Reform of the Australian Health Care Agreements: progress or political ploy?

Having acknowledged problems with previous Australian Health Care Agreements, the Federal and State Health Ministers have established working groups in nine health policy areas, each co-chaired by a clinician and a bureaucrat, and including other clinicians. Involving the medical workforce in health policy discussions is a positive step. EVERY FIVE YEARS over the past 15 years, the Commonwealth , States and Territories have negotiated healthcare agreements, and new agreements are about to be signed for the next five-year period (2003–2008). The Australian Health Care Agreements (AHCAs), which are negotiated bilaterally with each State, provide Commonwealth monies to the States in exchange for ensuring the States continue to provide free hospital care. If the negotiations of previous agreements are any guide, the States will stick together in arguing the overall size of the Commonwealth's contribution to the States, until the Commonwealth courts one State (usually a smaller one or one going into election mode) and offers a very good deal to break from the pack. That State accepts, and the " domino principle " then cuts in. If the content of previous agreements is any guide, the next agreement will be devoid of national health policy, contain perverse performance measures, be largely incomprehensible to all but its authors, and preserve the existing capacity and incentives to shift costs from State to Commonwealth funding sources and vice versa. Will this one be any different? Based on the April 2002 Joint Statement by the Commonwealth and State Health Ministers, it will be substantially different. In this statement the Ministers: 1 ■ acknowledged that previous negotiations had focused more on health funding than on health outcomes; ■ acknowledged the long history of " buck-passing " between States and the Commonwealth; The Joint Statement indicated that the 2003–2008 agreement would encapsulate national objectives for providing improved healthcare to all Australians. 1 If these aims are only partially realised, they will substantially change the relationship between healthcare and health-care financing in Australia. What are the problems with current AHCA arrangements? The focus of the existing agreements is narrowly limited to one aspect of healthcare. AHCAs provide money to the States on the basis that the States preserve the core feature of Medicare — the maintenance of universally accessible public hospital care free of charge. The call for the agreements to be used to articulate a national health policy for Australia highlights the fact that there is …