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The health system: what should our priorities be?
Author(s) -
Boxall Annemarie,
Leeder Stephen R.
Publication year - 2006
Publication title -
health promotion journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.515
H-Index - 32
eISSN - 2201-1617
pISSN - 1036-1073
DOI - 10.1071/he06200
Subject(s) - health promotion , population health , incentive , health policy , health economics , health care , public economics , competition (biology) , community health , commonwealth , social determinants of health , public health , medicine , business , disadvantaged , economic growth , economics , political science , nursing , ecology , law , biology , microeconomics
Issue addressed The way the health system is organised is a critically important social determinant of health. Australia's current health system funding arrangements contain serious barriers to effective health promotion and chronic disease management. The consequences are most evident among disadvantaged people. Major health system reform is needed in Australia to rectify this problem. Methods This paper describes current mechanisms for funding health care in Australia and examines a recent reform experiment, the Co‐ordinated Care Trials. It discusses why the trials were unsuccessful and identifies key criteria for future success. Three existing proposals for health system reform are assessed against these criteria – managed competition, a Commonwealth takeover of health and medical saving accounts. Results Successful reform of Australia's health system will need to ensure that more flexible services are delivered, changes are made on a large scale to affect demand and strong incentives to use cost‐effective services are put in place. Of the models considered, managed competition best meets these criteria and is most likely to reduce health disparities and improve health promotion and disease prevention. A Commonwealth takeover of health funding is a less ambitious alternative but because of this, it is also likely to have less impact. It is doubtful whether medical savings accounts meet any of the criteria for success and they would also require a fundamental change in the values that underpin the Austrlian health system. Conclusion Recent reforms of Australia's health system have been too small and have had little impact. Although radical reform of the health system is politically unpalatable and extremely rare, it may be the only way Australia will be able to meet the health challenges of the 21st Century. So what? Health professionals and policy makers wanting to ensure health outcomes improve for all Australians should attend diligently to the way health care is financed. Because of the major impact of health care on health outcomes, this particular social determinant of health deserves priority action.