Interim Report of the National Health and Hospitals Reform Commission

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;

  1. Taking responsibility
    • Building good health and wellbeing into communities and lives.
  2. 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
  3. 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
  4. Driving quality performance
  5. Strengthening the governance of health and health care
  6. Raising and spending money for health services
  7. Ensuring the sustainability of the health workforce into the future
  8. Fostering continuous learning in our health system
Theme Recommendations
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.
  • Removing any existing regulatory barriers to the delivery of workplace health promotion and wellness programs.
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
  • Centres to include GPs, pathology collection, diagnostic imaging, nursing and other health professionals and pharmacy services.
  • Voluntary enrolment with a single health care service provider for young families and complex and chronic patients (including 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 (greater delineation such as separating planned and emergency services) 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), coronary surgery or cancer treatment (measured in weeks or days) and for planned surgery (measured in months).
  • Expand choices for care and accommodation in aged care.
  • 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 universal entitlement to health services with targeting on the basis of health need.
  • National Indigenous Health Authority –expert purchasing body to achieve better Indigenous health outcomes.
  • Establishing ‘Denticare Australia’ – funded by an 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 Better use of people, resources, and evolving knowledge
  • Options for better governance of the health system.
  • 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.

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:
The final report of the NHHRC is due to be completed in June 2009.


National Health and Hospitals Commission website
Media Release – National Health and Hospitals Reform Commission 16 February 2009