Around the Globe

Change of Government and a Health Reform Commission for Australia?
Richard Day
Professor of Clinical Pharmacology
University of New South Wales

ustralians go to the polls in May this year and a change of government from the Conservative Coalition to the Labor party appears quite likely. This means Australia might have a new Prime Minister: Bill Shorten, head of the Labor Party. If elected, he will be Australia’s eighth Prime Minister in the last 12 years! Labor’s current “shadow” Health Minister, Catherine King, has foreshadowed a radical departure from our national health arrangements.

However, Australia’s health system, generally considered to be effective in world terms, is hampered by two significant problems. First, there is a division of responsibility for components of the sector between the Federal government (e.g., primary health services) and our Six States and two Territories governments (e.g., public hospitals). Second, the ultimate responsibility for operation of the health system is under the control of the Commonwealth and State and Territory parliaments.

The first problem leads to “cost-shifting,” inefficiency, and poor integration–for example, between primary care and hospital services. The second problem of parliamentary control of the system means that health is subject to the “short” political cycle of about three years and the adversarial nature of political parties and their modus operandi in Australian parliaments. This leads to short-term, politically tinged decisions and manifest “pork barreling,” especially around election time, by competing promises from both sides of politics to “fix” waiting lists, propose “quicker access” to expensive medicines, promise new hospitals in marginal electorates, etc.

Health Reform Commission

Shadow Health Minister King has foreshadowed the formation of a permanent policy-producing body to be known as the Health Reform Commission. King indicated this would be an “independent, legislated body.” Its aim is to remove the “short-term” political cycle (and all the distortions it introduces) from the national health system. This is definitely a big ask!

The initial focus of the Commission will be on long-term solutions to chronic illness, primary care sector reform, earlier and easier community access to public hospital specialists, and reducing endemic “cost-shifting” between Federal and State governments. “The big, structural reform that’s so clearly needed has been repeatedly undermined by the short-term and combative nature of our political system,” King said in her National Press Club presentation 13 February 2019. She went on to say, “Labor’s goal is to ensure that every Australian can access affordable, high-quality health care,” clearly an extremely laudable aim.

What could this mean for the medicines sector? “It is time for the Australian Government to have a long-term vision for health, to prepare for the disruptive, transformative, innovations of the future, particularly in medicines, and ensure that Australians can always choose the best healthcare options available, when they need them,” said Elizabeth de Somer, CEO of Medicines Australia, in her comments in support of the Shadow Minister. She went on to say ““The challenge for government, the community and industry is to ensure that the PBS (Pharmaceutical Benefits Scheme) can fully fund the needs and demands of Australian patients, not just for today’s medicines and vaccines, but for tomorrow’s advancements in innovative therapies.”

Reducing stakeholder and political pressures on the PBS and its influential and expert Pharmaceutical Advisory Committee would be a potential benefit accruing from the establishment of the Health Reform Commission, moving decisions regarding the subsidy of high-cost medicines towards more predictable footing.

Responses to Shadow Minister King’s proposal so far reflect a deep desire across stakeholders for a national health system for all citizens, based on national health priorities, the needs and means of individual patients, credible evidence for interventions and policies, and nimble adoption to achieve worthwhile health outcomes. The Royal Australasian College of Physicians said the Commission “was long overdue and would be a welcome addition to the sector,” while the Australian Healthcare and Hospitals Association noted that it would remove “the politics and finger-pointing out of health.” Most importantly, the Consumers Health Forum stated that the Commission was “a timely step towards improvement and innovation of Australia’s health system.”

References available upon request.