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bureaucrats redesigning the health workforce? « Previous | |Next »
May 4, 2007

I attended the national Health Workforce forum in Melbourne yesterday. The forum is designed to help implement the National Health Workforce Strategic Framework, which addresses health workforce shortages and maldistribution against a background of demographic change, new technologies and empowered consumers.

This policy reform is concerned less with the continuation of the status quo with ever larger numbers of doctors and health care professionals and workers,which seems to be the position of many state premiers, and more about future changes in the kind of health workforce in Australia. For instance, the Health Workforce Strategic Framework recognizes that the more difficult issue will be that:

the types of healthcare workers may change and that these changes will be deeply impacted by technology. So ensuring the right practitioner mix will be crucially important and this is likely to involve a mixture of new disciplines and new roles for old disciplines. Boundaries and established professional roles will need to evolve; and new knowledge and skills be acquired, maintained and expanded. In turn, all this will place a greater focus on the length of education and training and the content of education and training programs.

So what we have is decade-long state planning in a neo-liberal world. The mixture of planning and market forces undermines the conventional view that the struggle against socialist planning in a social democratic Australia is over.

Friedrich Hayek or Milton Friedman, of course, would have regarded this kind of planning as presupposing the elitist belief that naive rationalist bureaucrats can be trusted to advance the public good and denounced this planning as socialism by the centralized state as interference of the state in the life of the individual. If cutting taxes is often advocated as a way of constraining the centralized, planning state, then the critique would be directed at the knowledge presupposed by the planners.

Contemporary neo-liberals would, no doubt, follow Hayek in firing their well directed arrows at the fatal conceit of the bureaucrats--their undue faith in the power of a 'constructivist rationalism' to subject society to control through planning, and so ignores the fact that civil society is a "spontaneous order".

However, the current situation more complicated than that, since the rational bureaucrats know that the impetus or driver of major reforms to make the health system more responsive to patient needs, and more focused on preventative primary care , will come from consumer pressure----ie., Friedman's consumer sovereignty. Consumer pressure will motivate the reform-fatigued politicians to continue with ongoing reform of the health care system.

Of course, the neo-liberal heirs of Hayek and Friedman interpret consumer sovereignty in terms of the egoistic drives of possessive individuals pursuing their desires and so focused on finding happiness in financial wealth and consumption. However, the health consumers are not short-term utility maximizers of neo-classical economics as they are concerned about health, and preventing themselves from becoming sick and and wellbeing. What we have is a new politics of well being.

In Australia the politics of wellbeing, that is based on policies of time and care, is argued for by Clive Hamilton at the Australia Institute, and the way it understands wellbeing can be seen from The Wellbeing Manifesto.

However, it is true that in a neo-liberal mode of governing health financing is the major driving force behind reforms. Whereas equity was the dominant issue of earlier decades, the 1990s saw it displaced by the issue of financing and expenditure. Tjis is more than cost containment, as there are changes in the underlying principles of the health system, since health care becomes a 'commodity' and care recipients 'consumers'. Greater emphasis is placed on goals such as increased outputs for decreased inputs, performance and efficacy, quality assurance and financial accountability, and evidence-based evaluation.

| Posted by Gary Sauer-Thompson at 12:37 PM | | Comments (2)
Comments

Comments

It is comforting to realise there are some who are not only familiar with neo liberal thinking, particularly in its current bastardised form, but are prepared to take productive time from their busy days to reduce it to comprehensibility for the 'laity'.
The means of presentation of it as to its original goals, the (ab)use of its theoretical form as part of its adaptation as ideological alibiing mechanism for reinforcement of the current ignorance-based and dark ages hierarchical power structures has me inclined to ask Gary if he can recommend some sort of definitive introductory literature which examines neo liberalism, including in its morphing (corrruption?) into ideology over time, and resulting contradictions inevitably thus arising, in a comprehensive but comprehensible way, after for example, his above comments.

Paul,
A good start is to read Milton Friedman's text Free to Choose.

Another classic text is F.A Hayek's Road to Serfdom A detailed account of Hayek's work is John Gray's F. A. Hayek and the Rebirth of Classical Liberalism".