Nursing Online – December 2008

Reforming health care

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. The Commission has been established to develop a long-term health reform plan for a modern Australia. This month Nursing Online features four key contributions to the current discourse.

Achieving Safe, Satisfying and Sustainable Maternity Services in Australia
Australian College of Midwives

This submission urges the Commission to recommend reforms to Australia’s maternity services in its report to Government. Discussions of health reform usually focus on issues such as chronic disease, accident and emergency care, mental health and aged care. While these are important areas of healthcare, so too is maternity care. The 1999 Senate Inquiry into Childbirth Procedures found that maternity bed days accounts for the largest single use of hospital bed days in Australia each year.

The escalation of operative birth is also putting unnecessary pressure not just on extended bed days in hospital for women postnataly but also on surgical resources, contracting opportunities for elective surgery and health care funding. As such the provision of maternity care accounts for a substantial proportion of annual hospital expenditures and services.$FILE/027%20-%20SUBMISSION%20-%20Australian%20College%20of%20Midwives.pdf

A health policy for Australia – reclaiming universal health care
Ian McAuley and John Menadue

The short-termism of successive governments has given Australia a set of health policies which are increasingly complex, inequitable, inefficient and incoherent.

Opportunistic initiatives, such as the subsidisation of private health insurance, cost-shifting between governments, arbitrary imposts on users, and protection of vested provider interests are putting our health care arrangements under stress. So too is neglect, particularly neglect of fundamental efficiency reforms and of longer term workforce issues.

That stress is manifest in many ways – in misallocation of scarce health care resources (particularly away from prevention and primary care), in administrative inefficiency, and, above all, a loss of universalism.

This ReThink paper proposes basic reforms. Rather than the ‘patch ups’ which have characterised health policy for many years, it suggests a fundamental re-design. We can use the same health care resources that we have at present in both the private and public sectors, but we can employ them more efficiently and effectively.

Universalism should be restored and embedded. A universal system is not only fair; it is also the most affordable in terms of private and public spending, as is clear from the examples set by countries with universal systems. An important aspect of citizenship is that we should all use the same high standard health care services, rather than a ‘two tier’ set of services.$FILE/Submissions%20060%20-%20Centre%20for%20Policy%20Development%20Attachment%20A.pdf

New and emerging nurse-led models of primary health care
Mary Chiarella

The contributions of nurses and midwives form the backbone of PHC services world-wide, although in Australia much of this contribution has been of an adhoc nature and has therefore not come to prominence in the same way as in other developed and developing countries. There is a real need for policy, funding and education that creates a space for nurses to deliver effective and equitable primary health care services.

It is anticipated that these international exemplars can provide valuable insight into what could be achieved by actively promo-ting the role of nurses in PHC in Australia. This paper will begin by stating some overarching assumptions about the future of primary health care in Australia, then will briefly describe the work undertaken for the global compendium, will focus on the key findings of the study and will then highlight potential areas of development and change that might occur with relative ease within the Australian context.$File/New%20and%20emerging%20nurseled%20models%20of%20primary%20health%20care%20(M%20Chiarella).pdf

Submission from the Australian Nurse Practitioner Association to the National Health and Hospitals Reform Commission
The Australian Nurse Practitioner Association

The expansion of nursing roles has been an important feature of health care in recent years, stimulating much debate in which the role of the nurse practitioner has been central. The pressures on health care provision have encouraged re-orientation of health services to cost effectively meet consumer needs whilst also facilitating the patient’s journey within the health system. Nurse practitioners have responded to this challenge in a well-planned and rigorous manner. They have developed advanced skills and expanded their scopes of practice, providing safe, comprehensive, timely and efficient access to excellent nursing care for their patients and their communities.$FILE/014%20Australian%20Nurse%20Practitioners%20Association%20Submission.pdf