KERRY GOULSTON. Healthcare Reform at last?

Feb 18, 2019

Will meaningful and significant reform of the Australian health care system occur at last?

Will there be bipartisan political support for the initiatives proposed by Labor? 2019 could be the year that delivers.

Over the past 14 years a group calling itself the Health Reform Group has met for a working dinner 3-4 times a year to debate health reform.  The group has a mixed and disparate membership. Nurses, general practitioners, dentists, allied health professionals, specialist clinicians, consumers, health academics, health economists, the young and not so young, and those from major cities, regional centres and rural areas. All members have a passionate commitment to the Australian public health system. Members are encouraged to freely express their varied views, which are vigorously debated until a consensus is reached. The group has gone public at times to present a consensus view – for example, in convincing the Garling Enquiry into NSW health that clinicians should have more input into health policy and management.


Over the years, guests have been invited including Federal and State Health Ministers, Shadow Health Ministers, senior health bureaucrats and journalists. Guests are told that the Chatham House Rule applies, so all can speak freely and will not be cited elsewhere. The only guest not to accept an invitation has been the current Federal Health Minister whereas the Shadow Federal Health Minister has attended twice in recent years.

The concept of a permanent Health Reform Commission, comparable to the Productivity Commission, was first proposed by John Dwyer (a member of the Health Reform Group) and has been endorsed by all members. This was not to be a time-limited Royal Commission but rather a permanent commission reporting not only to the Federal Health Minister but to Federal Parliament and all state Parliaments through COAG.  As with the productivity Commission, the Health Reform Commission would also report to the Australian public.

Major concerns of the Health Reform Group include: 

  • The separate funding of hospitals by the States and of primary care by the Federal Government, which is peculiar to Australia.
  • The drawbacks of the “fee for service” funding of clinicians
  • Increasing “out of pocket” or “gap” costs to patients, now estimated to be $27 billion yearly.
  • Lack of adequate funding for dental care, so that many people cannot afford to visit a dentist.
  • Increasing corporatisation of radiology and pathology services and also general practice.
  • The $11 billion subsidy to the private health insurance  industry and private hospitals.
  • The pressing need to upgrade the role of nurses in hospitals, nursing homes and the community.
  • The need for easier access to specialists at public hospital outpatient clinics, which is currently patchy throughout Australia.

The February 13th announcement by Catherine King at the National Press Club was astounding.  She has listened to our Health Reform Group and to other groups which have been saying much the same thing.

The proposed Health Reform Commission has the potential to produce long-lasting changes to the Australian Healthcare system – at last. Is it too much to hope for a bipartisan approach to the suggested reforms?

Kerry Goulston is Emeritus Professor of Medicine, University of Sydney. Professor Goulston worked for years in both public and private sectors of the Australian health care system as a Gastroenterologist. 

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