As we’ve heard in the last few days, the Federal Government has dropped plans for a National Funding Authority, which was announced as part of its health reform package, to oversee the distribution of money to state funding authorities for local health and hospital networks (see here and here for reports in The Australian, and this from ABC radio).
Does this matter?
Perhaps not as much as some of the headlines are suggesting and perhaps not as much as some of the bigger picture issues, says Andrew Podger, a former Federal Health Department Secretary and Public Service Commissioner.
“Nicola Roxon is mostly right. Dropping the National Health and Hospitals Network Funding Authority will not change anything substantial in the Government’s health reforms. The state-based Funds (with boards including both state and federal representatives) will still be there to introduce activity-based funding of Local Hospital Networks.
But it does highlight the unfortunate compromise made with Premier Brumby that leaves the states with exclusive authority over much of the design and management of the Local Hospital Networks and constrains ability to achieve a central objective of reform concerning a more flexible and integrated health and aged care system.
Hopefully the Government’s move to direct the moneys straight from Treasury to these funds will not mean the continuation of the silliest aspect of the 2008 COAG ‘reforms’ which has the Federal Health portfolio only tangentially involved in public hospitals (via its Outcome 13 for goodness sake) with the bulk of the funds identified only in the Treasury portfolio.
Please let us see the Health portfolio having overall responsibility for a single national health system, with all the Commonwealth funds identified there, and all the accountabilities for national standards being brought together there.
Roxon is also right to say there is a large implementation task and inevitably there will be tweaking in the process. I certainly hope so.
It is essential to give more strength to the Primary Care Organisations and their influence over planning and reporting on the overall health system in their regions, and to ensure they have some authority to shift resources between types of care.
I am sure there is also more work to be done on the structure of the Federal Health portfolio to ensure capacity to analyse health and financial risks across the health system and to identify cost effective approaches to manage them, as a true national health insurer must. This might also lead in time to some separation of policy from administration, and a rethinking of the relationship between the department and Medicare Australia, now unfortunately in another portfolio.
The key now is to maximise the benefits that can be obtained from the Government’s initiatives, notwithstanding the disappointment of many of us that they did not go far enough.
There is still real potential for long-term gains not only to patient care but also to cost controls. But this potential will only be realised by careful implementation and some complementary measures over time.”