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Health Reform or Alphabet Soup?

The early phase of Mr Rudd’s first government was marked by a focus on health reform. This followed an election commitment to ‘fix health’.

Mr Rudd and his then Health Minister, Nicola Roxon, travelled the length and breadth of the country describing their goals and meeting clinicians. No Prime Minister before or since could have made a greater effort to meet the clinicians at the coalface of health care.

The talk was of ending the ‘blame game’ and increasing transparency and accountability, increasing hospital bed capacity, managing the waiting lists for elective procedures and building a better health system for all. Lots of announcements suggested a frenetic pace of health reform to come: HPAs, IHPA, HWA, PCEHR, NHPA, ACSQHC, AOTA and more.

Plenty of acronyms and authorities. Lots of vision statements and values. But has access to health care actually been improved, the quality of healthcare increased or a more robust framework for healthcare and its planning resulted from all this activity?

The HPAs – Health Partnership Agreements – have covered some important areas of health care: Indigenous health through ‘Closing the Gap’, mental health and preventive health. The aim is clearly to improve the efficiency of program delivery by establishing partnerships between the Commonwealth and States and at the same time reduce the ‘blame game’. This should be a strong model for Commonwealth-State collaboration, as long as the programs come with lean overheads and deliver on their outcomes. The uncertainty around the ongoing Commonwealth funding for the ‘Closing the Gap’ program illustrated the fragility of these complex arrangements.

IHPA – the Independent Hospital Pricing Authority –has the task of determining the NEP (National Efficient Price) per WAU (Weighted Activity Unit) within a system of ABF/ABM (Activity Based Funding and Management). Even before the IHPA many states were moving to ABF or had already introduced it. Nevertheless, the nationally consistent approach has some merit and was probably overdue. It will be interesting to see how the funding drivers produce winners and losers – you just don’t want to be a health consumer for a service that is a consistent loser. Getting ABF right for subacute care and mental health will be particularly challenging but is a work in progress for IHPA.

ANPHA – the Australian National Preventive Health Agency – is there to assist all governments in tackling ‘the increasingly complex challenges associated with preventing chronic disease’. Its targets include reducing the incidence of smoking, harmful alcohol use and obesity – all priorities for the AMA’s Public Health Committee – and mean the AMA supports its objectives. But this is a crowded space with many NGOs very active in preventive health, some supported by ANPHA, but potentially duplicating some of ANPHA’s work.

HWA – Health Workforce Australia – had undoubtedly filled a big gap in health workforce intelligence and planning. Its reports on the current and future health workforce represent a huge and important piece of work. Now all jurisdictions need to work together to get the gains Australia should get from record numbers of students in health care professions. Health workforce isn’t just about filling our universities. Health professions need the graduate programs, internships and further training needed to develop the skills our health system needs. Coordinated policies and action are the only answer. For medicine this means we need HWA to get its sums right and persuade the jurisdictions that they need to step up to the mark, not just with intern positions but also the vocational training positions to produce the specialists of the future.

The NHPA – National Health Performance Authority – has the task of monitoring and reporting on the performance of Local Hospital Networks, Medicare Locals and hospitals, including maintaining the MyHospitals website. A lot of this information is also available on State health department web sites or from the Australian Institute of Health and Welfare but at least there is now some consistency in reporting and a one-stop-shop.

The ACSQHC – Australian Commission on Safety and Quality in Health Care – has developed nationally agreed standards against which health care facilities are assessed.

AOTA – the Australian Organ and Tissue Authority – has led reform in organ and tissue donation. As Mr Rudd acknowledged in the speech when he stood down as Prime Minister, this has been a success with a significant increase in organ donors.

There is much more to the Government’s health reform agenda than these organisations (see www.yourhealth.gov.au), and a lot more alphabet soup: PCEHR, GPSCs, MLs, LHNs, NHFP, NHFB and more.

The reforms doctors want to see are more hospital beds, improved access to health care, the resources to deliver higher quality care and robust workforce planning with implementation that ensures Australia’s future needs are met.

All doctors can make their own judgement on the extent to which the alphabet soup of health reform has made a real difference.

Disclosure: Prof Dobb represents the AMA on several committees of organisations mentioned and is a member of the AOTA Advisory Council.

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