The complexity of the National Health and Hospitals Reform Commission report means it deserves a complex response, suggests Professor John Wakerman, Director of the Centre for Remote Health, a joint initiative of Flinders University & Charles Darwin University. He has filed this analysis for Croakey:
“The greatest understatement in the NHHRC’s final report is that ‘Opportunity for major health reform is rare and highly anticipated.’ It is indeed. This is a complex report that will require time to digest. However, at initial glance there is much to like about the Commission’s recommendations. And there are some disappointments.
The Commission recommends a strengthening of Primary Health Care (PHC) services, that will provide the solid foundation of the health system characterized by an enhanced emphasis on disease prevention, health promotion and consumer engagement,. It calls on the Commonwealth to take national leadership, and to accept responsibility for funding all PHC, aged, dental, mental health services and workforce development. It recommends a personal, patient held electronic health record for all Australians, and strengthening of e health systems generally. All of this is very welcome.
With respect to remote and rural health, the report focuses on more equitable funding by adjusting for MBS & PBS under-expenditure through per capita funding, adjusting for levels of sickness and increased costs of remote service delivery. It has responded positively to repeated calls for increased and nationally consistent payments for patient transport and accommodation to access services. The Commission also makes positive recommendations about supporting education and training across all health disciplines, and for preferential access to specialist training for remote and rural practitioners. It also recommends strengthening of research effort through a rural and remote health research program.
Indigenous health is a priority for the Commission and it recommends a National Aboriginal and Torres Strait Islander Health Authority, responsible for purchasing services, and ensuring clear accountability and quality. It recommends that all Indigenous people be eligible to enroll with PHC services (in contrast to the more limited voluntary enrolment recommended generally). This is already the case for many Indigenous health consumers. It also calls for investment in food security and enhancing workforce initiatives.
So far, so good. However there are disappointments.
The Commission is tentative in its recommendation for the Commonwealth to move slowly in taking responsibility for complete funding of public hospitals, and thus having one health system, one level of government responsible for it and truly ending the blame game.
Another disappointment is the Commission’s rejection of regional governance and service delivery mechanisms. This underestimates the capacity of remote and rural areas, and fails to build on existing successful regional models.
There will be much discussion and lobbying over the next few months. We are still to see the results of the primary health care strategy and preventative taskforce efforts. The government is to be congratulated on commissioning this much needed reviews. It needs to be bold and display the leadership expected in this rare opportunity it has afforded itself.”