It is a truth universally acknowledged that a new government in possession of a reform agenda must be in want of a Taskforce (or a Commission…or a review…or a policy committee). The Rudd Government is no exception to this rule having established, in its first year of office, taskforces, policy reviews, commissions and consultation processes in almost every area of the health system. These include the following:
- A National Primary Care Policy Reference Group
- The National Health and Hospitals Reform Commission
- A Preventative Health Care Taskforce
- Consultation processes for the development of both a Women’s and Men’s Health Strategy
- The National eHealth and Information Principal Committee
Looking at the list above, it is not surprising that health interest groups feel like they have done little else during 2008 than prepare submissions and appear in front of committees.
So, what does this tell us about the Rudd Government? On the plus side, its focus on involving stakeholders in these review and developmental processes is evidence that, compared with previous governments, the new regime is actively seeking input into policy from a broad spectrum of experts, providers and consumers.
Another positive is that the Government has committed to addressing important areas of policy neglect, such as ehealth and primary care, in an effort to develop a framework around key areas of health care which have been developing in a policy vacuum.
Prime Minister Kevin Rudd and Health Minister Nicola Roxon have also acknowledged the need for structural reform within the health sector and flagged support for major changes to workforce roles and responsibilities, and they have committed to an increased focus on performance and outcomes. These are long overdue issues which previous governments have neglected or put in the "too hard" basket.
However, unfortunately for the long-term success of the Rudd Government’s reform agenda, these efforts alone, even if backed up by additional health spending, will not be enough to improve the overall health of the community.
As the history of health policy in Australia demonstrates, even the most dedicated taskforce or the most comprehensive and inclusive review will not improve health outcomes unless it results in real changes in the way in which health care is delivered. This will only occur if the Rudd Government is prepared to undertake two challenges that previous governments have considered to be too politically risky to confront.
The first of these is to resist the traditional role of the medical profession and medical lobby groups in orienting the health system around the needs of doctors rather than consumers. While the Government has made an obvious commitment to listening to stakeholders other than doctors when developing its health policies, it has not yet demonstrated the extent to which it is willing to take on medical interest groups if they oppose recommended reforms.
The second of these is to explicitly address the role of rationing within the health system. Currently, health resource allocation decisions are made in a variety of ways, often not transparent to consumers or reflective of community priorities. Involving the community in making decisions about rationing of health care resources is vital to ensure they reflect community (rather than provider or government) priorities. However, involving consumers more directly in setting priorities for resource allocation will also mean confronting the politically challenging reality that not everyone can have all the health care they believe they need.
These are both politically sensitive and challenging issues. However, unless the Rudd Government is prepared to tackle them directly, they have the potential to undermine the successful implementation of its reform agenda and the long-term potential for this Government to achieve lasting positive changes to our health care system.
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