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Commission criticises Medicare approach

The World Today - Thursday, 8 May , 2008 12:34:00

Reporter: Alexandra Kirk

ELEANOR HALL: A group of health experts appointed by the Prime Minister says Australia's
40-year-old universal healthcare system is failing to deal with new developments, most notably in
mental health and dental care.

The National Health and Hospitals Reform Commission says Medicare needs to focus on the "total
person", and that this goes beyond the system's original aims of access to doctors and hospitals.

And the commission has also recommended there be cleaner accountability for the different arms of

In Canberra, Alexandra Kirk reports.

ALEXANDRA KIRK: The National Health and Hospitals Reform Commission was appointed by the Prime
Minister to advise the Commonwealth and the states through the Council of Australian Governments.

In its first report, the commission, which includes former Western Australian premier Geoff Gallop,
former Victorian health minister Rob Knowles and a former health department chief, Dr Stephen
Duckett, says to end the so-called "blame game" the next set of healthcare agreements must be
different: broader than just hospitals, and with strong performance benchmarks for each tier of
government to enforce their accountability.

CHRISTINE BENNETT: This advice to the governments of Australia is about the healthcare agreements
between the Commonwealth and the state, and we're suggesting that that reflect the whole health
needs of the person, including mental and dental health.

ALEXANDRA KIRK: The 10-member committee is chaired by former paediatrician Dr Christine Bennett,
now chief medical officer with private insurer MBF. The commission says Medicare doesn't focus on
the health needs of the whole person, that key gaps in access exist, citing support for mental
health and dental care.

CHRISTINE BENNETT: In mental health, for example, there is a need for coordination of multiple
disciplines across different settings.

There's the need to be able to access psychologists, social workers and doctors in the community,
but also in the acute and the supported accommodation sector, and at the present time, there's a
difficulty for people navigating that. So the system addresses largely the acute end, the hospital
end, but not so much the community end.

ALEXANDRA KIRK: And with dental health?

CHRISTINE BENNETT: With dental health of course there is some publicly funded dental health
coverage, and for those with health insurance there's also some coverage.

But for general dental that's not a feature of the current MBF scheme. Now, we need to consider
that and look at that further. We've not made recommendations at this stage, because we're actually
now going out to consult with the community about these and a lot broader range of issues as well.

ALEXANDRA KIRK: To move beyond the blame game, the report also proposes more than 40 benchmarks to
make the health system more accountable, where performance against a target should have a clear and
usually financial consequence, attributable to either the Commonwealth or state governments, but
not both.

CHRISTINE BENNETT: So what we have recommended is that the states focus on hospital sector, and
that the Commonwealth take a lead role in primary care and prevention, but that they work very
closely together.

They way we've structured the indicators and the benchmarks is to allocate a primary responsibility
to the Commonwealth or the state so that there's some clarity about those accountabilities.

ALEXANDRA KIRK: As to exactly who should run what parts of healthcare, Dr Bennett says that's the
subject of the big draft report on redesigning the entire system, due in November.

Opposition health spokesman Joe Hockey says the first report gives the Government enough impetus to
make important changes to Medicare in Tuesday's Budget.

JOE HOCKEY: We certainly expect that the Government would react to this report in the Budget.
Psychology and dentistry were put into Medicare under the Howard Government. So far, the Rudd
Government has removed oral health from Medicare. We oppose that.

We believe, as does this hospital commission, we believe that Medicare should be covering oral
health, and given the fact that this report is being released just before the Budget, we would
expect that oral health would be back in under Medicare on Tuesday night.

ALEXANDRA KIRK: But Health Minister Nicola Roxon sees this report as preliminary advice to feed
into federal negotiations with the states.

NICOLA ROXON: Well, this report is the first stage in a process, but it's not the end of the
process, it's the start of the process. An important start, but there is still a lot of reform work
to be done.

ALEXANDRA KIRK: So can we expect to see some changes in next week's Budget?

NICOLA ROXON: Obviously the changes that will be in the Budget, the expenditure that will be in the
Budget, will be announced as part of the Budget.

But I think it's quite breathtaking that a previous government that ignored health reform for so
long, in fact had a minister that thought health reform was a dirty word, should now be calling for
immediate action.

We are rebuilding the system. We are investing. But we will take our time to get the reform right,
and this first interim report from our Health and Hospital Reform Commission is an important first

ELEANOR HALL: That's Federal Health Minister Nicola Roxon speaking to Alexandra Kirk in Canberra.