The Interim Report of the National Hospitals and Health Reform Commission provides a blueprint for reforming Australia’s health system in the medium to longer term. Australia could do a lot worse than take the blueprint as the working document for the future.

All the elements of well functioning system are included: prevention, primary care, acute care, dealing with inequities, quality and safety, workforce and better governance arrangements for the system. It shows a way to address a major gap in Medicare — oral health — and suggests a mechanism for tackling our major inequity — health outcomes for Indigenous people.

Already the vested interests are gathering to attack the parts that do not suit them — doctors, nurses, dentists and so on. More will surface in the coming days as the full import of the report’s directions is better understood.

It would be a mistake to let these side debates interfere with the major reform task. Of course there are gaps in the report, some policy suggestions that are questionable and some that are obvious compromises to at least soften some of the vested interests’ criticisms.

The fundamentals, however, hit the mark. The focus on primary care as the part of our system that needs most attention is hard to dispute. The proposed means to achieve it is bold and fraught with the inevitable argy bargy between levels of government. Nevertheless the problem must be faced and dealt with.

The “denticare” scheme will be criticised as too costly. Before that argument is allowed to run, perhaps a proper cost analysis of letting Australia’s oral health to continue to run down should be undertaken. The proposed scheme has some features that could well be borrowed by Medicare itself- especially bringing the private sector on board as real partners in the overall arrangement.

The biggest disappointment is the failure of the Commission to seriously tackle the question as to how the public investment in private insurance can be better realised as a benefit to the system overall. Option three for governance has some potential to achieve this, but that option seems to be there to frighten governments back to options one or two.

Now would be an excellent time for Australia’s health experts and interests to put aside their usual negativity and carping, embrace the broader vision and engage in a constructive debate about directions for the future. The NHHRC Interim report provides that challenge for us all.

Peter Fray

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