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local control of health « Previous | |Next »
March 4, 2010

The authors of Putting Health in Local Hands at the Centre for Policy Development rightly argue that the health care system is more fragmented and duplicative, inequitable and less efficient than it might be.

They then suggest that "shifting health care governance and funding to regional agencies that are more responsive to the needs of communities would improve both equity and effectiveness in Australian health care."


They propose that all current health care funding from local, state and federal governments be pooled within a national agency and equitably distributed to local Regional Health Organisations (RHOs ) on the basis of evidence about health care needs.

They argue that the current emphasis on hospital care, rather than primary and preventive care, is increasingly recognised as inefficient and that there is broad agreement that effective primary care reduces health care costs and that improved access to primary health care services in the community would reduce unnecessary admissions to hospitals. However, our current system of primary care does not deal well with chronic diseases, nor does it work effectively with the acute sector.

To achieve more efficient and equitable outcomes it is not enough simply to shift resources from hospitals to health centres; we must address the social determinants of health and the inequalities of health in that the rich, urban, and healthy access more health care resources and services than the poor, rural, and sick.

| Posted by Gary Sauer-Thompson at 5:06 PM | | Comments (4)


The Rudd Government's proposal to appoint local clinicians and community leaders to the boards of new ''local hospital networks''.

The tendency is for boards to pursue local interests at the expense of overall capacity to fund projects.

local clinicians wanted to have more say in the running of their hospitals

James Gillespie in Health reform: the opening shot at Inside Story comments on the local control that the Rudd Government's plans for a National Health and Hospitals Network:

One paradox of Australian federalism is that states – often defended as “closer to the people” – have been remorseless centralisers within their own territories. As state governments gradually supplanted charities and churches as the direct funders of public hospitals, administrative control moved from local boards to departments of health or, at most, large area health services, with a lot of interstate variation. The displacement of local control made possible a better alignment of health needs and resources. Maternity and children’s hospital services were moved out of the old inner cities to the newer areas of growth.

He adds that the existing hospital boards often resisted these reforms and are increasingly seen as sclerotic, marked by political cronyism or dominated by conservative senior clinicians hostile to any change.

That process of centralization certainly happened in SA---administrative control moved from local hospital boards to the department of health.

Gillespie comments on the state's turn away from local control that the Rudd Government's plans for a National Health and Hospitals Network in his Health reform: the opening shot at Inside Story. He says:

This drive towards centralisation intensified the alienation of many working in hospitals, who felt disenfranchised by a system marked by administrative instability – constant reorganisation for the sake of it – and driven by faceless bureaucrats ignorant of the real problems of those dealing with overcrowded wards. Centralisation also blurred lines of accountability.....A key problem, particularly in New South Wales and Queensland, is that central micromanagement means every problem, however technical or best managed at a local level, moves straight to the minister’s office, intensifying the politicisation of the health system.

In Rudd's scheme many problems would be localized rather than move straight to the minister’s office.