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Why are we here? What reforms do we want? Paper presented at the Australian Health Care Summit, Old Parliament House, Canberra, 17-19 August 2003



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Why are We Here? What Reforms Do We Want? Dr Robin Mortimer

President,

The Royal Australasian College of Physicians

Presentation to the

National Health Summit Old Parliament House, Canberra 17-19 August 2003

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Why Are We Here? What Reforms Do We Want? Introduction • The RACP supports efforts to maintain the momentum for reform

 

• Medicare has become an accepted part of the Australian

health care system and has provided us with very good

outcomes, even if it is in need of some reform to strengthen

its intended purpose

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Why Are We Here? What Reforms Do We Want? The College has a proud history in supporting:

• a national health system;

• universal access to health care;

• social policies that promote good health outcomes;

• equity based health care policies and services; and

• health financing arrangements that remove incentives for cost shifting and disincentives to integrated care.

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Why Are We Here? What Reforms Do We Want? • The College also has a history of working with other organisations and our partnerships with health consumers

through the Australian Consumers Association and Health

Issues Centre, and with indigenous Australians through the

Australian Indigenous Doctors Association

• We also work very cooperatively with Governments, regardless

of political persuasion, at the Commonwealth and

State/Territory level in a range of areas such as quality and

safety, workforce development and training, mentoring and

rural health

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Why Are We Here? What Reforms Do We Want? The Australian Health Care Agreements • have been the mechanism since the advent of Medicare to

reform and fund the national health system

  • The Agreements are bilateral between the Commonwealth

and State/Territories and detail funding arrangements for public

hospitals

• The other planks of our national health system are the Medical

Benefits Schedule (MBS) - that forms the other plank of

Medicare with the Agreements - and the Pharmaceutical

Benefits Scheme (PBS)

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Why Are We Here? What Reforms Do We Want? The Summit • This summit is a last minute attempt to convince all Governments - Commonwealth and State - the health community wants

assurances that modifications to the Agreements will occur that

promote reform

  • As you may be aware, we at the College have been concerned

about the financing of health services since we contributed to

the Senate Inquiry into Public Hospital Funding in 1 999

  • At that time we pointed out that inadequate funding levels, cost

shifting between levels of Government would precipitate a crisis

in the provision of care and adversely affect health care delivery

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Why Are We Here? What Reforms Do We Want? The Summit • Two years ago, the College offered to host a national one-day

summit in Brisbane so that Governments and the health

professions could discuss ideas for reform and the upcoming

Australian Health Care Agreements.

  • A date was set and some funding was approved but the

proposal did not go ahead when the Australian Health

Ministers Conference established the nine reform working

groups

  • It was thought then by Governments that a way forward had

been found and that the summit was unnecessary

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Why Are We Here? What Reforms Do We Want?

The Summit • At the time, the College expressed some concern that the nine working groups may not achieve their intended purpose but we

remained hopeful that we would be proved wrong

  • Unfortunately our foresight in the submission to the Senate inquiry

and our concern about the reform agenda was correct

  • Cost shifting has continued - to consumers by out of pocket

contributions that have had a major impact on disadvantaged

groups in particular - and between levels of Government

  • We recommended that the funding of health services by the

Commonwealth to State/Territory be re-organised with an emphasis

on the coordination and integration of services

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Why Are We Here? What Reforms Do We Want? What do we need in reform? • The new Australian Health Care Agreements must include

health reform commitments from the Federal, State and Territory Governments

  • We need a new model of continuous care that enables us to

provide care where it is most appropriate - whether that be the hospital, the community or in a different kind of ambulatory setting

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Why Are We Here? What Reforms Do We Want? What do we need in reform? • Our health system is under an enormous strain from

chronic illness and disease exacerbated by lifestyle

choices, a situation exacerbated by an ageing

population

  • An inadequate supply of aged care places has led to an

increase in the length of hospitalisation times and

frequently, unsatisfactory interim care arrangements.

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Why Are We Here? What Reforms Do We Want? What do we need in reform? • We need improved early detection strategies and preventative interventions. We need to focus on prevention

and health promotion strategies

  • We need improvements in the allocation and distribution of

Commonwealth funded residential aged care places

  • We need incentives to encourage the public and private

sector to jointly plan, develop and deploy hospital and

healthcare infrastructure

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Why Are We Here? What Reforms Do We Want? What do we need in reform? • We need funding transparency and a clear understanding

of what is happening to hospital costs so that we can plan reforms that transfer care between appropriate settings when it is needed NOT according to who funds and how much they fund

  • We need to maintain and strengthen initiatives, such as the

National Public Health Partnership, that allow us to take a population view of health care while providing the best possible care to individual patients

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Why Are We Here? What Reforms Do We Want? What do we need in reform? • We must maintain national standards of access and quality and we need a national approach to workforce planning and development   • The delivery of safe, appropriate and cost effective

healthcare requires a continuum of care involving patients, primary care physicians, community health services and hospitals

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Why Are We Here? What Reforms Do We Want? The new Australian Health Care Agreements • We understand the Commonwealth has offered $42

billion in the new Agreements, and claims that is an

additional $ 1 0 billion to help run public hospitals

 

• We also understand the Commonwealth is asking the

State/Territory Governments to match funding on these

outlays

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Why Are We Here? What Reforms Do We Want? The new Australian Health Care Agreements • We understand the Commonwealth has offered $42

billion in the new Agreements, and claims that is an

additional $ 1 0 billion to help run public hospitals

 

• We also understand the Commonwealth is asking the

State/Territory Governments to match funding on these

outlays

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Why Are We Here? What Reforms Do We Want? The new Australian Health Care Agreements • While this sounds good, we are advised by State Ministers that in real terms it amounts to $ 1 billion less than the previous five year agreement

  • And we are advised that the Agreements focus too

much on hospital beds numbers and not on health nor importantly, the reform agenda set by AHMC through the nine working groups

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Why Are We Here? What Reforms Do We Want? The new Australian Health Care Agreements • We need the Commonwealth to commit to maintaining their

real levels of funding

  • We need to immediately link reform and funding in the

Agreements

  • We need the States and Territories to commit to transparency of

resource allocation, reform and a continuum of care

  • We need to link public health measures to prevent disease to

the Agreements with commitments from all Governments to

health promotion and prevention

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Why Are We Here? What Reforms Do We Want? The new Australian Health Care Agreements • We need to recognise that flexibility and reform means that the funding issues cannot be divorced from the reform agenda

  • As a result, the Alliance partners have called on the

Commonwealth and States/Territories to sign interim Australian

Health Care Agreements for twelve months to enable the

reform agenda to become embedded in them

  • We are pleased to note that the States/Territories have agreed

with this proposal and have asked that the matter be placed

on the COAG agenda for discussion at Heads of Government

level

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Why Are We Here? What Reforms Do We Want? Conclusion • We are all part of an unprecedented alliance of Australia’s

key health and consumer groups

  • We are concerned about equity of access and health

outcomes for all Australians

  • We want to be partners in governance to improve the

Australian Health Care Agreements