The National Health and Hospitals Reform Commission – Can it Make a Difference?

As anyone who has not been under a rock for the last few weeks will know the Prime Minister has announced a Health Reform Commission.

http://www.health.gov.au/internet/main/publishing.nsf/Content/nhrc-1

National Health & Hospitals Reform Commission

On 25 February 2008, the Prime Minister and the Minister for Health and Ageing announced the establishment of the National Health and Hospitals Reform Commission. A copy of their media release is available here.

The Commission has been established to develop a long-term health reform plan for a modern Australia. The Chair of the Commission is Dr Christine Bennett, who is currently Chief Medical Officer at MBF Australia Ltd. Nine other Commissioners will assist Dr Bennett. They are:

• Rob Knowles, former Victorian Liberal Health Minister;
• Geoff Gallop, former Premier of Western Australia;
• Mukesh Haikerwal, Melbourne GP and immediate past-President of the AMA;
• Stephen Duckett, health economist and former Secretary of the Commonwealth Department of Health;
• Ron Penny, Emeritus Professor of Medicine, University of NSW;
• Sabina Knight, Senior Lecturer, Centre for Remote Health and remote area nurse;
• Sharon Willcox, Director of consulting firm Health Policy Solutions;
• Justin Beilby, Executive Dean of the University of Adelaide’s Medical School; and
• Mary Ann O’Loughlin, Director, The Allen Consulting Group.

Associated with the press release were the terms of reference for the new Commission

Terms of Reference

Australia’s health system is in need of reform to meet a range of long-term challenges, including access to services, the growing burden of chronic disease, population ageing, costs and inefficiencies generated by blame and cost shifting, and the escalating costs of new health technologies.

The Commonwealth Government will establish a National Health and Hospitals Reform Commission to provide advice on performance benchmarks and practical reforms to the Australian health system which could be implemented in both the short and long term, to address these challenges.

1. By April 2008, the Commission will provide advice on the framework for the next Australian Health Care Agreements (AHCAs), including robust performance benchmarks in areas such as (but not restricted to) elective surgery, aged and transition care, and quality of health care.

2. By June 2009, the Commission will report on a long-term health reform plan to provide sustainable improvements in the performance of the health system addressing the need to:

a. reduce inefficiencies generated by cost-shifting, blame-shifting and buck-passing;

b. better integrate and coordinate care across all aspects of the health sector, particularly between primary care and hospital services around key measurable outputs for health;

c. bring a greater focus on prevention to the health system;

d. better integrate acute services and aged care services, and improve the transition between hospital and aged care;

e. improve frontline care to better promote healthy lifestyles and prevent and intervene early in chronic illness;

f. improve the provision of health services in rural areas;

g. improve Indigenous health outcomes; and

h. provide a well qualified and sustainable health workforce into the future

The Commission’s long-term health reform plan will maintain the principles of universality of Medicare and the Pharmaceutical Benefits Scheme, and public hospital care.

The Commission will report to the Commonwealth Minister for Health and Ageing, and, through her to the Prime Minister, and to the Council of Australian Governments and the Australian Health Ministers’ Conference.

The Commonwealth, in consultation with the States and Territories from time to time, may provide additional terms of reference to the Commission.

The Commission will comprise a Chair, and between four to six part-time commissioners who will represent a wide range of experience and perspectives, but will not be representatives of any individual stakeholder groups.

The Commission will consult widely with consumers, health professionals, hospital administrators, State and Territory governments and other interested stakeholders.

The Commission will address overlap and duplication including in regulation between the Commonwealth and States.

The Commission will provide the Commonwealth Minister for Health and Ageing with regular progress reports.

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From an e-Health Perspective it seems a bit sad that with the number of commissioners appointed there is not an obvious e-Health representative although at least two of the new members are known to have at least some interest in the area. (Mukesh and Justin)

What is more worrying however is that there is not a term of reference to explore the potential roles of technology to support the stated goals and indeed there does not seem to be a clear recognition of the degree of decay in the health system infrastructure overall, which will need to be addressed for the reforms to succeed.

The lack of apparent understanding of the importance of the importance of information flows as enablers of integration and prevention I hope is accidental rather than deliberate.

Lastly there do seem to be a lot of people who are former this or that involved. I hope this means they bring wisdom and not ‘old thinking’ to their task. We have had way to much of that in the last decade or two.

It seems to me e-Health has a lot to offer in the crucial domains of health system sustainability, patient safety, quality of care, consumer centricity and health system efficiency.

David.