained in the community with support from a hospital, and quite sophisticated surgical procedures can now be done without an overnight hospital stay. The Coalition government from 1949 de-emphasised direct Commonwealth involvement in and responsibility for access to hospital services, and pursued policies to encourage private health insurance as a way of consumers covering the cost of hospital care. Improvements in measurement will also be necessary to respond to the ideologically inspired wave of privatisations of hospital care. The sine qua non of any contract is specification of what is being bought and sold.
