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What are the experts saying about health reform? Some recommended reading

The latest issue of the Asia Pacific Journal of Health Management has a series of articles examining the Australian health reform agenda from local and international perspectives. You can find the latest issue by clicking on the journal link on the left side of this page.

The editor, Dr David Briggs, has provided an overview for Croakey readers (and there will be another post coming shortly from one of the journal’s authors). He writes:

“The current issue of the APJHM provides perspectives from leading health academics and policy analysts on the national health reforms. Dr Geoffrey Lieu from Hong Kong, points out that in the USA no one since President Johnson has been successful in achieving health reform. He believes the achievement of Obama was remarkable given the challenges he faced, will the Rudd reforms equal that achievement?

Asia has been careful and cautious in approaching reform.  Lieu examples Asian developed economies with below the OECD average spending and with some of the world’s best health outcome indicators. Lieu points to prior years of public consultation as the hallmark of the reform announced in China.

Back in Australia, Andrew Podger affirms that there are too many unanswered questions, favours a single funder with clear funder, purchaser provider responsibilities and amongst other things wonders where the linkages to primary and aged care with the networks might be?

James Gillespie, Angela Beaton and Stephen Leeder are encouraged that the reform has at least got the health debate going and in the end it might eventually lead to effective reform, if they do not get stuck in the mire of debate over federalism, fiscal battles and continued blame games. Rudd mobilised popular support for reform in the face of hostility to the States with ‘profound morale problems’ in their systems but left them with ‘skin in the game’.

Judith Dwyer sees the positive in the return to more localised management. Both sides of politics seem to have heard and heeded this message. However, are our managers equipped to get on with the business? Again, there are too many unanswered questions but with strong public support for reform perhaps…

Jo Martins questions the capacity of the reforms to move away from micromanagement and questions lack of attention to organisational cultural issues about how the system operates. He points out that the health system is about people and its success rests on how well that human resource is managed. There has to be an emphasis on the need for good quality managers’ not just clinical leadership.

Sandra Leggat asserts that the reforms ‘may be national and focus on hospitals but it is definitely not about health’ and reflects on earlier Canadian experience to reinforce that statement, likening current proposals to policy approaches of the 1950s. Leggat questions the emphasis on hospitals at the expense of meeting population needs.

Jo-An Baber questions the underlying motivation for the current reform, the inadequate documentation of the detail. Short follows this approach suggesting that there is a priority political need to be seen to be acting and implementing reform. The positive is better more secure funding, the challenge is that with the States still central to management will Rudd and the Federal government really have the power to achieve effective reform.

In a separate paper and in Croakey, Isouard emphasises that effective leadership and management is the success factor required for successful health reform.

Well, at least we are starting a journey even if we can’t all agree how to get there!”

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