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Evaluating CoAG reforms « Previous | |Next »
March 27, 2008

So what do we make of CoAG's Adelaide agreements on health? Is it historic? Hardly. Public hospitals will receive an extra $1 billion after state governments warned Rudd they could not they could not meet his challenge to lift their health performance on current funding levels.

That extra interim funding of $1billion - $500 million in new money and another $500 million over last year's funding levels to match rising inflation---restores some of the reduction in funding under the Howard regime.What had been for years had been a 50-50 funding deal between states and commonwealth had turned into a 60-40 deal under Howard.

However, the new money will not be subject to strict performance reporting levels promised by the Prime Minister to improve hospital efficiency by making states more accountable for how they spend public money. So it is just more money for the states with no strings attached. The states only agreed to work creating performance benchmarks across all areas in which they receive common wealth grants. Why not performance benchmarks for state health funding as well? The states appear to interested in wanting to get as much money out of the Commonwealth as possible and not in a fundamental redesign of Australia’s health "system".

Will this kind of accountability be argued for by the newly created National Health and Hospitals Reform Commission? We will have to wait and see. The Commission has wide terms of reference though.

Is the Adelaide health agreement a step in the reform process that was blocked by the previous Howard Government ?

The National Registration and Accreditation scheme went through, despite the AMA's objections. The details are unclear. That reform has been a long time coming and it is long overdue. But it's no great reform shift. It is even unclear how far the movement from self-regulation has been or how it is connected to other reforms.

The workforce plan to create 50,000 health training places for enrolled nurses, dental health workers, allied health professionals, ambulance officers and Aboriginal health workers was agreed to Such a contrast to the Howard Government focus on solely creating more doctors, and it is a belated response to health workforce crisis that has been building since the 1990s.

Will there be problem filling the training places? Are people attracted to this kind of work? Will the states boost the wages of nurses in the public health system to attract the nurses? Unlikely. We seem to have disjointed incrementalism, a process where policy initiatives are made in isolation rather than against a background of a broad strategic vision for the system.

The implication is that this CoAG meeting did not have a reform agenda that actually delivers better health outcomes. Maybe the Rudd Government is awaiting the work of the National Health and Hospitals Reform Commission key issues of chronic disease, ageing of the population and rising health costs).These will require solutions based on workforce reform and restructure, including clinical role substitution and a greater focus on multi-disciplinary care, the exclusion of experts from the non-medical health professions.

Will the Commission find ways to overcome the power barrier to the identification of innovative approaches that don't place doctors at the centre of the health system?

| Posted by Gary Sauer-Thompson at 9:12 AM | | Comments (3)
Comments

Comments

So it is tinkering around the edges then? What happened to Rudd's promise of root and branch reform?

Nan,
The Centre of Policy Development says that:

...successive governments have examined our health care policies and done little more than slap on some sticking-plaster and send the more demanding patients away with a jellybean.

At the moment it does look as if the Rudd Government is continuing this tradition in spite of all the root and branch reform rhetoric.

Still, there are opportunities opened under Rudd that were kept closed under the Howard regime that say health in terms of GP's, drugs and private health insurance.

Gary
you missed the Aged Care component. The Rudd Government's aged-care package $158million to fund 2000 "transition beds" over five years, and $300million in interest-free loans to fund 2500 additional aged-care places.This will free up acute-care hospital beds now occupied by elderly patients awaiting placement in nursing homes.

Is this a short-term policy response, which may well achieve its objectives, but does not adequately addressing the long-term challenges posed by the ageing of the population?