Perspectives
153 MJA 199 (3) · 5 August 2013
The Medical Journal of Australia ISSN: 0025-729X 5 August 2013 199 3 153-153
©The Medical Journal of Australia 2013 www.mja.com.au
Perspectives — Pre-election series
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 working relations between clinicians and management which is very detrimental to patients. It is alienating the most skilled in the medical workforce from service in the public system.4 The problems identified by Garling and in 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
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 Mar. http://www.theaustralian.com.au/politics/kevin-rudds-better-health-better-hospitals-speech/story-e6frgczf-1225836509805 (accessed Jul 2013). 2Council of Australian Governments. National Health Reform Agreement. July
2011. http://www.federalfinancialrelations.gov.au/content/npa/health_ reform/national-agreement.pdf (accessed Jul 2013).
3COAG 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-2011-12-comparing-performance-across-australia (accessed Jul 2013).
4Garling 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).
5Davis 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).
6McKeon 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_2013-Final_Report.pdf (accessed Jul 2013). ❏
Challenges in health policy: the next 10 years
A
Perspectives
David G Penington AC, DM, FRCP, Emeritus Professor,1 and Chairman2
1 University of Melbourne, Melbourne, VIC. 2 Bionic Vision Australia, Melbourne, VIC.
doi: 10.5694/mja13.10838
Hospital governance that prioritises waiting times or patient
throughput does not adequately address health care quality
“
clinical research is the greatest safeguard of quality of care
