Page 3468 - Week 12 - Wednesday, 18 September 1991
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Because of the existing program structure, a number of concerns and issues have emerged, such as cost shifting, and consequently incentives for bad practice, between hospital and community services; pharmaceuticals provided in outpatient departments of public hospitals are funded by the States, whereas pharmaceuticals provided in the community are funded by the Commonwealth; and the existing complex arrangements mean that it is very difficult for patients and clients to access required services, and the standards of care can be compromised.
An overarching committee comprising representatives of health and aged care from all States and Territories reviewed these arrangements and brought forward to the joint Ministers meeting some proposed new program structures, in an attempt to resolve some of these problems. Members of the Assembly may be aware that, in parallel with the intergovernmental consideration of how best to rationalise the jurisdictional responsibilities across the enormous scope of programs, the Federal Minister established a national health strategy to review the complete range of issues in health care in Australia today.
In July this year the first issues paper, "The Australian Health Jigsaw", was released for public comment and focused on the need to improve integration of the health care service delivery system. It documents a number of problem areas which are experienced by both clients and health system planners. A number of new program arrangements were proposed.
At the meeting on 6 September these two processes were brought together for the first time. A new structure has been proposed, which may have the following five principal policy groupings: First, medical specialist and diagnostic services, including those now provided in outpatients which could, on clinical grounds, be delivered interchangeably in either a hospital outpatient department, specialist private rooms or a community setting. Secondly, all non-inpatient pharmaceutical services to be incorporated into a single program, whether they are provided in a public hospital setting or community pharmacies.
Thirdly, a new public hospital program to cover policy and funding for inpatient services, day surgery, day treatment and other clinical services where a hospital setting is necessary for clinical reasons, such as emergency services. Fourthly, a primary care program to include general practice, community health services, palliative care, post acute care, community based care services and such primary medical care as is provided in public hospitals. It is recognised that the implications of linking general practice with community health services will require further exploration and policy development. Fifthly, a new program of long-term care for the aged to draw together residential care such as nursing homes and hostels as well as support services in the community aimed at maintaining people in their own homes.
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