|Implemented in this survey?|
The new national government in Australia has set aside AUD6 million to fund a National Health and Hospitals Reform Commission. The main aim of the Commission is to "develop a long-term health reform plan for a modern Australia". The Commission comprises a Chair, and 10 part-time commissioners who represent a range of experience and perspectives, but are not representatives of any individual stakeholder groups. An interim report will be produced by the end of 2008; a final report by mid-2009.
The Commission has been established to develop a long-term health reform plan for a modern Australia. Its terms of reference are to provide advice about how to:
a. reduce innefficiencies generated by cost-shifting, blame-shifting and buck-passing;
b. better integrate and coordinate care across all aspects of the health sector, particularly between primary care and hospital services around key measurable outputs for health;
c. bring a greater focus on prevention to the health system;
d. better integrate acute services and aged care services, and improve the transition between hospital and aged care;
e. improve frontline care to better promote healthy lifestyles and prevent and intervene early in chronic illness;
f. improve the provision of health services in rural areas;
g. improve Indigenous health outcomes; and
h. provide a well qualified and sustainable health workforce into the future
The formation of the Commission was an election promise given by the Labor Party. An important election issue was the extent to which the States and the national government could work together constructively - especially in relation to health policy. Under the previous Liberal government, the extent of cooperation between it and the states (all governed by Labor administrations) had reduced substantially over time. Now that all governments in Australia, both State and Federal, are Labor, it is important that they be seen to be able to work cooperatively together. In the short term, their capacity to cooperate will be tested as new 5-year Australian Health Agreements are being negotiated between the Commonwealth and the States. As a first step, the Commission has been asked to provide advice on the Agreement - but as the Commission has only just commenced work, the date for a final agreement has been postponed.
To establish the National Health and Hospitals Reform Commission, which has as its main aim the provision of advice on performance benchmarks and practical reforms to the Australian health system, which could be implemented in both the short and long term; to address these challenges.
The results of the Commission's work may lead to changes in both financial and non-financial incentives, but the only incentive the Commisison has is to complete its work by the specified time and be seen to contribute to greater cooperation among the States and the national government on issues of health policy.
National govennment, State governments, Health services
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The use of a commisison of experts is not a new idea. So far, it has not generated any controversy but may do so, at least with respect to some recommendations or to the extent to which the govennment accepts its recommendations. The long term implications may be fundamental, but, especially given that not all issues are able to be addressed by the Commission, the short term impact is likely to be neutral at best. At the moment, the work of the Commission is not visible to the public. No workplan has been released. There are plans to develop a website, but this has not been done as yet. Given the importance of the Commonwealth-State relationship in the development and implementation of health policy, the need to re-negotiate the Australian Health Agreements (which has been postponed until later in the year), the rivalry between the states for federal money and the power of providers to maintain the status quo, what recommendations are made by the Commission and the reaction of the various governments will be influenced by the context of the Australian political and health systems.
In November, Australians elected a new national Labor government. After more than 10 years in opposition, the Labor Party has many policy ideas regarding health and health services. Moreover, the change of government has provided interest groups with the opportunity to put forward their ideas about health policy. The formation of the Commission has focussed the attention of interest groups and many have provided public comments about the composition of the Commission as well as advice to the Commissioners about the issues they should address. There has been unprecendented press coverage of health issues since the election of the Labor government. Despite the formation of the Commisison, the new government has announced a number of new policies. Issues such as national reporting on the safety and quality of care provided by hospitals and individual surgeons, a review of the schedule of fees under which the government pays for ambulatory medical services, targets for Indigenous health and changes to mental health and dental health treatment arrangements and funding have generated public debate. Meanwhile, the federal Minister for Health has recently approved requests from the PHI companies for a rise in premiums. Some academic groups have called for fundamental reform of the health system, seeing the new government and the formation of the Commission as an opportunity to advocate for an end to duplication of funding and services.
A new national Labor government was elected in November 2007. Among promises made during the election, the Labor party committed to the formation of a Health Reform Commission and promotion of cooperation between state and national governments.
|Implemented in this survey?|
The idea of a national commission was generated as a Labor party policy. It was articulated during the election campaign; the terms of reference and the members of the Commission were announced soon after the election. Apart from deadlines, little information about the workplan of the Commission has been released.
In the 1970s, the Whitlam Labor government used legislation to establish the Hospitals and Health Services Commission. Its work, which has been described as a blend of study and action, was very successful. In the 1980s, the then Labor government implemented a National Health Strategy which was led by a current Minister in the Rudd Labor government, Jenny Macklin. Both initiatives demonstrate the value of a national entity with sufficient resources to analyse data, develop appropriate policy proposals, provide advice about translating them into programs and implementing rigorous evaluation mechanisms.
The approach of the idea is described as:
new: In the recent past, such a body as the Commision has not operated in Australia.
There is overall support for the idea of a body to produce recommendations about a coordinated set of short and long term health policies. However, there has been some criticism of the terms of reference and the membership of the Commission. For example, the terms of reference do not mention or include private health insurance. PHI policies were among the most contentious of those introduced by the former government. In addition, the chair of the Commission is the chief medical officer of MBF, one of the largest PHI funds in Australia.
|Government||very supportive||strongly opposed|
|Providers||very supportive||strongly opposed|
|Scientific community||very supportive||strongly opposed|
|Media||very supportive||strongly opposed|
|Scientific community||very strong||none|
The Commission will meet (although it is not clear how often, given that the members are part-time). It will also consult other stakeholders in formulating its recommendations. However, it is not clear whether or how much independent research or evaluation will be commissioned by the Commission and how this will be organised.
No plans for implementing or evaluating the recommendations of the Commission have been announced.
There is no doubt that the Commission will produce both interim and final reports providing advice and making recommendations about performance benchmarks and practical reforms to the Australian health system, which could be implemented in both the short and long term. However, the extent to which these are accepted and adopted is less certain. Although the terms of reference of the Commission refer to better integration of care and improved access to care for Aboriginal people and people living in rural areas, it is not clear whether the Commission will make detailed recommendations about issues such as the incentives that might be required to achieve these objectives. At this stage, it is not possible to anticipate undesirable effects or effects on costs, quality, access etc. As individual policies are proposed and/or accepted by the government, it will be possible to predict their likely effects.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
The impact has been rated neutral because it seems unlikely that any short term changes will have a fundamental impact, and it is not possible to anticipate what long term changes might be proposed or introduced.
"Robust debate a medical certainty for commissioners". The Australian. February 26, 2008
"Wider Medicare. A reform call". The Australian. March 1, 2008.
"Nurses could step into GPs' shoes to relieve shortages, study suggests". The Sydney Morning Herald. March 3, 2008.
"Health funds ready to inflict more pain". The Sydney Morning Herald. March 10, 2008
"Patients to check fatality rates". The Australian. March 25, 2008
"Rudd's hospital revamp". The Australian. March 25, 2008
"Aboriginal health policy requires a dose of strong medicine". Canberra Times. March 25, 2008
"Health system set for big injection, not for doctors". The Sydney Morning Herald. March 26, 2008
"Health reform can learn from the past". The Canberra Times. March 27, 2008.
"Mental health program faces axe". The Australian. March 31, 2008
"Dental scheme more about 'spin' than treatment". The Australian April 1, 2008