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Queens Health Policy Change Conference Series

Australian Health Reform Progress

Prof Mick ReidMay 2014

Health/Hospital BoardsMost States have created District Hospital Boards

- Devolved authority from State Authorities.

- Increased local autonomy.

- Improved clinical engagement.

- Fostered local innovation e.g. Workforce.

- Adopted transparent funding arrangements.

- Greater public/private interaction to provide public services.

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Primary Health Care

Federal Government has created 61 ‘Medicare Locals’ throughout Australia – GP and other community health personnel.

- In some States boundaries of Medicare Locals equate District Hospital Boards.

- Joint Planning now enabled.

- Some contracts evolved between DHBs and MLs re hospital avoidance/frequent flyers.

- Still too early to judge overall effectiveness.

- Under review.

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Transparency/Performance

National Health Performance Authority

- Role to monitor and report on performance of public and private hospitals and Medicare Locals.

- Reporting scope determined by Federal/State Health Ministers.

- This year will publish first ‘poor performance’ report.

- Complements actions of States in managing/monitoring performance of their hospitals.

Transparency/PricingIndependent Hospital Pricing Authority

- Role is to calculate an annual National Efficient Price.

- NEP determines Commonwealth funding contribution to hospitals according to hospital activity levels or block funding (for smaller hospitals).

- In all States, public hospitals paid for number/mix of patients they treat.

- Pricing extended from inpatient to outpatient clinics, community based clinics and inpatients homes (HITH).

- Creates $ incentives for hospital avoidance, early discharge.

- Greater pressure on hospitals as ‘efficient price’ more rigorously enforced.

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E-HealthNational E-Health Transition Authority (NEHTA) owned by Federal/State governments.

- Role is to develop foundations/services for national e-health capability.

- Particular emphasis on creation of Personally Controlled Electronic Health Record. Designed for consumers to share health

information with different providers.

- Commenced 1/7/2012. An opt in system

- 1.5 million Australians have joined

- strong collaboration with vendors re specs/standards

- not a replacement for local clinical information systems.

Currently under review (opt in to opt out/greater private ‘ownership’).

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Safety and QualityAustralian Commission of Safety and Quality in Health Care

- Coordinates national improvements in safety and quality.

- Focus on clinical communications/falls prevention/health associated infection/medication safety/open disclosure/accreditation standards/patient experience.

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Health Reform ProgressUncertainties

- Health Reform initiated prior to change to conservative governments Federally and in most States.

- New governments concerned with achieving balanced budgets/decreasing government outlays.

- Status of Commission of Audit Report

- Federal Budget.

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Commission of Audit Proposals

- Universal access to bulk billing (i.e. free to consumer)

GP services abolished.

- $5–$15 copayment on GP attendances.

- Increased copayment for pharmaceuticals.

- Enforcing private health insurance for high income earners.

- Introduce copayment for ‘GP like’ attendances at emergency departments.

- Recommends merging of a number of national health agencies on pricing, performance, quality and data collection, abolishes others.

- Allow pharmacists/nurses to take broader role.