The Australian Health Care Reform Alliance

The Australian Health Care Reform Alliance, AHCRA, is a coalition of peak health groups working towards a better health system for Australia’s future, stating its vision as:

'a health system that assists individuals to be healthy and delivers compassionate and quality health care to all'.

The Federal Government has embarked on a major health reform initiative, involving making significant changes to the ways in which health care is funded and delivered. AHCRA supports the overall goals of health reform and is working to ensure that the reform measures deliver a fairer, more efficient and sustainable health system.

On 30 January 2013 the AHCRA Executive convened a one day workshop to discuss planning for the year ahead. HCCA is a member of AHCRA and Sue Andrews and Russell McGowan attended the meeting. What follows is a summary of AHCRA’s work in monitoring progress of the Federal Government’s health reform agenda to date. It is based on a report prepared by Dr Tony McBride which framed the day’s discussions and informed consideration of work for the upcoming election year.

For AHCRA, the health system’s underlying principles should be based on:

• Equitable access
• Equitable outcomes
• Primary Health Care
• Community engagement and consumer participation
• Workforce
• Efficiency

Using six criteria developed from these principles AHCRA undertook an analysis of how new policies and funding mechanisms/initiatives would:

• create positive permanent changes to what health care was provided (not just more of the same)
• increase effective preventive effort/early intervention and better integrated multi-disciplinary primary health care
• improve equitable access to health care, especially primary health care
• ensure stronger consumer, carer and community engagement in both care and planning 
• increase efficiency of use of resources and workforce
• create a more rational split of responsibilities between governments.

These were applied to the areas of health reform: hospitals funding, primary health care, aged care, mental health, dental care, health prevention, eHealth and workforce issues.

Whilst the analysis reflected a broad-brush assessment of each initiative, what emerged was a ready shorthand summary of progress. However, noting this qualification, it indicates that:

• Most of the initiatives are permanent (as much as one can say) in nature (e.g. not short-term funding, or trials)
• Less than a third are aimed at increasing a focus on prevention or early intervention
• Less than a half are aimed at addressing inequities
• Few address increasing the involvement or centrality of consumers or community in the system
• About a half seem to be addressing efficiency
• About a third seek to clarify funding/policy/service delivery responsibilities
• Some key disadvantaged groups, especially those typically hidden such as people with an intellectual disability, are not identified as requiring specific strategies.
• Overall this amounts to a picture of disjointed incrementalism with some progress but a disappointing level of action on some of the most important issues to AHCRA members
• There is still a long way to go on the long and winding road.

Overall, the reforms appear to be moving in some of the right directions although overall modest in nature and patchy. Positives of the reform process and other Federal Government initiatives in the last three years include: 

• The recent national dental package, with its reform of at least the child and adolescent system, is a significant gain, and creates some of the building blocks required for a future universal system
• Greater funding into innovative areas of mental health provision
• Establishment of Medicare Locals (MLs) as supports for and change agents for reform and improvement in primary health care. In particular their population health planning will create shared understandings of the local system (currently not available) and a platform to address the gaps identified. The MLs also offer new opportunities for community engagement.
• Other initiatives offer the opportunities for a more nationally consistent system, and one where the efficiencies gained in some states can be spread across the remainder (e.g. in hospital care pricing).
• And although not strictly part of the reform process, the Federal Government’s legislation for tobacco plain packaging was a major gain.

However, for many initiatives there is too little implementation progress so far to measure what has been achieved. The vast majority of health consumers would have noticed little impact so far, so judgement on many reforms may have to wait a year or two to be valid. And for some, implementation will need to be closely monitored to ensure that the anticipated benefits are achieved.

However there is also a range of important gaps and system flaws that have not been adequately addressed or even recognised at all. So in some key areas there has been no or little progress, including prevention (whose share of the national health budget is going backwards)^[1], consumer participation and moving towards consumer-focussed services, and action to meet the needs of some identified vulnerable population groups, including people with intellectual disabilities.

The fee-for-service model remains unscathed despite its many drawbacks including constraining innovation. In other areas there has been only very modest progress (e.g. in increasing the equity of the system, so for example mal-distribution of services and professionals remains chronic in many parts of Australia and out-of-pocket expenses for consumers continue to rise, hitting the poor hardest). There has also been some action in workforce, for example to improve the availability of allied health professionals in rural areas, but it falls far short of the need (and has been exacerbated by the wholesale slashing of allied posts by at least one State Government).

Two key challenges present themselves for AHCRA and its members. The first is to continue to advocate for the gaps to be addressed, albeit in an environment where the appetite of the major parties for significant reform appears sated. The second is to identify opportunities to influence the effective implementation of the current reform agenda, especially those addressing equity, the strengthening of prevention and primary health care and reducing demand on hospitals, so that such reforms achieve the maximum possible benefit to the community.

For more information about AHCRA see www.healthreform.org.au or contact HCCA.

Sue Andrews

HCCA President

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[1]Australian Institute of Health and Welfare 2012. Health expenditure Australia 2010–11. Health and Welfare Expenditure series no. 47. Cat. no. HWE 56. Canberra.^↩