Final Report – National Health and Hospitals Commission

The Prime Minister today released the final report of the National Health and Hospitals Reform Commission (NHHRC). On 25 February 2008 the NHHRC was established by the Federal Cabinet to develop a long-term health reform plan for Australia –a key Labor election commitment.

On 16 February 2009 Dr Christine Bennett, the Chair of the NHHRC, released the Commission’s interim report. The interim report was designed to generate debate across the health care system and within the community as a whole, and the Commission received over 240 submissions providing feedback to inform the development of the final report.

The final report, A Healthier Future for All Australians, includes 120 proposed 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 Prime Minister said that the Government would consider the recommendations of the report and conduct detailed, direct consultations with major hospitals, rural and regional hospitals and representatives of the health sector over the next six months.

In late 2009 a meeting of the Council of Australian Governments (COAG) will be convened to deal explicitly with health reform. Following this, COAG will meet in early 2010 where a reform plan will be put to the States. If no agreement is reached, the Prime Minister indicated he would seek a mandate from the people (via a referendum) on health reform.

The Prime Minister also noted that the government faces serious fiscal restraints due to the global financial downturn, and that any reforms to the health system must be made in this context, particularly over the coming years when measures will be put into place to return the Budget to surplus. Consequently, while much of the reform debate will be about improving service delivery, debate will also centre on how to improve efficiency and ‘do more with less’.

Finally, the Prime Minister flagged two reports due by the end of 2009 that will inform policy decisions for the future: the Henry Tax Review and the Inter-generational Report. These reports will provide information about Australia’s long-term fiscal outlook, and will provide further context for the consideration of health reforms.

Key recommendations
The commission’s report details more than 120 proposed changes which focus on better preventative measures, improved access for all Australians, and building a more sustainable long-term system.

Some of the key recommendations include:

Taking responsibility
Individual and collective action to build good health and wellbeing.

  • Developing a rolling series of ten-year goals for health promotion and prevention known as the Healthy Australia Goals (the first set will be for 2020).
  • Establishment of a National Health Promotion and Prevention Agency –education, evidence and research to make prevention a top priority.
  • Support for strategies that promote greater personal responsibility for improving health as well as policies that make healthy choices easier.
  • Health literacy to be included in a National Curriculum for all primary and secondary schools.
  • Better information about creating healthy local communities – taking a broad view of the factors contributing to healthy communities, or ‘wellness footprints’. For example, urban planning and public transport.
  • Recognition and support for carers.

Connecting care
Comprehensive care for people over their lifetime.

  • The Commonwealth should assume responsibility for all primary health care policy and funding.
  • Establishment of Comprehensive Primary Health Care Centres and Services. These centres to include GPs, pathology collection, diagnostic imaging, nursing and other health professionals and pharmacy services.
  • Voluntary enrolment for young families, Indigenous people and complex and chronic patients with a single health care service provider (their ‘health care home’).
  • Creation of regional Primary Health Care organisations by transforming Divisions of General Practice.
  • Development of a person-controlled electronic health record.
  • Focus and investment in a healthy start to life from before conception through the early years through home visits, school nurses, better targeted special care and intensive care to those children at risk or for those with disabilities and other major health problems.
  • Reshaping hospital roles for emergency and planned care and reflecting this in the use of activity-based funding for both public and private hospitals.
  • Prioritising and investing in ‘sub-acute services’ (rehabilitation, geriatric evaluation and management, transition care and other ‘step up’ or ‘step down’ programs).
  • Hospitals –National Access Guarantees and Targets for mental health (measured in hours), urgent primary care (measured in weeks or days), attending emergency departments (measured in minutes to hours), coronary artery surgery or cancer treatment (measured in weeks/days) and for planned surgery (measured in months).
  • Expand choices for care and accommodation in aged care.
  • Government subsidies for aged care to be more directly linked to people rather than places.
  • Improve access to specialist palliative care services and strengthening workforce skills in palliative care. Support for advanced care planning.

Facing inequalities
Recognising and tackling the causes and impacts of health inequalities.

  • Establishing a National Aboriginal and Torres Strait Islander Health Authority – an expert commissioning, purchasing and brokering of services specifically for Indigenous people.
  • Additional investment in an Aboriginal and Torres Strait Islander health workforce.
  • Improving the affordability of fresh food in targeted remote Indigenous communities through subsidies and also investment in nutrition education.
  • Establishing ‘Denticare Australia’ – funded by a 0.75% increase in the Medicare levy to provide universal access to restorative and preventative oral health care. People would choose a dental health plan with a private health insurer paid for by the levy or they could opt to rely on public dental services for which increased funding would be provided.
  • Remote and rural health –equitable and flexible funding, innovative workforce models, telehealth, patient travel support, expansion of specialist outreach services, e.g. pharmacy and dental/oral services.
  • Mental health –early intervention for young people, rapid response teams, sub-acute care, linked health and social services.
  • National reporting on progress in tackling health inequities.

Driving quality performance
Leadership and systems to achieve best use of people, resources and evolving knowledge.

  • Recommendation that Ministers agree to a new Healthy Australia Accord to articulate the agreed and complimentary roles of all governments (state, territory, local, federal) in improving health service and outcomes
  • Commonwealth Government to assume full responsibility for the policy and public funding of primary health care services. This includes all existing community health, public dental services, family and child health services, and alcohol and drug treatment services that are currently funded by state, territory and local governments.
  • The Commonwealth Government would meet 100% of the efficient costs of public hospital outpatient services using an agreed casemix classification and an agreed, capped activity-based budget.
  • The Commonwealth Government would pay 40% of the efficient cost of care for every episode of acute care and sub-acute care for public patients admitted to a hospital or public health care facility for care, and for every attendance at a public hospital emergency department.
  • This proportion could be incrementally increased over time to 100% of the efficient cost for these services. This would mean the Commonwealth Government would have close to total responsibility for government funding of all public health care services across the care continuum.
  • National leadership for national functions such as health technology assessment.
  • Activity based funding with payments for performance and quality.
  • National registration of health professions.
  • Better use of workforce capabilities – framework for competency based practice.
  • Remote and rural area health – appropriately credentialed nurse practitioners and other registered health professionals should be able to order diagnostic tests and make specialist referrals that are covered by Medicare.
  • Improved clinical training infrastructure and establishing a National Clinical Education and Training Agency.
  • Establishing a permanent national body to promote, monitor and report on quality and safety.
  • Public reporting on access, efficiency and quality for public and private hospitals.
  • Building a culture of continuous improvement, research and innovation with clinical leadership.

The commission estimates its changes would cost between $2.8 and $5.7 billion a year, with a five-year capital injection of between $4.3 and $7.3 billion also needed. The proposed public dental system, named ‘Denticare’, would also cost $3.6 billion a year. The commission estimated that about $4 billion a year would be saved by 2032 if the key recommendations are implemented.

The NHHRC Final Report (June 2009) is available online at

Hawker Britton’s Occasional Paper on the interim report (February 2009) is available at

A copy of the Prime Minister’s statement will shortly be available at