The changing landscape of national health reform: challenges and opportunities

Professor Christine Bennett AODean, School of Medicine, Sydney The University of Notre Dame Australia; Board Chair, The Sydney Children’s Hospitals Network

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The changing landscape of national health reform:

challenges and opportunities

Professor Christine Bennett AODean, School of Medicine, Sydney

The University of Notre Dame AustraliaFormer Chair of the National Health and Hospitals

Reform Commission

2014 NSW Health Symposium19th June 2014

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Changing political

landscape

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A long-term blueprint for

reform• Four reform themes

• Taking responsibility

• Connecting care

• Facing inequities

• Driving quality performance

• 123 recommendations for action

• 108 accepted / 14 noted / 1 rejected

• 44 being implemented , 61 in part, 17 no action (March 2013)

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Taking responsibility

Individual and collective action by people, families, communities,

health professionals, employers, health funders and governments

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Taking responsibility

• ANPHA abolished

• Tobacco, alcohol and obesity

reduced investment

• Healthy kids, healthy communities, healthy workplaces NPA ceased

• Healthy Communities Report

• WHO social determinants

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Taking responsibility -

PCEHR

General Practice

PharmaciesPrivate Health Insurance

Hospitals

Progress review and further investment

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Connecting care

Comprehensive care for people over their lifetime

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Connecting care –strengthening primary

care• GP Superclinics – program ceased

• Primary health care organisations (Medicare

Locals) – transition to Primary Care Networks

• Voluntary Enrolment Diabetes pilot – no results available yet

• Sub-acute care – NPA ended June 2014

• GP copayment - $7 per visit

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Connecting care – aged

care

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Facing inequities

Recognise and tackle the causes and impacts of health inequities

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National Disability Insurance Scheme

DisabilityCare Australia –

support for people with

permanent and significant

disabilities, their families and

carers

Continuing to progress

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Driving quality

performance

Leadership and systems to achieve best use of

people, resources, and evolving knowledge

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Australia’s

‘health system’

Source: NHHRC A Healthier Future For All Australians, Final Report June 2009 pg 47

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Commonwealth-state funding shares

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Source: A National Health and Hospitals Network for Australia’s Future – Delivering better health and better hospitals, 2010

Health financing

sustainability

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National Health Reform Agreement 2011

• Intergovernmental compact on health reform package

• National Partnership Agreements: prevention, subacute care, waiting list reductions

• Introduction of efficient activity based funding (ABF) with Commonwealth increasing share of growth from 2014/15

• Commitment to performance monitoring

• States established local hospital networks (>55)

• Commonwealth formed 61 Medicare Locals - primary healthcare

• National bodies: APHRA, ACSQHC, ANPHA, HWA

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Federal Health Budget 2014-15• National Partnership Agreements - ceased

• Removal of minimum growth guarantee

• 45% share of growth 2014/15 only to 2017/18

• Abolish or merge national bodies:

• HWA – DoH

• ACSQHC, IPHA, NHPA, AIHW – new performance and productivity agency

• Medicare Locals transition to Primary care Networks

• New copayments

• Medical Research Future Fund

• ANPHA – abolished

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May 2014 budget changes to reformsHealth Measures Total $m

2014/15-2017/18

Medical research 445.8

MBS -5,512.2

Primary care networks -

Hospitals -1,958.8

PBS -865.9

Workforce 72.0

Mental Health 2.5

Dental -635.0

Prevention programs -274.9

ANPHA abolish -6.4

Flexible funds -201.5

PCEHR 140.6

Indigenous Affairs rationalisation - 121.8

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Changes in the fiscal gap since the 2013-14 Budget

Source: NSW Budget Statement 2014-15

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Projected Commonwealth share of NSW Health funding

Source: NSW Budget Statement 2014-15

Commonwealth moderating spending growth

• ‘From 2017-18 the Government will index public hospitals funding by a combination of growth in the Consumer Price Index and population.’

• ‘State and Territory governments are responsible for managing public hospitals, and are therefore best placed to improve efficiency in the hospital system.’

• ‘The changes in this Budget will provide a platform to consider longer term arrangements in the context of the White papers on the Reform of the Federation and the Reform of Australia’s Tax System.’

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Source: Commonwealth of Australia, Budget 2014-15 Health

Rationalising roles and responsibilities

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Source: Report of the National Commission of Audit – Volume 1, Appendix, 8.2

Challenges

• Changed Commonwealth funding contribution – widening the fiscal gap

• Uncertainty and reduced transparency

• National prevention leadership

• Health workforce planning – national, public/private

• ACSQCHE - across public and private sectors

• Copayment – pressure on public hospitals

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Opportunities

• PCEHR and HealtheNet

• Prevention – State leadership

• Primary Care Networks – shape agenda for integrated care

• Copayments – ? States enter primary care

• ABM Portal – smart use of data

• Health Productivity and Performance – ensure breadth and relevance

• White papers on the Reform of the Federation and Tax Reform

• Medical Research Future Fund

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Medical research future fund

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Source: Commonwealth of Australia, Budget 2014-15 Health

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ReferencesAustralian National Preventive Health Agency – www.anpha.gov.au/internet/anpha/publishing.nsf/Content/state-of-prev-health-2013

Australian Bureau of Statistics - www.abs.gov.au

Australian Institute of Health and Welfare - www.aihw.gov.au

National Disability Insurance Scheme - www.disabilitycareaustralia.gov.au

National Heath and Hospitals Reform Commission Report - www.health.gov.au/internet/nhhrc/publishing.nsf/content/nhhrc-report

NSW Budget Papers 2014-15 – Budget Paper No. 2 – www.treasury.nsw.gov.au

Commonwealth of Australia, Budget 2014-15 Health – www.budget.gov.au/2014-15

Towards Responsible Government - Appendix to Report of the National Commission of Audit – Volume 1, 8.2 - www.ncoa.gov.au

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Questions & Discussion