Croakey thanks “Hannah Swarts” – a health policy analyst who must remain anonymous because of a job that does not allow public commentary – for providing this overview of developments in the health reform debate:
“The Crawford School at the Australian National University recently hosted a health reform featuring such speakers as John Deeble, Ian McAuley, Stephen Podger, Paul Dugdale, Adrian Kay and Ann Neville. Videos and powerpoint presentations can be found here.
The presentations and discussion raised similar issues to what was reported about a similar forum hosted by the Menzies Centre for Health Policy and Sydney University.
Once again, concerns were raised about the boundaries of the local hospital networks (LHNs) and Medicare Locals and the lack of detail about ‘how’ the proposed reforms will work, in particular the relations between LHNs and Medicare Locals. The need for common governance structures was canvassed and strong political leadership was considered integral to success.
Although there are many recurring themes in discussions by health policy analysts and advocates about the shortcomings of the reform, the seminar also highlighted:
- Compared to other OCED countries Australia has an over-reliance on hospitals and the reform package entrenches the role of hospitals in the health care system. Under the proposed reforms, the Commonwealth has done little to address chronic illness or accept responsibility for prevention
- The role of private health insurance and private hospitals has not been articulated in the reform or the implementation strategy. We were reminded again of how the incentives for PHI and subsequent increase in membership made little difference to admissions to public hospitals
- The role of the States has changed significantly under the reforms from being hospital providers to program managers. Yet despite this, there is little understanding or information about the role of the States and their relationships with the various bodies that will be established (or even their relationship with the Commonwealth)
- The reforms have not adequately addressed the inconsistency of copayment policies for consumers or the broader issue of ‘cost-sharing’ between governments and consumers for the provision of health care
- As ‘primary care’ is not yet defined, there is potential for costs to be significantly more than the Government estimated which may affect funding arrangements in the long term
- It was suggested that the success of the reforms is dependent on the devolution of power from the Commonwealth to the various entities – requiring the Commonwealth to show restraint!
- Responsibility for policy development under the new structures remains undefined
- And a timely reminder that hospitals are, essentially, a political problem (a similar point was made by Stephen Leeder here) and a reflection from the NHS, that one is always ‘in the middle of reform’
Since the reform, the Government has released the implementation plan for the reform and there has been debate about implementation arrangements for the proposed enrolment of patients with diabetes. Catholic Health Australia has released its election platform, essentially arguing that the reforms have failed to address the significant inequities in health.
As the Government grapples with implementation and the establishment of the ‘Transition Office’, it remains to be seen whether the concerns of stakeholders about the lack of integration between primary care and hospital care, health inequality, poor consultation mechanisms and those articulated by various policy forums will be considered, or addressed, by Government.”
• Hannah Swarts is a pseudonym for a health policy analyst whose job does not allow public commentary.