John Menadue: making health reform possible

Health ministers may be in office but they are seldom in power, says John Menadue. The former head of the Australian Public Service, who also chaired the NSW Health Council and SA Generational Health Review says a Health Reform Commission could outflank the vested interests and stagnant imagination.

I’ve written about the areas in our health sector that need reform, and of the obstacles, particularly those imposed by vested interests in the health sector to protect their own interests by delaying or stopping reform. In this article, I will be suggesting ways we can overcome these obstacles to health reform.

Don’t rush the process

The political process encourages parties seeking election or re-election to address problems with high political salience — waiting lists in public hospitals, needs among certain groups with chronic illness, and identified funding gaps. The political response is to develop specific proposals, usually involving carefully calculated budgetary costs.

Such a process, while providing short-term solutions to proximate problems, fails to address the structural problems — the fragmented nature of our health care arrangements, inequities, gaps in services, such as dental care, the allocation of resources towards high-cost hospital interventions at the expense of promotion, prevention and primary care, and the distortions associated with private health insurance.

It also privileges those vested interests, who can mobilize resources to block all but the most minor reforms.

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