Australia’s healthcare reform body is criticised for its narrow membership

BMJ 2008; 336 doi: (Published 06 March 2008) Cite this as: BMJ 2008;336:524
  1. Melissa Sweet
  1. 1Australia

    The body set up by Australia’s new Labor government to reform the country’s healthcare and hospital system does not represent some important groups, including consumers, indigenous people, and the non-medical workforce, critics say.

    The National Health and Hospitals Reform Commission, which is charged with drawing up a blueprint for the future healthcare system, will be chaired by a senior medical executive of a private health fund and includes four doctors, two health policy consultants, two former politicians, one nurse, and a health economist with experience in academia and bureaucracy.

    The former Australia Consumers’ Association, now called Choice, and the Consumers’ Health Forum of Australia joined many health industry leaders in expressing concern at the commission’s lack of representation of health service users.

    “If we’re trying to reform the system, the people who actually interface with that system at every level are missing,” said Mitch Messer, chairman of the Consumers’ Health Forum.

    Members of the Australian Health Care Reform Alliance, which since 2003 has been agitating for fundamental changes to the healthcare system, also noted the omission of many of the most prominent advocates for reform.

    Robert Wells, director of the Menzies Centre for Health Policy at the Australian National University and formerly a senior federal health administrator, said that “another glaring omission” was the lack of a member from Australia’s indigenous peoples. This, he said, was particularly surprising given the government’s commitment to narrowing the 17 year gap in life expectancy between indigenous people and other Australians (BMJ 2008;336:409, 23 Feb doi: 10.1136/bmj.39493.479491.DB).

    Health policy analyst Jennifer Doggett said that the exclusion of allied health professionals was also a concern, as key challenges facing the health system—including chronic diseases, the ageing of the population, and rising health costs—would require solutions that are based on reform and restructure of the workforce and a greater focus on multidisciplinary care.

    She said, “The exclusion of experts from the non-medical health professions may present a barrier to the identification of innovative approaches that don’t place doctors at the centre of the health system.

    “The history of health policy demonstrates that it is very hard to get it right when consumers are not closely involved at all stages of development and implementation.”

    The appointment of Christine Bennett as commissioner, who will continue her employment as chief medical officer with the health insurance provider MBF Australia while in the post, has also caused disquiet. Public health advocates, who have long argued that federal subsidies for private health insurance, worth more than $A4bn (£1.9bn; €2.5bn; $3.7bn) a year, are inequitable and inefficient, have interpreted the appointment as a strong message about the government’s commitment to the private sector.

    The subsidies were introduced by the previous conservative government and were strongly endorsed by the new prime minister, Kevin Rudd, when he announced the new commission.

    Stephen Leeder, director of the Australian Health Policy Institute at the University of Sydney, said, “The commission’s terms of reference suggest a strong commitment to a mixed public-private system, and under those circumstances it’s not easy to see what clear future is anticipated for publicly funded backbone services.”

    The commission will be working to an extremely tight schedule because of Mr Rudd’s pre-election commitment to seize financial control of Australia’s 750 public hospitals if state and territory governments have not begun implementing an agreed national healthcare reform plan by mid-2009.

    Some health policy experts describe the commission as caught between a rock and a hard place—their consensus is that the healthcare system needs to be reoriented to community based primary care to cope with future challenges, but they are concerned that hospitals dominate the attention of the media and politicians.

    They fear that political pressure will result in the commission focusing on solving the political problem of public hospitals rather than initiating the wider reform that is needed.

    “My worst worry is that it turns into a political management exercise of setting minimal targets to do with hospital waiting times so they can declare victory in two years, nothing much having changed,” said James Gillespie, a health policy expert at the University of Sydney.

    Dr Bennett, who has previously run public hospitals and worked in the New South Wales state administration as well as in the private and non-profit sectors, told the BMJ that the commission would consult consumers and other groups.

    “Everyone around that table is an advocate for consumers,” she said.

    She defended her commitment to the private sector: “I and some others around the commission table have got a view that . . . the mix of public and private has served us well.

    “Part of the scope of the commission is to look at the productive relationship between public and private and how to deliver that in an efficient and effective way.”

    Dr Bennett did not want to pre-empt the commission’s plans before its first meeting but said that it would have three key reporting times: at the end of April, at the end of the year, and mid-2009, when a final blueprint would be delivered.

    “Australia does have one of the best health systems in the world,” she said. “It’s clearly under pressure. My hope for this commission is that this blueprint will keep it right up there with the best health care the world has to offer.”

    Dr Bennett said that she felt privileged to be bringing together a diverse and eminent group. “One of my strengths is the ability to bring people with different views together and to facilitate constructive discussion,” she said. “Just give us a chance.”


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