On 25 February 2008 the Federal Cabinet approved the establishment of the National Health and Hospitals Reform Commission (NHHRC) to develop a long-term health reform plan for Australia –a key Labor election commitment. Today (16 February 2009) Dr Christine Bennett, the Chair of the NHHRC, released the Commission’s interim report, A Healthier Future for all Australians.
This interim report has been designed to generate debate across the health care system and within the community as a whole. The NHHRC has invited comments on the reform directions, with responses to be received by 16 March 2009. There are a number of ways to provide feedback – via electronic survey, email or post (see details on how to respond here). The Commission’s Final Report is expected to be completed by June 2009. The Government will then respond to the final recommendation of the Commission.
The interim report proposes 116 reform directions across the spectrum of health service delivery coving a range of issues including governance, preventative health, indigenous health, hospitals, aged care, mental health, primary health care, workforce and rural health.
The report is organised into four strategic reform themes;
- Taking responsibility
- Building good health and wellbeing into communities and lives.
- Connecting care
- Creating strong primary health care services
- Nurturing a healthy start to life
- Ensuring timely access and safe care in hospitals
- Restoring people to better health and independent living
- Increasing choice in aged care
- Caring for people at the end of life
- Facing inequalities
- Closing the health gap for Aboriginal and Torres Strait Islander peoples
- Delivering better health outcomes for remote and rural communities
- Supporting people living with mental illness
- Improving oral health and access to dental care
- Driving quality performance
- Strengthening the governance of health and health care
- Raising and spending money for health services
- Ensuring the sustainability of the health workforce into the future
- Fostering continuous learning in our health system
|Individual and collective action to build good health and wellbeing.||
|Comprehensive care for people over their lifetime.||
|Recognising and tackling the causes and impacts of health inequalities.||
Driving quality performance
|Better use of people, resources, and evolving knowledge||
Governance of the Health Care System
One of the key issues addressed by the NHHRC is the governance of the health care system. The interim report canvases three options for reform;
Option A –Shared responsibility clearer accountability
- Retaining both Commonwealth and state and territory involvement in health policy and services but re-aligning responsibilities between them.
- Commonwealth to become responsible for all primary health care funding and policy.
- Commonwealth paying to states a significant proportion per episode of the efficient costs of inpatient treatment and of emergency treatment (40%).
- Commonwealth paying, using a case mix classification, 100% of the efficient costs of delivery of hospital outpatient treatments.
Option B –Commonwealth to be solely responsible for all aspects of health care, with delivery through regional health authorities.
- Transfer all responsibility for public funding, policy and regulation to the Commonwealth
- The Commonwealth establishing and funding regional health authorities to take responsibility for former state health services such as public hospitals and community health services, in parallel to continued national programs of medical and pharmaceutical benefits and aged care subsidies.
Option C –Commonwealth to be solely responsible for all aspects of health and health care
- Commonwealth to establish compulsory social insurance to fund local delivery.
- Transfer of all responsibility for public funding, policy and regulation to the Commonwealth
- Commonwealth to establish a tax-funded community insurance scheme under which there would be multiple, competing health plans for people to choose from, which would be required to cover a mandatory set of services including hospital, medical, pharmaceutical, allied health and aged care.
The Parliamentary Library released a Background Note as a guide to some of the recent proposals for health reform. The Note focuses on the main features of each model and seeks to explain what problems they are intended to address and how they differ from one another. The Note also highlights some of the main criticisms that are made of each.
The publication is available at: http://www.aph.gov.au/library/pubs/bn/2008-09/HealthReform.htm
The final report of the NHHRC is due to be completed in June 2009.