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South Australia Health Review

Partner Institute: 
Centre for Health, Economics Research and Evaluation (CHERE), University of Technology, Sydney
Survey no: 
Marion Haas
Health Policy Issues: 
New Technology, Funding / Pooling, Benefit Basket, Responsiveness, HR Training/Capacities
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes yes no no no no no


The objective of this policy is to commission an independent review of the South Australian (SA) health system which will deliver a plan that provides effective strategies for health system reform and ensures that residents of SA have the best possible health, and have access to high standards of care.

Purpose of health policy or idea

The objective of this policy is to commission an independent review of the South Australian (SA) health system which will deliver a plan that provides effective strategies for health system reform.

The expected outcomes of the plan are strategies that reflect the values and principles of the health system, ensure that residents of SA have the best possible health and have access to high standards of care. In the recently released Progress report key aspects of a future health system for SA include:

  • Primary care networks (focussed on health promotion, disease prevention, early intervention, treatment and rehabilitation and providing services in the home and community)
  • Integrated community care services (visualised as serving 100,000 - 250,000 people, providing acute, immediate, diagnostic and treatment services. These could evolve from existing hospitals)
  • Acute hospitals (deliver more complex and specialised care, be centres for the introduction of new technologies, focus on teaching and research and provide 24 hour/7 days professional and specialist care.
  • Networked clinical services and statewide networks (some program areas such as child health could be networked across the health system. Others, such as emergency, trauma and cardiac services could be networked at a clinical level to determine the level of service required ay each acute hospital and integrated community care service)

The detailed strategies have not yet been articulated or plans proposed for their implementation, so statements about incentives are not possible.

Main points

Main objectives

  • to produce a plan which will enunciate strategies to ensure equity of access to health services, equality of health outcomes, consultation in developing plans for implementation, including participation by communities and individuals in the planning process

Groups affected

Population, Patients, Providers, Bureaucrats

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal rather marginal fundamental
Public Visibility very low high very high
Transferability strongly system-dependent rather system-neutral system-neutral

Political and economic background

  • There has been a recent change of government in SA.
  • The health system was last reviewed in 1973 and it has been identified that the current arrangements are not sustainable. Significant pressure is being felt due to:
  • Growing demand for services
  • Increasing community expectations
  • Workforce unable to meet demands
  • Inappropriate and inefficient configuration of services and infrastructure
  • State unable to meet the cost burden associated with increasing demand
  • These issues were considered best assessed by a wide ranging review.

Change of government

New governments often feel the need to put their stamp on important aspects of State responsibility such as health, education or law and order.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes yes no no no no no

Origins of health policy idea

  • The idea of a review is a political idea (ie an idea of the new SA government)
  • Reviews are relatively common in Australia, particularly in health as they allow many conflicting points of view to be aired and enable problems to be discussed and documented. In addition, it has become more common for medical and other clinical staff to be invited to provide input to strategic and planning for a. Recently, the NSW government commissioned a similar review (the NW Health Council) whose recommended changes are in the process of being implemented.
  • The SA generational report will be generated by the Committee (consisting of 9 expert members and 2 SA officials in supporting roles) who will undertake stakeholder consultations, including public meetings across the State and receive submissions from individuals and organisations.
  • The review has released a Discussion Paper and a progress report and the final report is due at the end of March 2003.
  • The final report will be responded to by the government and, depending on what the response entails, plans for implementation will be made public after March 2003.

Approach of idea

The approach of the idea is described as:
renewed: last such review in 1973

Stakeholder positions

  • At the time of release of the Progress Report (January 2003), 324 submissions had been received and 60 consultations had been undertaken. The messages received by the review have led to three important ideas:
  • The system is fragmented and changes are essential to move the focus of the system away from hospitals to community based services
  • The focus should be on the needs of the population rather than on those of institutions
  • The SA community must be involved in decision making to dispel misconceptions about the use of resources and opportunities to re-allocate resources to illness prevention and community health and health promotion services.
  • A discussion paper and progress report have been released.
  • The Committee is taking the lead in presenting the policies generated by the review.

Influences in policy making and legislation

  • It may be necessary to introduce legislation to change the structure of the SA health system once the final report has been presented and its recommendations adopted/rejected.

Legislative outcome


Adoption and implementation

  • In likely order of importance, the actors and stakeholders involved in the adoption process will be the SA government, the bureaucracy, providers and provider groups, administrative jurisdictions and consumers.
  • The means and extent of participation are not yet clear.

Monitoring and evaluation

It is not known at this stage, but some form of evaluation of the implementation of the review strategy is likely in the long term.

Expected outcome

  • The changes proposed to the SA health system are potentially substantial. Moreover, they envisage a fundamental shift away from institution-centric health care to population-based health care. For both these reasons, change will be difficult to implement. Institutions are large, employ many people and have many vested interests. The outputs and outcomes of institutions treating acutely ill people are easy to identify and measure (relative to those from community-based services or health promotion activities) and are inevitably sensitive issues for politicians. So, no matter how much health and/or economic sense the proposed changes make, it will require a great deal of political will to implement.
  • There is good reason to believe that the changes, if implemented, will have a positive impact on quality of care and equity as they are based on serving the needs of the population at a community level. However, despite some forecasts that costs will be reduced due to fewer people requiring hospital care or expensive care (as they will be treated at home or in the community or their problem will be prevented), in the short term (ie over the next 5-10 years) costs reductions are unlikely.


Sources of Information

South Australia Health System Review, Discussion Paper, Progress Report (01/03), see website

Final report due end of March 2003

Author/s and/or contributors to this survey

Marion Haas

Suggested citation for this online article

Marion Haas. "South Australia Health Review". Health Policy Monitor, May 2003. Available at