Governance, transparency and alignment in the Council of Australian Governments (COAG) 2011 National Health Reform Agreement

Abstract

Objective This article provides a policy analysis of the Australian government’s National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. Methods The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. Results The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. Conclusions It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms. What is known about the topic? The Council of Australian Governments (COAG) 2011 health reforms have introduced governance structures and transparency mechanisms that are unprecedented in the Australian context. There is still a gap in knowledge and overall understanding in relation to their significance and how they will fare given the complex characteristics of the Australian health system. What does this paper add? This article discusses the positive changes introduced, such as the rationalisation of the relationships between the Commonwealth and states and territories, the introduction of more transparent funding arrangements, the provision of unified governance templates and the potential gains in reducing waiting lists. It also highlights the most glaring shortcoming of the health reforms, which is the missed opportunity to strengthen integration between primary, secondary and tertiary care providers. What are the implications for practitioners? More effective integration between care providers appears to be one of the greatest challenges ahead. Further changes are needed to make the primary care and secondary and tertiary arms of the health system work together more effectively. Moreover, general practice needs to be brought into a closer working relationship with non-medical primary health and community care to tackle the growing burden of chronic disease.