Challenges in health policy the next 10
Perspectives
Perspectives
Challenges in health policy: the next 10 years
Hospital governance that prioritises waiting times or patient
throughput does not adequately address health care quality
A
t the 2007 federal election, Kevin Rudd announced
plans to reform the health system. The National
Health and Hospitals Reform Commission
(NHHRC) was established the following year to find
solutions. In 2010, Rudd presented his response to the
NHHRC’s report, proposing local hospital networks
interfacing with primary health care, with governance in
which health professionals would play a part.1 Regrettably,
other forces with a focus primarily on external regulation of
hospitals subsequently came to bear, and this became
formulated as national policy by the Council of Australian
Governments (COAG).2 But does the framework of the COAG
agreement deliver what is needed?
The NHHRC saw that health care costs, internationally,
were rising well ahead of the consumer price index. State
governments, with fixed revenue bases, are unable to fund
this. The first, welcome, outcome of the COAG agreement
was a progressive increase in the federal share of funding from
40%, building to 50% by 2017.2
In the context of its new funding model, the COAG Reform
Council now monitors hospitals against the politically
sensitive yardsticks of waiting lists, waiting times in
emergency departments, and hospital separation numbers.
Performance is patchy across Australia.3 Sadly, none of the
performance criteria assess quality of services or the key
relationship between hospitals and primary care. Good health
care must be a continuum between these two sectors.
Health care has vastly improved through innovations in
diagnosis and treatment over many decades. This must
continue with improving services, if patients are to get the care
they need. The NHHRC and COAG envisaged that this would
be handled by bodies in Canberra propounding models for
treatment and the need for quality and safety. However, when
management of hospitals is geared toward providing figures
sought by government, it focuses on numbers rather than
quality and safety for those treated. This has long been the case.
Even before the NHHRC report, egregious problems in
patient care had hit the press. In the report of the Special
Commission of Inquiry in New South Wales, Garling stated:
During the course of this inquiry, I have identified one
impediment to good, safe care which infects the whole
public hospital system. I liken it to the Great Schism of
1054. It is the
breakdown
of good of
working
relations
The
Medical Journal
Australia
ISSN: 0025between clinicians
and
management
which
is very
729X 5 August 2013 199 3 153-153
detrimental©The
to patients.
It is alienating
skilled in
Medical
Journal the
of most
Australia
2013
the medicalwww.mja.com.au
workforce from service in the public system.4
Perspectives
—Garling
Pre-election
The problems
identified by
and inseries
the media were
in hospitals that were performing well on the criteria of
patient throughput and waiting times.
The perception of poor quality, safety and coordination of
health services in Australia, compared with those in New
David G Penington
AC, DM, FRCP,
Emeritus Professor, 1 and
Chairman2
1 University of Melbourne,
Melbourne, VIC.
2 Bionic Vision Australia,
Melbourne, VIC.
dgp@unimelb.edu.au
doi: 10.5694/mja13.10838
“
clinical
research is
the greatest
safeguard of
quality of
care
”
Zealand, the Netherlands and the United Kingdom, is borne
out by surveys conducted by the Commonwealth Fund.5
Good health care must be informed by ongoing research,
and clinical research is the greatest safeguard of quality of care.
To ensure appropriate resource allocation, monitoring of
research outcomes should include economic evaluation. Where
outdated strategies do not work, they must be replaced.
The report of the McKeon Review,6 released in April this
year, is a breath of fresh air. It seeks better health through
research. It argues that to have a $135 billion health sector
with no systematic commitment to embedded research and
development, which would ensure efficiency and
sustainability, makes no sense. The authors propose a 10-year
program progressing towards 3%–4% of government health
budgets being devoted to research and development.
McKeon and colleagues also propose initial establishment
of four to eight (building in time to 10–20) “integrated health
research centres” across Australia. These centres would
combine hospital and community-care networks with
universities and medical research institutes. They could
change the face of Australian health care by providing
leadership in care that draws on cross-disciplinary
professional and research skills. Health care would be tested
and progressively developed, embracing not only hospitals
but also primary care, mental health care, community nursing
and aged care, with changed professional roles and overall
monitoring of outcomes.
New Medicare Locals seek to better integrate primary
medical care with other important health services. They also
need to be linked with the hospital system and with training
of health professionals. There are now big opportunities as we
look to the future.
Competing interests: No relevant disclosures.
Provenance: Commissioned; not externally peer reviewed.
1 Kevin Rudd’s Better health, better hospitals speech. The Australian 2010; 3
2
3
4
5
6
Mar. http://www.theaustralian.com.au/politics/kevin-rudds-better-healthbetter-hospitals-speech/story-e6frgczf-1225836509805 (accessed Jul 2013).
Council of Australian Governments. National Health Reform Agreement. July
2011. http://www.federalfinancialrelations.gov.au/content/npa/health_
reform/national-agreement.pdf (accessed Jul 2013).
COAG Reform Council. Healthcare 2011–12: comparing performance across
Australia. Report to the Council of Australian Governments. 30 April 2013.
http://www.coagreformcouncil.gov.au/reports/healthcare/healthcare-201112-comparing-performance-across-australia (accessed Jul 2013).
Garling P. Final report of the Special Commission of Inquiry: Acute Care Services
in NSW Public Hospitals. Sydney: NSW Government, 27 Nov 2008. http://
www.lawlink.nsw.gov.au/Lawlink/Corporate/ll_corporate.nsf/pages/
attorney_generals_department_acsinquiry (accessed Jul 2013).
Davis K, Schoen C, Stremikis K. Mirror, mirror on the wall: how the performance
of the US health care system compares internationally, 2010 update. New
York: The Commonwealth Fund, June 2010. http://www.commonwealthfund.
org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=
all (accessed Jul 2013).
McKeon S, Alexander E, Brodaty H, et al. Strategic review of health and
medical research: final report February 2013. Canberra: Australian Government
Department of Health and Ageing, 2013. http://www.mckeonreview.org.au/
downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013Final_Report.pdf (accessed Jul 2013).
❏
MJA 199 (3) · 5 August 2013
153
Perspectives
Challenges in health policy: the next 10 years
Hospital governance that prioritises waiting times or patient
throughput does not adequately address health care quality
A
t the 2007 federal election, Kevin Rudd announced
plans to reform the health system. The National
Health and Hospitals Reform Commission
(NHHRC) was established the following year to find
solutions. In 2010, Rudd presented his response to the
NHHRC’s report, proposing local hospital networks
interfacing with primary health care, with governance in
which health professionals would play a part.1 Regrettably,
other forces with a focus primarily on external regulation of
hospitals subsequently came to bear, and this became
formulated as national policy by the Council of Australian
Governments (COAG).2 But does the framework of the COAG
agreement deliver what is needed?
The NHHRC saw that health care costs, internationally,
were rising well ahead of the consumer price index. State
governments, with fixed revenue bases, are unable to fund
this. The first, welcome, outcome of the COAG agreement
was a progressive increase in the federal share of funding from
40%, building to 50% by 2017.2
In the context of its new funding model, the COAG Reform
Council now monitors hospitals against the politically
sensitive yardsticks of waiting lists, waiting times in
emergency departments, and hospital separation numbers.
Performance is patchy across Australia.3 Sadly, none of the
performance criteria assess quality of services or the key
relationship between hospitals and primary care. Good health
care must be a continuum between these two sectors.
Health care has vastly improved through innovations in
diagnosis and treatment over many decades. This must
continue with improving services, if patients are to get the care
they need. The NHHRC and COAG envisaged that this would
be handled by bodies in Canberra propounding models for
treatment and the need for quality and safety. However, when
management of hospitals is geared toward providing figures
sought by government, it focuses on numbers rather than
quality and safety for those treated. This has long been the case.
Even before the NHHRC report, egregious problems in
patient care had hit the press. In the report of the Special
Commission of Inquiry in New South Wales, Garling stated:
During the course of this inquiry, I have identified one
impediment to good, safe care which infects the whole
public hospital system. I liken it to the Great Schism of
1054. It is the
breakdown
of good of
working
relations
The
Medical Journal
Australia
ISSN: 0025between clinicians
and
management
which
is very
729X 5 August 2013 199 3 153-153
detrimental©The
to patients.
It is alienating
skilled in
Medical
Journal the
of most
Australia
2013
the medicalwww.mja.com.au
workforce from service in the public system.4
Perspectives
—Garling
Pre-election
The problems
identified by
and inseries
the media were
in hospitals that were performing well on the criteria of
patient throughput and waiting times.
The perception of poor quality, safety and coordination of
health services in Australia, compared with those in New
David G Penington
AC, DM, FRCP,
Emeritus Professor, 1 and
Chairman2
1 University of Melbourne,
Melbourne, VIC.
2 Bionic Vision Australia,
Melbourne, VIC.
dgp@unimelb.edu.au
doi: 10.5694/mja13.10838
“
clinical
research is
the greatest
safeguard of
quality of
care
”
Zealand, the Netherlands and the United Kingdom, is borne
out by surveys conducted by the Commonwealth Fund.5
Good health care must be informed by ongoing research,
and clinical research is the greatest safeguard of quality of care.
To ensure appropriate resource allocation, monitoring of
research outcomes should include economic evaluation. Where
outdated strategies do not work, they must be replaced.
The report of the McKeon Review,6 released in April this
year, is a breath of fresh air. It seeks better health through
research. It argues that to have a $135 billion health sector
with no systematic commitment to embedded research and
development, which would ensure efficiency and
sustainability, makes no sense. The authors propose a 10-year
program progressing towards 3%–4% of government health
budgets being devoted to research and development.
McKeon and colleagues also propose initial establishment
of four to eight (building in time to 10–20) “integrated health
research centres” across Australia. These centres would
combine hospital and community-care networks with
universities and medical research institutes. They could
change the face of Australian health care by providing
leadership in care that draws on cross-disciplinary
professional and research skills. Health care would be tested
and progressively developed, embracing not only hospitals
but also primary care, mental health care, community nursing
and aged care, with changed professional roles and overall
monitoring of outcomes.
New Medicare Locals seek to better integrate primary
medical care with other important health services. They also
need to be linked with the hospital system and with training
of health professionals. There are now big opportunities as we
look to the future.
Competing interests: No relevant disclosures.
Provenance: Commissioned; not externally peer reviewed.
1 Kevin Rudd’s Better health, better hospitals speech. The Australian 2010; 3
2
3
4
5
6
Mar. http://www.theaustralian.com.au/politics/kevin-rudds-better-healthbetter-hospitals-speech/story-e6frgczf-1225836509805 (accessed Jul 2013).
Council of Australian Governments. National Health Reform Agreement. July
2011. http://www.federalfinancialrelations.gov.au/content/npa/health_
reform/national-agreement.pdf (accessed Jul 2013).
COAG Reform Council. Healthcare 2011–12: comparing performance across
Australia. Report to the Council of Australian Governments. 30 April 2013.
http://www.coagreformcouncil.gov.au/reports/healthcare/healthcare-201112-comparing-performance-across-australia (accessed Jul 2013).
Garling P. Final report of the Special Commission of Inquiry: Acute Care Services
in NSW Public Hospitals. Sydney: NSW Government, 27 Nov 2008. http://
www.lawlink.nsw.gov.au/Lawlink/Corporate/ll_corporate.nsf/pages/
attorney_generals_department_acsinquiry (accessed Jul 2013).
Davis K, Schoen C, Stremikis K. Mirror, mirror on the wall: how the performance
of the US health care system compares internationally, 2010 update. New
York: The Commonwealth Fund, June 2010. http://www.commonwealthfund.
org/Publications/Fund-Reports/2010/Jun/Mirror-Mirror-Update.aspx?page=
all (accessed Jul 2013).
McKeon S, Alexander E, Brodaty H, et al. Strategic review of health and
medical research: final report February 2013. Canberra: Australian Government
Department of Health and Ageing, 2013. http://www.mckeonreview.org.au/
downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013Final_Report.pdf (accessed Jul 2013).
❏
MJA 199 (3) · 5 August 2013
153