Australian health reform matters

Australia’s health: Why the need for reform?

Whilst Australia’s health status is among the highest in the world, our health system is in need of reform to meet long-term challenges such as access to services, the growing burden of chronic disease, population ageing, cost inefficiencies, safety and quality, and the cost of new health technologies.

The reform process

Pivotal to the reform process was the establishment of three key groups:

National Health and Hospital Reform Commission (NHHRC)
The Commonwealth Government established the National Health and Hospital Reform Commission (NHHRC) in 2008 to provide advice on performance benchmarks and practical reforms to the Australian health system. The NHHRC produced interim reports in December 2008 then embarked on a consultation process, before releasing its final report in June 2009.
External Reference Group (ERG) of primary care experts to inform the National Primary Health Care Strategy (NPHCS)
In June 2008 the Minister of Health announced the process for developing the first National Primary Health Care Strategy (NPHCS) that will provide a road map for the future direction of primary care in Australia. The NPHCS called for public submissions on the release of its Discussion paper in late 2008. The draft NPHC Strategy and supporting report were released in September 2009
Preventative Health Taskforce (PHT)
The Preventative Health Taskforce (PHT) was appointed to provide evidence-based advice to government and health providers on preventative health programs and strategies, and support the development of a National Preventative Health Strategy. The Strategy will provide a blueprint for tackling the burden of chronic disease currently caused by obesity, tobacco, and excessive consumption of alcohol. The Taskforce released its discussion paper on 10 October 2008, and following public submissions and an exhaustive consultation process the final report was released by the Department of Health and Ageing in September 2009

Other national reviews

Improved maternity services in Australia
A review of maternity services conducted by the Australian Government Department of Health and Ageing, and led by the Commonwealth Chief Nurse and Midwifery Officer, Rosemary Bryant aimed to identify areas for improvement in maternity services in Australia.

Closing the gap for national Indigenous health equality
The Close the Gap coalition is committed to achieving Aboriginal and Torres Strait Islander health and life expectation equality and aims to devise Indigenous health equality targets and encourage Australian governments to review their commitment to Indigenous health.

Key Australian Health Reform documents

The Australian Government Department of Health and Ageing's website www.yourhealth.gov.au contains the key reform documents produced by the above groups and encourages ongoing participation by the public via the 'have your say' links.

Ten key Australian health reform documents are publicly accessible:

A Healthier Future for all Australians, National Health and Hospital Reform Commission (June 2009)
Primary Health Care Reform in Australia: Report to support Australia’s First National Primary Health Care Strategy, National Primary Health Care Taskforce (September 2009)
Australia: The Healthiest Country by 2020: National Preventive Health Strategy - Overview, Preventative Health Taskforce (September 2009)
Building a 21st Century Primary Health Care System, Australia’s First National Primary Health Care Strategy. Australian Government Department of Health and Ageing (2010).
A National Health and Hospitals Network for Australia's Future - Delivering the Reforms, this health reform document outlines Government activities over coming months and years, including timelines and major milestones to implement the major health reform agreed by COAG (April 2010)
A National Health and Hospitals Network for Australia's Future - Delivering better health and better hospitals, Australian Government (2010)
Taking Preventive Action - A response to Australia: The Healthiest Country by 2020, (May 2010)
Improving Primary Health Care for All Australians, (Feb 2011)
National Health Reform: Progress and Delivery, (September 2011)
National Health Reform Agreement, Coucil of Australian Governments (COAG) (August 2011)
The Performance and Accountability Framework, National Health Performance Authority (May 2012)

National Health Reform: Progress and Delivery

What is happening?

PCEHR Draft Concept of Operations Consultation
A Draft Concept of Operations - Relating to the introduction of a personally controlled electronic health record (PCEHR) system is available. This document provides details on how the PCEHR system may look, what information it might contain, and how it will function and connect with existing clinical systems. Submissions to the draft closed 7 June 2011. A PCEHR system Concept of Operations document will be released in August 2011.

The PCEHR consumer booklet, e-health - have your say describes key elements of the proposed PCEHR system, and the impact it will have on health care in the future.

National Health Reform: Delivering Outcomes for Australians
Australian Government, June 2011
This publication provides a summary of the Commonwealth's assessment of progress towards key National Health Reform milestones as at 1 June 2011.

Medicare Locals Discussion Paper
The Australian Government has committed to establishing a national network of primary health care organisations, known as Medicare Locals. This discussion paper released November 2010 provides information to the public and other interested parties as to the proposed roles and functions specific to Medicare Locals. It specifically addresses: What will Medicare Locals do? What will Medicare Locals look like? How will Medicare Locals interact with patients and providers?

The first 19 of Australia's new network of primary health care organisations or Medicare Locals commenced 1 July 2011. This first group stem from high performing Divisions of General Practice and their collaborating organisations, with track records in improving primary health care for their community, and plans to further improve local primary care services. Each Medicare Local will be a locally run, independent non-government organisation, funded by the Australian Government. Sixty two Medicare Locals will be established nationally according to geographical regions.

A National Health & Hospitals Network for Australia
Prime Minister Kevin Rudd announced on 3 March 2010 that the Government will deliver better health services and better hospitals by establishing a National Health and Hospitals Network. The document, A National Health & Hospitals Network for Australia, sets out these structural reforms toward establishing the financing and governance foundations of a National Health and Hospitals Network for Australia's future.

A healthier future for rural and remote Australians
The Australian Government established the National Rural and Remote Health Infrastructure Program (NRRHIP) to improve access to health services by providing funding to rural and remote communities where the lack of infrastructure is a barrier to adequate health service provision. Applications for NRRHIP program opened on 14 November 2009.
More information is available: http://www.health.gov.au/nrrhip

Australia’s First Preventative Health Agency
Australia's first ever Preventive Health Agency was established following the passage of important legislation in the House of Representatives on 22 October 2009. The media release is available from the Minister of Health and Ageing's website.

Health Reform Progress Updates
See the yourHealth website for monthly National Health Reform Updates that provide details of specific health reform activities and achievements.

How can you help?

Have we missed something? Send us an email to let us know.

Primary Health Care Organisations (Medicare Locals)

The Minister for Health and Ageing at AGPN Forum

The Hon Nicola Roxon MP, Minister for Health and Ageing addressed the Australian General Practice Network (AGPN) Forum on the 6 November 2009. At this forum she outlined the government’s reform agenda for primary health care in Australia, and specifically outlined the role and challenges for the Divisions Network. The Draft National Primary Health Care Strategy (informed by the findings of the NHHRC) recommends the establishment of Primary Health Care Organisations (PHCOs) (later termed Medicare Locals) that would evolve from or substitute existing Divisions of General Practice with the intent of supporting better services coordination and population health planning.

The transcript of her speech is available from the Minister's website.

PHCOs Forum, Sydney, 21 October 2009

A report which summarises the national forum on PHCOs that was held 21 October 2009 and where representatives from departments of health, peak organisations (professional and consumer), the Divisions of General Practice Network, community health organisations and universities considered the functions and attributes of successful PHCOs. The national forum on PHCOs was sponsored by the Centre for Primary Health Care and Equity (CPHCE), University of NSW; the Australian Institute for Primary Care; the Primary Health Care Research & Information Service; the Australian Primary Health Care Research Institute and the National Primary & Community Health Network.

The report is available from the CPHCE website.

Australian General Practice Network blueprint for PHCOs

The Australian General Practice Network (AGPN) has released a blueprint for PHCOs which outlines the principles and characteristics for PHCOs in line with Australian health reform.

This is available from the AGPN website.

Additional reading - comments from others

Budget 2011-12 Delivering better hospitals, mental health and health services
Australian Government. (2011). Canberra: Commonwealth of Australia

An update on Medicare Locals and primary health care reform
Sweet M, Croakey the Crikey health blog, 19 June 2011

Medicare Locals in rural Australia, Fact Sheet 29
National Rural Health Alliance, June 2011. A fact sheet describing the role of Medicare Locals in primary health care for rural and remote Australia.

Medicare Locals - 2011 - AMA position statement
Australian Medical Association, March 2011. In this position statement by the AMA a range of views are set out about how Medicare Locals can be more effective.

National Health and Hospital Reform Commission final report and patient-centred suggestions for reform
This article outlines a qualitative study that explores the experiences of consumers in relation to patient-centred care alongside the recommendations of the final report of the National Health and Hospital Commission (NHHRC). The NHHRC report reccomended strengthened consumer voice and empowerment as keys to imrpoving care. This recent Australian study compares the recommendations for chronic illness care made in the NHHRC final report with suggestions made by people with chronic illness and family carers of people with chronic illness.
Jowsey T, Yen L, et al. (2011). Australian Journal of Primary Health, 17(2), 162-168

Will the NHHRC recommendations drive quality performance?
This article considers whether the recommendations of the NHHRC will enhance the already significant work undertaken toward quality improvement in general practice. It is suggested that active engagement of general practice in the implementation of NHHRC recommendations is integral to success. Authors suggest a paucity of outcome data is preventing assertions regarding the impact of NHHRC recommendations as impetus for further quality improvement.
Bonney A, Farmer EA. (2009). Will the NHHRC recommendations drive quality performance? Aust Fam Physician. Nov;38(11):913-4.

Evidence-based policy-making: What is it? How do we get it?
Gary Banks gave a speech at the Australian and New Zealand School of Government (ANZSOG)/Australian National University (ANU) on 4 February 2009. In his speech, he acknowledged the challenges in advancing health reform and outlined some prerequisites for reform.
Banks G. (2009). Evidence-based policy-making: What is it? How do we get it? ANZSOG/ANU Public Lecture Series 2009, Canberra, 4 February.

Why health reform?
A review of the case for health care reform was published by the Medical Journal of Australia (MJA) in September 2009.
Lewis SJ, Leeder SR. (2009). Why health reform? MJA. 191 (5): 270-272.

Putting Health in Local Hands: Shifting Governance and Funding to Regional Health Organisations
This report commissioned by The Centre for Policy Development proposes an alternative model to PHCOs and recommends that Regional Health Organisations (RHOs) are established across Australia. The RHOs governance and funding model would pool all current health care funding within a national agency for equitable distribution among RHOs on a local needs basis.
Armstrong F, Woodruff T, Legge D, Wilson R. (2009). Putting Health in Local Hands. Centre for Policy Development.

Worth listening to…
ABC Health Report: Health care reform:
Leading health care reform commentator Professor Elliott Fisher visited Australia to speak at a forum of the Hospital Alliance for Research Collaboration. In this ABC Health Report podcast Professor Fisher outlines his ideas about health care reform in the US and Australia.