Australian Government’s new Issues Paper examines the roles and responsibilities of federal and state governments in the provision of Australian healthcare.

A newly-released federal government ‘Issues Paper’ on the provision of healthcare in Australia concludes that, “Currently, our health care arrangements do not work well for Australians with complex and chronic conditions, such as diabetes, cancer and mental illness,” attributing this to the lack of “a single overarching ‘health system’ in Australia to provide this care.”

The paper, released by the Prime Minister in mid-December, is the forerunner to a Green Paper to be published in the second half of 2015, ahead of the publication of the definitive White Paper in 2016. The public will have the opportunity for written input to the process after the Green Paper is released.

Until then, readers are offered a summary of the ‘evolution of government involvement in health care’ since 1901, the current roles and responsibilities of federal and state governments, funding arrangements across the sector, morbidity data and patient management trends.

It comes as no surprise that chronic disease is the leading cause of illness, disability and death in Australia, that it is more likely to affect Indigenous Australians, and is expensive to treat, “particularly because the current arrangements result in many unnecessary and avoidable admissions to hospital, which is the most expensive setting for health care.”

Indeed, the cost of the four most expensive chronic diseases equates to around 36 per cent of all health expenditure. For the record, these four are cardiovascular diseases, oral health [largely not covered under Medicare], mental disorders, and musculoskeletal.

Who is – and who should be – responsible for doing what in health care provision is central to the discussion.

Even when patients with chronic and complex conditions are supported by their general practitioner they are affected by “information gaps, fragmented services, and duplication of clinical interventions”, the paper says.

Such challenges lead to the paper’s ‘Threshold Questions’ –

  • What is the appropriate role of government, as well as non-government and private providers, in health care?
  • What should we change in the allocation of roles and responsibilities between the Commonwealth and the States and Territories to improve the health of Australians? Why?
  • Should any roles be shared? If so, which ones, and how can they be clarified and coordinated to minimise overlap, duplication and blame-shifting and improve service delivery?
  • What aspects of our health care arrangements involving the Commonwealth and the States and Territories are working well and should be maintained or extended?

A further, perhaps more pointed, question asks: “If one level of government assumed full responsibility for government funding of the health sector, would this improve fiscal sustainability? If so, what could this look like?”

As that ‘one level’ is unlikely to be any other than the Commonwealth, which, the paper tells us, provided $60.5B in health funding in 2012-13, the idea evokes a memory of Kevin Rudd’s ‘threat’ to take over the running of Australia’s public hospitals.

In a reference to the need for a national ‘health literacy’ debate, an off-the-radar term in the post-Rudd era, the paper asks, “How can governments manage community expectations on the level (and cost) of health care provided?”

The Green Paper, which the government has ample time to prepare, will address these issues, and more. The debate over who funds and controls healthcare can then be expected to resume with vigour.