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March 28, 2007
In his ‘Health Reform: Important but easy to overrate speech to the Australian Financial Review Conference at the Sydney Marriott Hotel on February 2007 Tony Abbott, the Minister of Health and Ageing, strikes a warning note about reforming Australia's health care system. He says that:
The “health reform” debate has three recurring themes: changing the way public hospitals are managed; “big bang” restructuring to end the blame game between Commonwealth and state governments; and renegotiating the Health Care Agreements in ways which keep the structure but change the outcomes.
This account overlooks the structuring themes around health workforce issues and the regulation of the health professions.
Regulation of health professions(medical and non-medical) is a health reform in the light of the failures of professional self-regulation to ensure public safety, most notably with the case of Dr.Jayant Paytel in Queensland. CoAG has moved in this direction with its proposal for a national registration and accreditation scheme under the National Reform Agenda. This scheme proposes a single regulatory body to ensure public accountability.
This shift to national registration is part of the CoAG's response to the Productivity Commission's important Report on Australia's health workforce.
Minister Abbott's reluctance for reform can be seen in his responses to CoAG's national registration and accreditation scheme in his speech to Global Access Partners Conference, Parliament House, Melbourne on 16 February. He states:
The draft scheme circulated last year proposed a single national health registration board with authority over all the professions. A national advisory committee (perhaps comprising the chairmen of the various national registration boards) now seems more feasible. This committee would meet regularly to discuss issues of common interest and would report to the Health Ministers' Council but would not have authority over the professions' individual national boards. It would operate in much the same way as the committee of medical college presidents, a sounding board for ideas and a forum for finding common ground.
This rejection of a single regulatory body that would ensure the accountability of professional self-regulation is a rejected by the Minister in favour of the continuance of self-regulation. Minister Abbott adds:
Some of the professions are concerned that any national health registration board could be used to determine function rather than competence. As far as the Commonwealth is concerned, national health registration is about guaranteeing public safety, enabling portability of practice and reducing red tape. It's not about changing existing professional demarcations.
That leaves the professions investigating and adjudicating public complaints against bad practice with little by way of public accountability, even though the history of self-regulation shows the health professions frequently closing ranks against the public so as to protect their own.
The Minister, it would seem, has been captured by the AMA, which is resolutely opposed to any regulation of its autonomy or self-regulation by a single regulatory body
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Paytel is a Qld regulation problem - not a national one. Any excuse for anything is used to move the responsibility to the federal government.
It has to stop. Federalism is a good technology and devolution will be important as globalisation continues. Innovation in a market-state has to be local, not national.