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Only fundamental reform can save our health system

By Fiona Armstrong - posted Monday, 1 October 2007

As we have seen with global warming, national policy makers and politicians are slow to act when it comes to big, national, public policy decisions. Careful consideration is naturally prudent when major changes are required, as is the gathering of research data to ensure that any reform is evidence-based and likely to be effective. However, as evident in the findings of the report by UK Treasury head Nicolas Stern, glacier-like responses to the national and international risks posed by climate change, and failure to act when the evidence is well advanced, can pose profound economic risks as well as threaten social structures and food and energy security.

The ALP’s recent announcements about health reform aimed at reducing the blame game, removing the inefficiencies between different levels of government, and focusing the system on prevention and health promotion are a positive first step towards ensuring Australians will have access to safe, affordable, equitable, health services into the future.

Further action is necessary because the sustainability of a safe, high quality, universal health system for Australia is under threat. While less evident in current political debates than say, interest rates, the current dysfunctional structure of the nation’s health care system poses a far greater risk to the population than the actions of the Reserve Bank to keep a buoyant economy in check.


Out of pocket costs are increasing, putting essential health care beyond the reach of many low income Australians. Workforce shortages are such that access to services is becoming increasingly difficult. Around 10 per cent of people admitted to hospital suffer harm directly related to their health care, and each year, up to 18,000 people die as a result of the health care they receive. Indigenous Australians are suffering Third World health outcomes. Largely preventable chronic illnesses are creating a huge burden for the acute health system.

These are not the characteristics of a sustainable system.

Health policy making in Australia seems to have lost sight of the ultimate goal: to promote health. Even the bottom line to “do no harm” often fails to be met. Large scale policy planning is missing. For health policy is largely determined by the squeakiest wheel, which inevitably means that only the most powerful vested interests, capable of resourcing a sustained campaign, are able to elicit the policy outcomes they seek.

How did it come to this?

A major problem is the different levels of government in charge of different types of services, with the inevitable outcome that when services fail to deliver, each level of government blames the other. And thus, billions of precious health dollars are being wasted each year. Only by eliminating the opportunity for cost and blame shifting can we have truly accountable systems that are transparent, evidence based, and use resources efficiently.

There are several key stakeholder alliances in the Australian health sector who are deeply concerned the current state of Australia’s health system. The term “system” however is a gigantic misnomer, since it suggests some level of co-ordination, while the reality is that the so-called system is in fact a series of many thousands of disconnected programs.


The recent National Health Reform Summit, convened by the Australian Health Care Reform Alliance called for all governments to move to work collaboratively to improve the delivery of safe, affordable, equitable, and efficient health services and commit to a program of reform that acknowledges health care as a human right and will meet the needs of the Australian community into the future.

The development of a national health policy to ensure coherent national health services planning is a key recommendation. What is the vision for the Australian health sector for the next 10, or 20, years? How can we do anything other than “putting out fires” without a national plan?

As recognised by Labor, a national health reform commission is also required, as an independent body, to monitor policy and standards and outcomes for all aspects of health services, including workforce, and regularly report its findings publicly. Cost shifting can only be overcome if the many disparate sources of federal and state public health funds are pooled, and then distributed throughout the jurisdictions according to need. This would ensure not only accountability, but improve administrative efficiency, make services more cost effective, and ensure a seamless transition between all of the services provided for a single individual.

Eighteen key recommendations agreed by the members of the alliance accompany the summit’s communiqué (PDF 39 KB) as further details of necessary reforms.

All health professionals are working hard to deliver the best possible care with the resources available to them. But the complex nature and inefficient structure of the “system” is working against them. The ALP’s recent announcements are the first sign, in this election campaign, that someone in Canberra has the vision to take a positive first step towards a better, more efficient, health system.

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An edited version of this article was first published in The Weekend Australian on September 15, 2007.

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About the Author

Fiona Armstrong is a Melbourne based public policy analyst and commentator. She has a background in health policy and is an active campaigner for health reform in Australia. A longstanding environmentalist, she has recently turned her attention to climate policy.

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Creative Commons LicenseThis work is licensed under a Creative Commons License.

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