With the National Health and Hospitals Reform Commission due to release its interim report on Monday, there is much anticipation as to what reform proposals they will put forward for discussion.

Few would question the need for significant reform across the board — prevention, primary care and acute care.

The rates of death and serious injury in our hospitals through error remain unacceptably high. People suffering from chronic diseases do not receive the care that research evidence shows is optimal for their conditions.

Indigenous Australians are still disadvantaged in access to appropriate health care and have much poorer health outcomes than other Australians.

Our health funding arrangements are disjointed and cause distortions in access and patterns of care.

There are severe difficulties in relation to the supply and distribution of our health workforce. Much more needs to be done to tackle problems with obesity, alcohol and other substance abuse.

It will be an enormous challenge for the Commission to suggest approaches to dealing with these problems that are both strategic and result in improvements quickly in the moist critical areas. Clearly there will be a need for bold and politically difficult actions by governments.

Leaving aside what specifics the Commission might put forward, the real question is: what are the prospects for reform? The history of recent reform process — for example, through the Council of Australian Governments (COAG) — does not fill one with optimism.

The global financial crisis will further inhibit health reform, especially where additional outlays are required. Additional spending that does not have an immediate economic stimulus will be of a lower priority.

Recent political events show that, even where there is an atmosphere of crisis and apparent consensus on the need for action, passage of legislation through the Senate cannot be assured.

So while we await the Commission’s report with intense interest, the real outcome will, as has been the case in the past, be subject to the political winds of the day.

Peter Fray

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