On Tuesday, the Victorian government trumpeted the biggest hospital pledge in the state election campaign so far.
A $5 billion to $6 billion upgrade and expansion to the Royal Melbourne Hospital and Royal Women's Hospital in Melbourne's inner-north, with the government committing an initial investment of up to $2.5 billion for the 12-year project.
It was the third day in a row the government had spruiked a major hospital project.
The Coalition has been on its own hospital pledge storm, piling up around $4.5 billion in pledges spanning Melbourne and regional Victoria.
What are the hospital pledges so far?
The government's recent set of hospital pledges is coming in at more than $6 billion:
- $5 billion to $6 billion upgrade to the Royal Melbourne Hospital medical precinct, with an initial investment of $2.5 billion
- $675 million for a new hospital in West Gippsland
- $560 million for upgrades at Monash hospital
- More than $1 billion to redevelop the Austin and Northern hospitals in Melbourne's north
- $290 million to redevelop and expand Wonthaggi Hospital
- Up to $1.05 billion to redevelop the Maroondah Hospital
This list of Coalition promises is coming in at a little under $4.5 billion:
- $900 million for the Royal Children's Hospital Werribee campus
- $750 million for a new hospital at Mildura
- $550 million to rebuild Caulfield Hospital
- $400 million for a new hospital in West Gippsland
- $400 million for a new infectious diseases response centre
- $400 million to upgrade Maroondah Hospital
- $340 million to redevelop Rosebud Hospital
- $300 million for a new Albury-Wodonga hospital
- $100 million for a cancer centre at Shepparton
- $75 million to redevelop Daylesford Hospital
- $60 million to redevelop Mansfield District Hospital
- $30 million to upgrade St Arnaud Hospital
- $25 million to upgrade Sandringham Hospital
- Guaranteed funding to keep the state's bush hospitals at Euroa, Nagambie, Neerim, Heyfield and Cobden open
You can see more detail on the parties' pledges across a range of policy areas, including broader health commitments, on our pledge tracker.
Why the massive focus on hospitals this election?
It's hardly surprising that the COVID-19 pandemic has sharpened Victorians' minds on the capacity of the health system.
"Even if a big chunk of the population never quite made it into a hospital, we were all focused on the capacity of the hospital system," University of Melbourne politics lecturer James Murphy said.
"So I think health is on the brain for voters, it was on the brain for the federal election as well, the Albanese opposition made a big deal out of health and making it easier to see a doctor and stuff like that."
Dr Murphy said the Coalition's early suite of health pledges and critiques of "under-investment" in the health system had politically freed up the Andrews government to play to a traditional Labor strength.
"I reckon if the opposition was not making big pledges on health, the Andrews government might feel a little bit more constrained to go all-in on health," he said.
"Health is a traditional Labor area, right, they're pretty keen to make big investments in it and one of the things that limits them is criticism coming from the opposition saying that they're spending heaps of money.
"So they've got a bit of a green light, or at least an amber one from the opposition to go big on health, which is why I think we're seeing much bigger numbers than we used to."
But familiar tunes are still ringing out from the parties.
On Tuesday, the government reminded Victorians of health sector cuts under the Kennett years, while Shadow Treasurer David Davis warned the Labor government was racking up billions of promises "on the credit card".
Are the hospital pledges the best bang for buck?
While hospital promises have generated election headlines, those running public health services are keen to see the reasoning behind the big-ticket pledges.
The Victorian Healthcare Association's Juan Paolo Legaspi said given the "unlimited demand" for greater support, the health system would always welcome investment.
But the group is keen to see more transparency around the greatest needs in the community and how they will be addressed.
"Government doesn't have unlimited amounts of money to spend on building new hospitals and health services," he said.
"It needs to have a multi-year plan and transparent conversation with the community about what's in store, what's in the pipeline.
"And that allows hospitals to plan and adjust their services accordingly."
Dr Murphy said from a political perspective, Victoria had lacked a decades-long infrastructure priority list for some time.
"Victoria is bad at having a transparent set of priorities, it's really good at saying 'surprise, we have a new project!'," he said.
"And half the time there's a nakedly political rationale behind it."
Do we have the workers to staff expanded hospitals?
Of course, new and expanded hospitals are a one-off cost to build, but staffing them with trained health professionals is an ongoing expense.
Both parties are promising to pour millions into plans to bring tens of thousands of nurses and other healthcare workers into the sector.
According to recent government reports, an additional 65,000 healthcare and community services workers are needed to meet demand and replace people who are retiring.
Mr Legaspi said training and making the most of the existing workforce and bringing in new workers should be a priority for whoever forms government after November 26.
"Workforce shortage is the most critical issue facing the health system right now, and it affects how the health system can respond to elective surgery wait times, or emergency department wait times," he said.
"It really boils down to how many people we have in the system, that's absolutely critical."
The association has also warned in recent weeks that rising inflation is effectively cutting hospital funding during a period of record-breaking demand and has called for a fresh approach to funding.
While hospitals have dominated recent announcements, Mr Legaspi also urged the parties not to neglect community health services, whose critical importance had been underscored by the pandemic.
"They've got a very important role to play in the future of our healthcare system … because they keep people healthy and out of hospital," he said.
Is there an upper limit to the pledges?
The Coalition has said it will fund its health pledges by shelving the government's controversial Suburban Rail Loop — although there are questions on whether that will be enough.
The government has indicated the detail on how it will pay for its multi-billion-dollar pledges will be revealed in the upcoming pre-election budget.
Despite the state's debt rising during the pandemic, Dr Murphy said the pace of pledges was unlikely to slow down.
"I think the promises will continue to be big, and we could still see more billions racked up as the campaign goes along," he said.
"But either side is probably going to reach a point, if it's in government, where they say 'we can't do all of it all at once, we're going to have to make some choices with each budget'.
"I think the limits are going to come later and the promises are going to stay big."
