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CoAG and national health reform « Previous | |Next »
February 11, 2011

Paul McClintock, the chairman of the CoAG Reform Council, has pointed out that COAG's role had changed in the past two decades - from being ''an occasional summit meeting of domestic political leadership'' to being charged with ''the paramount leadership role in the federation, including detailed oversight of the implementation of federally agreed programs''.

CoAG's policy goal is to use deregulatory and competition reform to create a seamless national economy in an attempt to drive productivity growth. The states have been dragging their heels on this and ending the federal-state blame game by stopping the blurring of ''who is responsible for what''.

The co-operative federalism under Rudd is giving away to a competitive federalism under Gillard as more and more state governments dump Labor for Liberal--WA, Victoria and shortly NSW. That means an a shift away from centralized authority; an emphasis on decentralization and local control; the rejection of mandatory conformity; introducing essential features of the market into politics; limiting the central government to the carrying out of protective or minimal state functions.

You can see the shift in health reform. Rudd had hammered out a deal to take about 30 per cent of the states' GST money to pay for an increase in federal funding of hospitals from about 40 per cent to 60 per cent. He also promised a big injection of extra Commonwealth money for growth in health spending. Gillard has ditched the bid for the GST and making the Commonwealth the dominant funder of health. The current strategy is to the states is for the growth money (now at least $16.5 billion) in exchange for the reforms.

What kind of reforms? The talk is about shifting the priority to a greater emphasis on primary and community care rather than hospitals; the commonwealth is proposing to take over the bulk of primary care services through the network of Medicare Locals; and the commonwealth will directly fund local groups of doctors and other health professionals to boost primary healthcare.

It appears that this involves measures to ensure that patients will find it easier to access local doctors after hours from July and the number of government-funded primary health services will increase.Patients will be given information about where they can find these health services, their opening hours will be publicised and the government will report on patient outcomes and rates of preventable hospitalisations. The government will also publish the rates of chronic disease in each community.

What was agreed to at CoAG was a financial (funding) package--centred around hospitals not a health package centred around primary care and consumers (ie., bringing allied health, dental and mental health care into primary care) and breaking the near-monopoly of Medicare funding by GP's.

Secondly, it is unclear how the Medicare Locals connect with the local hospital networks, the individual primary care providers, community health, and provide quality care in the absence of substantial funding. It would appear that Medicare Locals do not have the levers to turn this analysis of needs and primary care services done at a local level into action and improved services.

Tony McBride, the chairman of the Australian Health Care Reform Alliance, accurately sums up the significance of CoAG's health announcements:

Yesterday's COAG health announcements were not health reform. They do ensure that the Commonwealth will share the cost equally of hospital growth funding, somewhat improving the long-term sustainability of the hospital system. But the agreements will not do more to prevent people getting sick, and they will not do more to treat people early and support them with their chronic diseases in the community. Such moves would have decreased the number of people needing to go to hospital. That would have been health reform.

He adds that the most significant announcement is what is not there – it appears the Commonwealth will no longer take responsibility for funding all of primary health care. This loses the crucial opportunity to create a single (more rational and fair) primary health care system in Australia.

| Posted by Gary Sauer-Thompson at 8:32 AM | | Comments (6)


we do need a shift away from the medico-hospital conception of health care to primary and community care.

The hospital-centred model is expensive and limited---its good for managing acute trauma, for complex multisystem diseases and the stabilising and intensive treatment of acute and severe recurrent conditions. Hospitals are places where people only need to be because of acute clinical danger or where rapid assessment requires investigations of the highest technology.

Hospitals are not much help for health promotion, prevention and early intervention programs for prevention of severe disease, reduction in acute hospital presentations, and minimising the development of chronic disease states---diabetes, obesity, eating disorders, anti-smoking, mental health. These involve wider, multidisciplinary models of care

We have a sickness model, not a wellness model; the health system is provider-driven, not client- or community-driven; politicians only respond to vested professional interests, so we don’t properly fund the Australian communities’ top priorities of mental health, Indigenous health and physical risk factor prevention; and we have too many hospitals when we need these health resources out in the community.

The value for the health dollar lies in preventing people from being admitted to hospital by providing adequate community care.

Rudd promised big on health reform with his co-operative federalism. With coast-to-coast Labor state governments federal Labor would sort out the mess, get funding on an equitable footing, set higher performance delivery benchmarks.

I recall Rudd appearing for bedside pictures at hospitals all around the country selling health reform to create a new, more accountable system of health delivery.

the states are going to fight to retain their authority over their hospitals. They will argue, rightly, that the public hospitals of Australia are run by state governments and they'll continue to be run by state governments.

It's all about state's rights, but they also want the extra money from the feds for their hospitals. It's a debate about a functioning federalism in the 21st century.

The national pooled funding arrangement survived the CoAG meeting. So the shift to a single funder remains.

Alan Kohler in New agreement a healthy way to run the system says that the new independent national authorities will make the state health bureaucracies and hospitals much more accountable.

About time.