The government's response needs to be big, bold and far-reaching. It has to spark and re-energise. It has to call to action. Kevin Rudd's National Health and Hospitals Network announcement this week meets those expectations.
It reflects very strongly the NHHRC's recommendations for public hospitals funding. Our recommendations were a product of hundreds of consultations across the country with front-line health workers and people who use the health system. The policy is also a product of the concerns raised in the 100 or so consultations conducted by the government, several of which I attended.
It's important to remember that this week's announcement is about the structural framework. It is not the whole health reform package. Much more is to come.
he NHHRC made recommendations on prevention, primary care, health workforce, mental health, sub-acute care, aged care, indigenous health and e-health, to name just a few areas.
The Prime Minister said in his National Press Club speech that more announcements are to come.
Change is needed. No change is not an option, it's a cop-out.
The operational, financial and political risks are high.
But the risks of doing nothing are even higher.
In my experience it is hard to have a productive conversation about reform of health services until the questions about the roles of government, and the governance and financing structures particularly in relation to public hospitals, are answered. So the government was probably right to put the policy out first. You need to get the framework agreed before you hang anything from it.
The NHHRC report says: "We have a fragmented health system with a complex division of funding responsibilities and performance accountabilities between different levels of government. The [present] separation of responsibilities means that no level of government has a detailed understanding of all aspects of the health system." It is therefore not surprising the government has responded with what it calls "major structural reforms to establish the financing and governance foundations of a National Health and Hospitals Network for Australia's future".
A key message of the NHHRC's work on governance is that we need to create one national health system with local flexibility and innovation in delivery. We presented a pathway similar to that described by the government. On funding responsibilities the government's plan is broadly consistent with our proposals that the commonwealth take up 100 per cent of primary health care and a substantial share of the direct, efficient cost of activity in public hospitals, which could increase through time.
In the government's plan, the commonwealth will assume the majority responsibility for hospital funding at 60 per cent, including teaching and research and capital costs. This is more than a symbolic gesture; it represents a significant exposure, which is important to sustaining the public financing of the system.
The clear statement about state government revenue growth not being able to keep pace with growing healthcare costs is critical, not only as one of the reasons a greater commonwealth funding responsibility makes sense but also as acknowledging the financing pressures that states, and therefore public hospitals, face.
The commonwealth assuming 100 per cent funding for primary health care creates part of the platform for the strengthening and integrating of care within general practice and primary health care. We need to see more detail of what is proposed in this area.
Paying an efficient price directly for activity actually delivered will encourage the capability of the local hospital networks to understand better their costs of producing health care.
It changes the dynamic from rationing or avoiding cost to being reimbursed for the activity actually done. This will encourage efficiency and possibly improve data at the local level.
The government must now provide clarity about how the local hospital networks would be appointed and by whom. It is important that flexibility be exercised in the size, scope and geography of the network to adapt to local needs such as in regional and rural Australia.
Some states have similar entities already, albeit with varying levels of centralised or devolved control and delegated authority. State-wide services role delineation and capital planning will be needed to ensure that every network isn't trying to do quaternary services such as transplant surgery. The government's plan suggests, I think appropriately, that the states hold these functions and responsibilities.
While the pressure on public hospitals is real and an important symptom of a system under stress, the debate and focus on solutions that are hospital-centric could unduly capture the reform agenda and miss one of the key messages of the NHHRC blueprint.
The solutions to the pressures on hospitals are in large part about strengthening and connecting care outside hospitals. It is vital that the reform agenda not be reduced to simply "fixing hospitals".
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Autor(en)/Author(s): Christine Bennett
Quelle/Source: The Australian, 06.03.2010
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