It’s no wonder the health sector today is feeling a bit like Miss Havisham, jilted at the public policy altar after COAG failed to follow through on its commitment on health-care reform.

After wooing health groups for more than two years with promises of a partnership approach to restructuring the health system, COAG has reneged on its obligations at the last minute with a hastily concocted “plan to make a plan” some time in 2010.

The media release from the Prime Minister and Health Minister claims that they are delaying a decision on the reform process in order to “get this right for the future”.

The problem is that when it comes to health system reform there is no “right”. As in all complex areas of public policy, the problems with our health system have no simple solutions.

That is why all countries that aspire to have a well-functioning health system (which is to say almost all of them) struggle with the same issues. If there was a right way to run a health system, at least one of these countries would have found it.

Instead, all countries embarking on the road to health system reform have to steer a course between equity and efficiency, juggle the competing interests of public expectations and lobby groups and manage the political process of reform without making so many concessions that they negate the benefits of the reform process.

The federal government is currently in a better position than most to undertake this task. The extensive consultation process leading up to the COAG meeting has generated a wealth of reform options and unprecedented agreement among health groups as to the major issues that need to be addressed.

The role of government now is to choose the best available option, taking into account the current and future needs of the Australian community and the political and practical realities of implementing reforms.

Of course, none of these options is perfect. Like prospective marriage partners, all reform options bring with them baggage from the past (Medicare Gold anyone?), unresolved issues (how to remove the politics from health funding without reducing accountability) and potentially suspect allegiances (the influence of private health insurance funds in developing Medicare Select).

If the government is waiting to find the perfect reform option, it will be waiting forever.

This is why health groups are becoming increasingly anxious over COAG’s failure to make a decision on health reform. And it’s not just the health sector that should be concerned. The consultation process has already involved the allocation of substantial public funding, which could be wasted if the federal government continues to prevaricate on the reform agenda.

While the cost of establishing processes such as National Health and Hospitals Reform Commission (NHHRC) are relatively transparent, it’s harder to see — and therefore quantify — the resources involved in preparing the hundreds of submissions from individual groups

However, a rough calculation demonstrates that these resources are substantial. The NHHRC alone received 317 submissions, more than 200 of them from groups that receive public funding. Even if these groups each only allocated one person for one week to preparing their submission (and many groups — particularly those who undertook consultation processes with their members — allocated considerably more) this adds up to an investment of more than $500,000. Clearly, when combined with the resources involved in other consultation processes, such as those leading to the development of the National Primary Care Strategy and the National Preventive Health Strategy, the costs to the tax payer would run into the millions.

This would be a sound investment if it results in a better health system for Australia’s future. However, COAG’s decision yesterday to delay —  again — any real commitment to health-care reform is making the health sector increasingly cynical and bitter about its intentions.

If not addressed, this resentment could leave the government desperate and dateless when it finally decides to walk down the health reform aisle.

Peter Fray

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