Commission maps out long-term health reform

Mixed reception for National Health and Hospitals Reform Commission report.

The final report of the National Health and Hospitals Reform Commission has met with a mixed reception from health sector stakeholders.

The report was released after 16 months of work by 10 health policy experts. It is touted by the Government as the blueprint for the largest overhaul to health since the introduction of Medicare in the 1980s.

The report contains 123 recommendations including that the Federal Government take full responsibility for primary health care, basic dental care and aged care.

It recommends a change in funding arrangements for public hospitals, moving from block funding to an arrangement where the Federal Government would pay the state governments based on each service provided.

The report proposes a new universal dental care scheme called ‘Denticare Australia’, which would give a choice of basic dental services through a private health insurance plan or through public dental services.

The Commission also recommended a new governance model – Medicare Select – that would establish ‘health and hospital plans’. In this model the Federal Government would be the sole government funder of health services. All Australians would automatically belong to a health and hospital plan, which could be operated by the government, a not-for-profit organisation or by private enterprise.

It’s not a quick fix

One of the Commissioners, Associate Professor Sabina Knight, who is a remote area nurse, said it would take 10 years to implement the report. ‘This report won’t change what’s happening today. It is a report for the long term. We were commissioned to take the long-term view: how should the system be designed for the future.’

Professor Knight said the Commission was driven by three perspectives: access and equity issues, the need to redesign the health system so it is responsive, and the need for an agile and self-improving system.

She said it was important to maintain and build on the current system’s strengths. ‘We have a strong ethic of universality in Australia. We think that is good and we should build on it.’

The critics say it is flawed

Many of the Commission’s recommendations have been greeted positively. In particular, the strong emphasis on prevention and primary care, measures to improve health outcomes for Aboriginal and Torres Islander people, improved care for people with serious mental illness and better access to health services in remote and rural areas.

But some of the recommendations have been met with scepticism. Prominent health commentator John Menadue said the report provides a platform for the expansion of government-subsidised private health insurance, which presently costs the taxpayer about $5 billion a year.

‘Private health insurance is insinuated throughout the report. The dental proposal is a means to churn further taxpayers’ money through private health insurance. Every country that has significant private health insurance has major problems with escalating health costs. Just ask Barack Obama,’ John said. ‘It can hardly be said that this report is independent when it takes such a partisan view on private health insurance.’

ANF Secretary Ged Kearney said she has concerns about the Commission’s section on aged care, in particular the recommendation to introduce accommodation bonds in high care.

‘Aged care is in desperate need for good reform. The population is ageing, people’s care needs are increasing, and nurses and assistants in nursing are under intense pressure. Putting the burden of funding on older Australians, perhaps forcing them out of their homes because they are in need of high-level care is not an answer. The Commission had the opportunity to bring positive reforms to aged care; instead they have ignored the critical issues of workforce and transparency and accountability of taxpayers funding.’

Roxon says no more business as usual

Health Minister Nicola Roxon said the report would give the Government the blueprint for change. ‘People care deeply about Medicare, hospitals and the health system, which is why they are upset to see it under stress – something the previous government chose to ignore.’

The Commission had come up with ‘a solid body of work,’ Roxon said. ‘The Commission’s work is … a fundamental examination of our health system, which represents an opportunity for the most important reform of our health system for decades, certainly since the introduction of Medicare.’

The report at a glance

The Commission set itself three reform goals:

Tackling major access and equity issues with five high priorities:

  • improving health outcomes of Aboriginal and Torres Strait Islander people;
  • improved care for people with serious mental illness;
  • support for people living in remote and rural areas;
  • improved access to dental health care;
  • timely access to quality care in public hospitals.

Redesigning the health system to meet emerging challenges:

  • embed prevention and early intervention;
  • connect and integrate health and aged care services;
  • modernising Medicare;
  • creating a sustainable health system;
  • more learning and support for the workforce.

Creating an agile and self-improving system:

  • strengthening consumer engagement and voice;
  • smart use of data, information and communication;
  • well-designed funding and strategic purchasing models;
  • reforming governance;
  • Medicare Select – an expansion of Medicare that is based on creating health and hospital plans.

Benefits for nurses

  • School nurses in all primary schools.
  • Fully-funded clinical placements for undergraduates.
  • Extends Medicare rebates to relevant diagnostic services and specialist medical services ordered or referred by nurse practitioners and other health professionals.

Three views on the report

John Menadue, health commentator

The report is strong on specifics and incremental change but does not espouse a clear health strategy based on a consensus of public values.

It is timid on the question of workplace reform. There are several examples such as nurse practitioners and midwives where greater productivity and professional satisfaction is possible. Nurses hold the system together but they are denied career opportunities and professional satisfaction.

Powerful vested interests – state governments and the health bureaucracies, the AMA, the private health insurance industry and the Pharmacy Guild – will now gear up to protect their interests during the six months’ consultation period that the government has announced.

Tony McBride, Chair of the Australian Health Care Reform Alliance

The report is the most comprehensive analysis of the entire health system we have ever had.

Many of the report’s recommendations represent valuable pieces of the jigsaw towards a more equitable health system.

Of course, the Government’s blind spot is around private health insurance and the wasteful rebate. Yet even there, some movement has been visible in the last Budget.

Ged Kearney, Secretary of the Australian Nurses’ Federation

We welcome the focus on primary health care from a range of health professionals, which means people and their community will have access to health care delivered by the right professional at the right time.

The ANF welcomes recommendations to extend Medicare rebates to relevant diagnostic services and specialist medical services ordered or referred by nurse practitioners and other health professionals, and for the establishment of person-controlled e-health records and better links between health services.

However, the ANF is concerned about the proposed introduction of Medicare Select. We will be looking for more information on this recommendation and all other funding models.