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Health reform: first steps? « Previous | |Next »
August 30, 2007

How far is the political system willing to push for reform of the health care "system", now that the problems of the current are coming to the surface, eg., adverse events and saving hospitals from closure or downgrading due to the lack of qualified staff. How is the health "system" to be reformed to meet the health needs of the ageing population? What instruments will be used to govern reform? Which political party--Liberal or Labor--shows more commitment to the reform process?

An insight can be gleaned from this recent op-ed by Leslie Russell in the Canberra Times Russell, a research fellow at the Menzies Centre for Health Policy says that the origin of the problems currently facing all public hospitals is the way in which public hospitals are funded:

by joint contributions from the Commonwealth and the states and territories through five-year Australian Health Care Agreements, and the lack of any incentives in these agreements for innovation to improve patient outcomes. When the last agreements were signed in 2003, the Commonwealth ignored calls for reforms around better integration of the primary, acute and aged-care sectors, information technology and e-health, quality, safety and workforce, and a push for better indexation of funding. The states and territories received almost $1 billion less under the 2003-08 agreements than expected, and the Commonwealth contribution to the costs of operating public hospitals has fallen so that is now about 40 per cent. The agreements have only one performance indicator on which funding is contingent [on] a commitment to provide public hospital inpatient services at an agreed level.

Russell, a former Labor health adviser to Julia Gillard, comments that at a time when the focus in health is turning to prevention, screening and better management of chronic illnesses, the Commonwealth's approach is a short-sighted one , as it rewards the provision of isolated episodes of treatment for illness rather than efforts to ensure ongoing health.

One can only agree with this interpretation. The five-year Australian Health Care Agreements between the Commonwealth and the States, which is due to be resigned, is not being used as a lever to reform the health care "system" in spite of CoAG's commitment to health care reform. Russell then pinpoints the exact failure:

The agreements fail to recognise that, increasingly, health services are delivered in day surgeries, outpatient clinics and patients' homes. They do nothing to provide resources to ensure that patients can access affordable GP services rather than attend busy emergency departments, and that there are residential aged-care beds for frail elderly patients so they are not left inappropriately in expensive hospital beds.

So which political party is in willing to tackle health reform? Russell argues that it is Labor. She says that its policy
begins the process of moving the funding relationship under the Health Care Agreements towards a greater focus on patient outcomes by offering financial incentives to the states and territories to implement programs to reduce avoidable hospitalisations and readmissions, reduce non-urgent emergency department presentations, tackle waiting times for elective surgery, and help get the frail elderly out of hospital into residential aged care.

What Russell shows is that we have the first steps being taken to a reform pathway. It is not one that begins to engage with the need to deal adverse events and the closure of professional ranks, the failure to keep the public informed of adverse events, the regulation of health professionals, a greater autonomous role of allied health professionals, or the challenge to medical hegemony in funding.

| Posted by Gary Sauer-Thompson at 7:16 AM |