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A quick guide to the National Health and Hospitals Reform Commission report

You can read the report in all its detail here, but in the meantime, here is a quick summary.

The executive summary identifies several priorities, including:

Indigenous health

• Establish a National Aboriginal and Torres Strait Islander Health Authority to buy services and to hold services accountable

• Strengthen community controlled health services, develop Indigenous health workforce and upskill existing workforce to provide culturally appropriate services

• Improve nutrition in targeted remote Indigenous communities

Mental health care

• Expand sub acute services in the community

• All acute mental health services should have a rapid response outreach team available 24 hours a day

• National access to youth friendly, community based services for encouraging good mental health in young people

Rural and remote

• Top up funding on a per capita basis to ensure receiving equivalent funding as well-served communities

• Increased funding for patient travel and accommodation

Dental Care

• A new universal scheme for access to basic services, Denticare Australia

• Expansion of preschool and school dental programs

Public hospitals

• Public hospitals with major emergency departments be funded to ensure enough beds are available

System redesign

• Establish National Health Promotion and Prevention Agency

• Strengthen primary health care with Comprehensive Primary Health Care Centres and Services to be established with extended opening hours

• Voluntary enrolment in a ‘health care home’ to encourage better continuity and coordination of care for people with chronic diseases and disabilities

• Current divisions of general practice should evolve into or be replaced by Primary Health Care organisations

Next generation of Medicare

• The Medicare Benefits Schedule should be “reshaped”, with the Commonwealth to decide what services should be covered and by whom they should be delivered

• A range of payment mechanisms including mix of salary, fee for service, grants, performance payments

• The Commonwealth should have full policy and funding responsibility for primary health care, basic dental care and aged care, as well as responsibility for buying health services for Aboriginal and Toress Strait Islander people

• The report lays open the way for the Feds to take over responsibility for health funding entirely. Initially the Feds would pay 100 pc of efficient cost of public hospital outpatient services with an agreed, capped activity-based budget and 40 pc of the efficient cost of every public patient admission to a hospital sub acute or mental health care facility and every emergendy department attendance. The Feds share could  be incrementally increased over time until it is completely responsible.  Under Medicare Select, the Commonwealth Government would become the sole government funder of health services, and all Australians would automatically belong to a health plan either operated by government, the not for profit sector or private enterprise. The NHHRC has recommended that over the next two years, the Feds explore the benefits, risks and feasibility of this recommendation.

In other words, two of the really hard-edged recommendations of the report – fundamental changes to the MBS and Medicare – are likely to be delayed long enough so as not to cause any pre-election grief for Rudd and co. It may also be worth noting that the report’s very first recommendation stresses the importance of private health insurance. Recommendation 92 adds: “We want to see the overall balance of spending through taxation, private health insurance, and out-of-pocket contribution maintained over the next decade.”

Strengthened consumer engagement and voice

• Build health literacy, eg as a core element of the National Curriculum in schools

• Foster community participation through citizen juries etc

• Every Australian should have a personal electronic health record that they own and control – by 2012

The Commission estimates the annual recurrent costs of their reforms are between $2.8 billion and $5.7 billion. A capital investment over five years of $4.3billion-$7.3billion is also required, they say. These figures do not include the costs of Denticare Australia, which it is estimated will cost the Feds $3.6 billion annually.

You can read more here from Crikey’s political correspondent, Bernard Keane.

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