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Skeketee: the politics of health reform « Previous | |Next »
August 20, 2009

Mike Steketee in Stumbling blocks on the journey to better health in The Australian highlights the key proposals of the National Health and Hospitals Reform Commission's final report. The recommendation is for the commonwealth to take full responsibility for primary healthcare, including presently shared responsibilities such as dental and aged care, as well as community services such as alcohol and drug treatment and mental health now run by the states.It suggests a shift away from fee-for-service medicine, which pays doctors for quantity rather than quality, to increased use of payments that reward outcomes or pay for the overall care for patients with chronic conditions.

Steketee argument is that though Kevin Rudd sounds deadly serious about wide-ranging reforms in health the question is whether the system, the politics and the economy will allow him to make them.

He does not sound like someone who has given up on health reform. But with the states already baulking over increased commonwealth responsibilities, it is hard to see how true health reform is compatible with the co-operative federalism in which Rudd has invested so much effort, unless a big commonwealth bribe to the states can do the trick.

Steketee adds that the National Health and Hospitals Reform Commission's final report caused relatively little offence, with a muted reaction so far from the AMA and supportive noises from the private health funds. That Rudd did not want the commission to look at the 30 per cent private insurance tax rebate helped with the politic.

Steketee's judgment is that the final report:

leaves an obvious gap: although the report dwells on growing pressures on health from increasing demand, technological advances and ageing, and says the system has reached a tipping point that requires tough decisions, it ignores the $4bn a year or more spent on subsidising private health insurance, the most inefficient use of government resources anywhere in health and an amount that would make a big difference if it were spent directly on hospitals, whether public or private. Talk about the elephant in the room.

We can put aside the rhetoric about "fundamental root and branch reform". This will be evolutionary change within political limits. of the possible.

| Posted by Gary Sauer-Thompson at 12:37 PM |