Australian Health Care Agreements 2003-2008: a new dawn?

When Health Ministers resolved to focus on continuity of care and health outcomes, they may have said more than they knew. What if they really meant it? IN THEIR JOINT STATEMENT of 5 April this year, the Federal and State Health Ministers acknowledged a widely recognised but rarely voiced truth — that past negotiations under the Australian Health Care Agreements (AHCAs) had focused more on health funding than health outcomes. The Ministers' candor took many completely by surprise. They laid a framework for work toward the 2003–2008 agreements, which emphasised a focus on provision of best care and health outcomes rather than jurisdictional boundaries , with jurisdictions working cooperatively to advance community health and well-being. To this end, they decided the agreements should contain a statement of principles, objectives and proposed outcomes. They also decided that work should be initially organised around a continuum across preventive, primary, chronic and acute care; improvement of the interface between aged and acute care; cross-jurisdictional collaboration on workforce, training and education ; the interaction between hospital funding and private health insurance; improvements in Indigenous, mental, and rural health; quality and safety; information technology; research; and " e-health ". This work is to precede and inform negotiations about funding within the AHCA. In that same week in April the Commonwealth Chief Medical Officer, Richard Smallwood, told a health conference in London that Australia's public hospitals are in " varying degrees of dilapidation " , and that morale among doctors and nurses was fragile. He was quoted as saying: " The results of our care and patient experiences of the health care system are too often less than ideal, ...Our public healthcare systems never seem to have enough resources... Access to care, while universal, is too often delayed. The medical workforce is undermanned, maldis-tributed, or both, and the shortage of nurses verges on the calamitous. In both professions, morale is fragile. " 1 Primary diagnosis The indications noted by our Chief Medical Officer are uncontroversial, and could easily be extended. Do they reflect separate causes, capable of treatment seriatim, or are they symptoms of a deeper malaise? The work proposed in the Ministers' Statement has been allocated to nine separate working groups, implying at least some separability. An underlying ailment seems more likely — this is not the first time Health Ministers have committed themselves to " outcomes " , yet the problems besetting the system …