Australia’s health system needs structural reform. Rates of chronic disease have risen and will keep rising. As the system strains to meet growing demand, it will also have to change, fixing the mismatch between the system we inherited from the 20th century and the system we need for the future.
The emphasis must shift from hospital care to keeping people healthy. Many people have to manage multiple chronic diseases over decades, so instead of planning and funding individual, fragmented healthcare interventions, the system needs to join up and fit around people’s needs.
Neither the federal nor state governments can achieve these changes alone. Service systems run by different levels of government – such as public hospitals and GP clinics – need to work together. The configuration of the system, from the workforce, to infrastructure, to digital systems, needs to be planned as a whole, not in silos. And how funding is divided should be based on population health needs, and the results that services will achieve, not based on turf, precedent, and cost-shifting.
That’s why the next version of the National Health Reform Agreement (the Agreement) must be very different from the current one.
Instead of galvanising reform, the Agreement reinforces the status quo. It focuses on hospital care, instead of the whole system. While the cost of hospital care has fallen (technical efficiency), it has failed to shift what care is offered, and where it’s offered (allocative efficiency), or increase investment in prevention (dynamic efficiency).
The Agreement gestures at reform, nominating the right themes, but it doesn’t go much further. The reform themes are vague and disconnected from the mechanics of change that the Agreement could put in motion: funding, measurement, and accountability.
This submission suggests a new approach that would make the Agreement an engine for reform, with examples of how that approach could be applied.
Peter Breadon
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