Can we get there from here? Implementing health reform in Australia. CHERE Working Paper 2013/02

The Australian Health Reform Agreement has provided the basis for major change in the delivery of health care services. While the components of reform have undergone extensivenegotiation between Commonwealth and State governments, and have been subject to academic and other commentary, little is known about the views of those charged with their implementation. This paper reports the opinions of key informants working in public health care during the early implementation period. It seeks to ascertain their views on the health system and the direction of the reforms, the likely effects and barriers to successful implementation. An anonymous online survey of 138 members of the Australian Healthcare and Hospitals Association (AHHA) was conducted in late 2011. The survey covered opinions about what was happening in the health system and the need for reform, access to information about the reforms, how changes were being effected and the perceived barriers to implementing activity based funding, and public performance reporting, and their perceptions of Medicare Locals and Super Clinics. Seventy-eight percent of respondents thought that fundamental reform of the system was needed but only 5% thought the current reforms would deliver the required improvements. Only 9% expected the new arrangements to remove the ?blame game? between the Commonwealth and States/Territories. Potential barriers to the implementation of the reforms included agreement among the Commonwealth and States, availability of alternatives to acute hospital care, valid measures of activity and performance and establishing appropriate funding models for Medicare Locals. The survey provides evidence that, among those involved in implementing the changes, there are perceptions of barriers to be overcome in implementing the reform agenda and there is an expectation that further reform will be needed.