May reform be with you

Space craft over a blue planet

May reform be with you

Space craft over a blue planet

Governments are forever undertaking ‘health reforms’ by initiating measures—sometimes incrementally, other times rapidly—to improve our vast, complex and geographically challenging health system. To make this task harder, we have three layers of government and multiple jurisdictions responsible for ‘reform’.

We have an obsessive hope that reforms will improve health outcomes, coordinate and join up care, and deliver transparency to governance and financing. 

Researchers studying the failure of health reform have identified common barriers that prevent holistic reforms from working.

The first is the knowledge and attitude of governments. 

We see this with physiotherapy, where we are grouped into ‘allied health’ and considered an adjunct to ‘mainstream’ medicine by an outdated and hierarchical health structure. 

This attitude drives top-down change and short-termism, which have little to do with putting patients first and are more about retaining power through partial action.

The second barrier is insufficient political will. 

Successive governments in Australia have been too fearful of the Australian Medical Association and the Royal Australian College of General Practitioners (and, until recently, the Pharmacy Guild of Australia) to challenge these dominant health groups. 

But what does political will even mean? 

I once heard it described as the political equivalent of the Force in Star Wars—it explains everything and nothing. 

It is not an innate quality but something that leaders must create through a commitment to the positive advancement of public policy.

The third, and this is one we struggle with at the APA, is insufficient consumer advocacy

Without a vocal consumer voice, governments can be reluctant to instigate necessary reforms. 

At times it seems as though the public accepts the gaps in services, given how amazing our health system is across so many indicators, although other objectives remain unmeasured and likely to yield more suboptimal results (eg, the consequences of unmanaged diabetes).

The fourth is familiar to every physiotherapist—reform is siloed and based on one discipline. 

It’s like the proverbial bandaid on a serious injury. 

Providing doctors with a Workforce Incentive Program, for example, does little to bring other essential services, like physiotherapy, to rural communities.

The fifth barrier is poor implementation. 

Services not funded properly, short-lived pilot programs, reforms delivered to some but not others and a lack of accountability and definable outcome measures all contribute to reform failure. 

Then our unique geography creates a distinct divide between city-based health services and the rest.

Radical health reforms cause more harm than good. 

We saw this with the hastily introduced National Disability Insurance Scheme, which had evident structural, financial and objective flaws from the outset despite a well-meaning ideology based on fairness. 

More than a decade on and it is far from the no-fault insurance scheme for Australians with severe and permanent disability that was intended. 

This is why incremental reforms, delivered on the back of patient need, are what is needed in Australia.

On the glass-half-full side, slow reforms are emerging at both federal and state level. 

The APA has been publicly supportive of many of these initiatives, although frustrated that there is a paucity of political will (as yet) to tackle the entrenched GP-as-gatekeeper model and to open up referral pathways and scope of practice, both evidence-based and well-documented reforms.

Perhaps we need to go back to basics. 

Is health reform about saving money through efficiencies and technology, increasing competition and choice for patients, reducing pressure on GPs and hospitals and providing accessible and affordable care in regional areas? 

Or should we start by addressing the structural barriers across the layers of government, local health networks and dozens of siloed sectors that struggle to coordinate care around the individual?

>>Simon Tatz General Manager, Policy and Government Relations

To contact Simon, email here


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