What does the Department of Health and Ageing’s brief to the incoming government tell us about the state-of-play on health reform? (The brief was recently released in response to Freedom of Information requests)
One conclusion is that many questions about the detail and implementation of reform remain unanswered, including exactly what aspects of primary health care will transfer to Federal responsibility. So reports Rebecca de Boer from the Commonwealth Parliamentary Library, who has been trawling the four volumes for the FlagPost blog (cross-posted below with permission).
Rebecca de Boer writes:
Various government departments have made publicly available incoming government briefs that have been released under Freedom of Information. Despite sections of the briefs having been blacked out, they provide an insight into the workings of government and the advice provided to Ministers in the post-election environment.
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The Department of Health and Ageing’s (DoHA) incoming government brief provides an overview of the health system and arrangements for implementing health reforms begun during the previous parliament. The brief also lists key decisions for the Minister to make in the first four months.
Some of these decisions have been made and legislation has already passed, for example, the establishment of the Australian Commission on Safety and Quality in Health Care and the changes to the Pharmaceutical Benefits Scheme (PBS) to give effect to the Memorandum of Understanding (MOU) between Medicines Australia and the Government.
The incoming government brief also gives an indication of how implementation of the National Health and Hospitals Network (NHHN) is progressing and the timeframe for implementation of some of the proposed arrangements such as Medicare Locals and Local Hospital Networks.
There has been some media commentary on the incoming government brief with respect to mental health, Pan Pharmaceuticals and private health insurance. This post will focus on the health reform arrangements.
The incoming government brief highlights the significant number of decisions that need to be taken by the Government to give effect to the NHHN. For example:
- The boundaries for Medicare Locals (see A1.02) as well as the approval of the roles, functions and governance arrangements for these organisations (see A1.01). However, it is expected that around 15 Medicare Locals will commence by July 2011 (see A1.02). Medicare Locals are independent organisations responsible for the coordination of primary care services for a defined geographical region
- Finalisation of the numbers and boundaries of Local Hospital Networks with Health Ministers by 31 December 2010 (see A1.01)
- Agreement on what constitutes primary care and what functions will be transferred to the Commonwealth (see A1.01). This also has implications for funding arrangements
- A decision about recommendations to the COAG December 2010 meeting on whether ‘community health promotion and population health programs, drug and alcohol treatment services, child and maternal health and community palliative care’ should transfer to the Commonwealth or ‘undergo strong national reform efforts within current roles and responsibilities’ (see A1.01)
- Finalisation of the terms of reference for the Independent Hospital Pricing Authority is outstanding (see A1.15)
- What the arrangements should be regarding the treatment of private patients in public hospitals (see A3.04). The broader question of the role of private hospitals in the NHHN was not canvassed in the incoming government brief.
- Implementation arrangements for States that have not yet signed the National Partnership Agreement (NPA) on Improving Hospital Services . Tasmania has not yet signed this agreement. At the time the brief was written, Victoria had not yet signed this NPA but the Victorian Government signed it prior to entering caretaker mode. It was also noted that issue of how to address funds that had been nominally allocated to Western Australia (WA) under this NPA had not yet been resolved.
One of the premises of the NHHN was that the Commonwealth would have full policy and funding responsibility for primary care. Yet primary care, and what constitutes primary care, has been a matter of contention from when the NHHN was announced. The lack of agreement on this matter was reflected in the NHHN Agreement (B34), and it does not appear that it has been resolved since. The incoming government brief suggests that this was to be discussed at the next COAG meeting in December 2010, which has however been deferred to February 2011.
Apart from commentary about internal implementation governance arrangements (see A1.01), such as the arrangements among central agencies and state health and treasury departments, the incoming government brief does not address the proposed governance arrangements for the NHHN. The lack of clarity about the linkages among the new national governance authorities of the NHHN was however highlighted the Treasury Red Book (Part 3).
The implementation plan for the NHHN detailed a series of key milestones and dates for implementation of the reform. Delays might be likely given the postponement of the December 2010 COAG meeting and the many key issues yet to be resolved detailed in the incoming government brief.
The WA government continues to oppose the health reform deal agreed at the April 2010 COAG meeting and the new Victorian Coalition Government is examining its position. The New South Wales Opposition Leader has recently indicated that, if elected, he would not be surrendering Goods and Services Tax (GST) revenue (a key source of funding for the deal) to the Commonwealth.
There also have been debates in the Parliament and elsewhere about the GST arrangements for the NHHN and the federal Opposition has indicated that it will not support the legislation to give effect to these changes.
The slow progress on implementation of the NHHN and the need for more clarity on key issues such as primary care and governance as well as the political opposition from the federal Opposition and some States would suggest that there are further obstacles ahead for the health reform effort.
Previous Croakey posts on the DoHA documents:
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