• Jeremy Sammut
• Centre for Independent Studies

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26 November 2009Instead of centrally planning the future of Australian health care as recommended by the National Health and Hospital Reform Commission, the federal government should establish a national health voucher system and let choice, competition, and patient need determine the right supply of health services required in an ageing Australia.

The final report of the National Health and Hospital Reform Commission (NHHRC or the Commission), A Healthier Future for All Australians (hereafter the Bennett Report), is like the curate’s egg -- only good in part and therefore spoiled overall.

The NHHRC has acknowledged the need to ensure health services are responsive to the needs of patients, and has recommended some very limited market-based reforms to improve the efficiency of public hospitals. But, overall, the Commission’s long-term health reform blueprint will not put consumers in charge and ‘develop a person-centred health system.’

The major recommendations contained in the Bennett Report concern:

(1)  Expanding the role of the Commonwealth in the primary care sector of the health system;

(2)  Ending the ‘blame game’ by clarifying the complex and overlapping governance
responsibilities of the federal and state governments; and

(3)  Modifying the way the public hospital system is run and funded.

The three major problems with the reforms recommended by the Commission are:

Ineffective primary care centred strategy. Spending billions of taxpayer’s dollars on a Commonwealth-financed GP Super Clinics network will not fix the problems in Australia’s public hospital system.

Tinkering with governance arrangements at the national level. Recasting federal and state responsibilities to establish clearer policy, funding and performance accountabilities for problems in the health system will not achieve structural reform of the way public hospital and other taxpayer-funded health services are produced.

Market-based hospital reform doesn’t go far enough. Requiring all public hospitals to be 100% funded on an activity-based casemix basis is an overdue reform, but casemix funding alone will not end the wasteful and inefficient administration of public hospitals by state government health bureaucracies.