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A Healthier Future for all Australians: key proposals « Previous | |Next »
February 19, 2009

The National Heath and Hospitals Reform Commission's interim report---A Healthier Future for all Australians is the first major cut at reforming the heath system; a reform process that has been consistently opposed by the AMA and the private insurance industry. Reforming and refocusing health-care systems is difficult, and new ideas provoke stakeholders' prejudices and vested interests.

The key proposals of the interim report are:

- Commonwealth takeover of primary care
- Universal dental scheme, called Denticare Australia, funded by an increase in the Medicare levy
- Accommodation bonds be permitted for high care residents in aged care facilities
- Nurse practitioners and other health professionals in remote and rural areas to be able to provide services covered by Medicare and prescriptions covered by the Pharmaceutical Benefits Scheme
- Creation of a patient-controlled e-health record, which could be accessed, with the patient's agreement, by multiple health professionals
- Delivery of wellness and health promotion programs by employers and private health insurers
- A youth-friendly community-based service to provide information on sexual health and mental disorders to be rolled out nationally
- A share of commonwealth hospital funding to the states to be tied to meeting or improving progress performance targets, payable as a bonus
-Three options were suggested relating to the structure of the health system. The most radical option is a commonwealth takeover of the system, with compulsory social insurance

This is a first cut since it does not integrate physical health and mentally health and avoids the opportunity costs implicit in the $4 billion spent annually on private health insurance rebates. The centre piece of the National Heath and Hospitals Reform Commission's reform is oral health-----bringing it into Medicare in the face of opposition from the dentists. Denticare is universal dental insurance that is funded by increasing the Medicare levy by 0.75 per cent.

The Australian Dental Association argues that the Government should target the 35 per cent of the community who could not access or afford proper dental care and said it would be fiscally irresponsible to introduce a universal scheme for dentistry.The Association for the Promotion of Oral Health argued that the Denticare scheme would create a two-tiered system, whereby federal funding would be simply given to the private system.

Alan Fels in The Age makes some good points about workforce issues. He says:

For too long, the health industry has relied on 19th and 20th century financing models and rigid professional roles to deliver 21st century care. The Prime Minister went to the last election promising real reform. But the real issues go well beyond resolution of federal and state responsibilities.The lesson from the 1980s and 1990s in other non-responsive industries was that real increases in productivity and improvements in quality were hard to achieve without genuine workforce reform....Sadly, our Medicare system pays top dollar for single practitioners to work on their own and see the same people each time they come back for care. The system actually penalises those who spend real time with those in trouble and those who work with other health professionals.

Australia is stuck in a mode of service delivery based on historic professional roles in which health professionals have jealously guarded their roles for a long time. As with all industries, there comes a time for a fundamental rethink of the way human resources are deployed, roles, responsibilities and reimbursement.

| Posted by Gary Sauer-Thompson at 5:53 AM | | Comments (1)


The commission argues that the health system should meet the entire range of people's health needs, including what is happening in their mouths. Or as one person quoted in the report summed it up: "If you've got a boil on your bum, it's covered by Medicare; if you've got a boil on your gum, it's not."

Looks to be a good argument to me