|Implemented in this survey?|
Australia's Productivity Commission released a report in December 2005 recommending a large number of reforms to do with the training, demand, supply and distribution of Australia's Health Workforce. This survey reports on the problems and recommendations identified by the Productivity Commission, as well as the Government's actions in the area of workforce reform since the release of the report.
In June 2004, the Council of Australian Governments (represented by the heads of each of the national State and Territory Governments) invited the Productivity Commission to investigate health
workforce issues, including the demand and supply pressures over the next 10 years. The investigation took a broad, whole-of-government perspective, including health and education
considerations for the full range of health workforce professionals. The Council instructed the Commission to look at the particular health workforce needs of rural areas.
The Productivity Commission is the Australian Government's principal and influential review and advisory body on microeconomic policy and regulation.
The objectives of the analysis were to:
None of the recommendations contained in the Commission's report directly target the demand side of the health workforce, but do impact on the supply side. A number of these are
structural recommendations that will impact on the professional group's control over workforce numbers.
Some recommendations will make it easier for the health care workforce to become more mobile. For example, current registration procedures are State based and impose barriers for the workforce to relocate. The Commission recommends a national registration agency to reduce variation in standards, duplication and enhance mobility.
Another set of recommendations target Australia's Medicare payment system. Medicare is a fee for service system that subsidises health care services provided by medical practitioners. Medicare has, for a long time, been restrictive in the sense that it inhibits innovation and flexibility in the provision of health care services other than medical practitioners. The Commission recommends that the Government introduce rebates for a wider range of delegated services and thereby encourage better use of available health workforce skills, beyond the current medically qualified base.
Professional groups and medical providers
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The recommendations do address several structural deficiencies in Thus far, some of the potential 'losers' have only expressed public concern over these issues but have not manifested themselves
into a large public debate. But of course this may change once the Federal Government starts considering implementing these recommendations. Public visibility may rise as the stakes get
These recommendations are a reflection of the idiosyncratic nature of the Australian Health Care System. However, recommendations that reduce monopoly power, and create a more flexible workforce have universal applications.
During the 1980's and 1990's there was a general view that Australia had an over-supply of health workers. This view changed around the turn of the century when, very suddenly, there was a perceived shortage. This was primarily evidenced in three ways:
Prior to the emergence of evidence on workforce shortages, the government's policy towards the workforce has been to restrict numbers. This general restrictive policy saw initiatives such
as limiting the number of university places, immigration restrictions and restricting access to Medicare provider numbers (such numbers are needed in order for a provider to
be eligible for Medicare subsidies).
The most immediate political problem associated with workforce shortages are barriers to health care access in form of higher out-of-pocket fees and waiting lists/times for emergency departments and elective surgery in public hospitals. Both issues attract considerable media attention and are important political problems at both the national and State government levels.
|Implemented in this survey?|
The majority of ideas contained in this report are not new. A large number of professional groups have been trying to get access to Medicare subsidies for a long time. For example, midwives' associations have unsuccessfully lobbied successive governments for their own Medicare subsidies. Until recently, these calls have been rejected and Medicare has remained within the domain of medical providers (with the one exception of optometry). What has changed over the last few years is the Medical workforce environment - from a perception of oversupply to one of shortage. As mentioned earlier, workforce shortages pose significant access, and therefore political problems. This change has meant that the Government may be more receptive for calls of widening Medicare eligibility. Furthermore, there is now a stronger economic argument in that
The approach of the idea is described as:
As with most Productivity Commission inquiries, organisations and members of the public are invited to make submissions. These submissions become public documents and may become part of
the final report. The various professional groups' positions were in line with what would be expected. Those groups that stood to lose from the Commission's
recommendations opposed them and those that stood to gain agreed with them.
The Federal Department of Health and Ageing supported allied health professionals providing primary care type services that are currently being met by general practitioners. This is perhaps a surprising position given their previous record of opposition to widening Medicare eligibility.
Thus far, we've categorized stakeholders' influence as 'neutral'. This is because of the nature of independent inquiries by the Commission. The influence of certain groups may change once these recommendations are considered for implementation.
|Medical provider groups||very supportive||strongly opposed|
|Non-medical provider groups||very supportive||strongly opposed|
|State and Federal Health Departments||very supportive||strongly opposed|
The Productivity Commission's report has not resulted in any legislative changes or input thus far.
|Medical provider groups||very strong||none|
|Non-medical provider groups||very strong||none|
|State and Federal Health Departments||very strong||none|
The Commission's report was only released in January 2006 and thus it is still early days to report on the adoptions and/or implementation of any of the recommendations. However, there already two
examples where the Coimmission's report has had direct or indirect impact. These are:
1. At a meeting of Australian national, state and territory health ministers on April 7 2006, participants agreed to a national scheme of portable medical registration to improve the mobility of the Australian medical workforce. The portability scheme will enable a medical practitioner who has been granted portable registration by one state or territory medical board, to practise in any other state or territory in Australia without having to:
Health Ministers endorsed proposed legislative changes for establishment of the portability scheme, and for jurisdictions to use their best endeavours to make the necessary amendments to their
legislation by June 2007.
2. The Federal Government has announced that it will create a Medicare item for psychologists - making them eligible for Medicare subsidies. This reform has the intention of providing greater access to psychology services and potentially reduces demand for general practice consultations that dealt with mental health issues.
The overall aim of the Productivity Commissions report has been to make recommendations that will improve the flexibility of the workforce and reduce control over supply that currently resides
with some of the professional groups. It also aims to reduce the inherent anti-competitive side-effects of the Medicare program which provides public funding to a restrictive number of medical
provider types. If the recommendations are implemented and reduce monopoly power over training places, these would be a welcome reform.
However, the Productivity Commission has been very limited in its scope to make recommendations on the ways that providers are paid and its impact on the workforce.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
Standardising accreditation and registration processes should create a more mobile work force. This may impact on the mal-distribution of the work force in some geographic areas of Proposed
changes to Medicare will generate greater access to allied health care workers - which, in some instances, will substitute for primary care services that have traditionally been in the
domain of general practitioners.
However, as mentioned above, the Productivity Commission has taken a very narrow view of payment options and has taken Australia's current fee-for-service system as a fait accompli. This is despite the widespread evidence that such systems create incentives that are at odds with an efficient, well integrated and coordinated workforce.
In other words, making allied health services more accessible may very well be a good idea - but that doesn't necessarily mean that they too should be paid for under a fee-for-service arrangement.
The Productivity Commission's report on Australia's Health Workforce can be found at:
Kees van Gool