John Menadue: fixing health cooperation in the Federation


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A Joint Health Commission starting in one state is a sound way to begin breaking the impasse between the Commonwealth and the states on health responsibility, argues former top mandarin John Menadue.

State governments spend about 25% of their budgets on health and another 25% on education. A cooperative arrangement between the commonwealth and state governments in one of these areas would greatly improve the operation of our federation. This article will focus on possible cooperation in health.

A state handover of health services to the Commonwealth, as suggested by Tony Abbott many years ago, would be one way to overcome the waste and buck-passing between the Commonwealth and state governments in health. Kevin Rudd suggested that his government might take over state hospitals. Opinion polls suggested that the public would support this approach. But Kevin Rudd backed away. In passing it should be noted that the Commonwealth has no recent experience in running hospitals. It is not an easy task.

But as a Commonwealth takeover is most unlikely, an alternative would be to establish a Joint Commonwealth/State Health Commission (Joint Health Commission) in any state where the Commonwealth and a state government can agree – a coalition of the willing, a Commonwealth/state partnership on a state by state basis.

It is envisaged that the joint commission, with shared Commonwealth/State governance would be responsible for funding, planning and integrating all health services in that state. Consistent with an agreed plan, the Commission would then buy health services from existing providers — Commonwealth, state, local, NGO and private.

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