Queens Health Policy Change Conference Series Australian Health Reform Progress. Prof Mick Reid May 2014. Health /Hospital Boards. Most States have created District Hospital Boards - Devolved authority from State Authorities. - I ncreased local autonomy .
Prof Mick Reid
Most 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.
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.
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.
Independent 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.
National 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’).
Australian 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.
- 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.
- 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.