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Managing health reform

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The Australian Medical Association (AMA) refers to itself as Australia’s Chief Health Policy Adviser. CEO of the association’s ACT branch Christine Brill says that this nicely sums up the role of the Association.

Brill explains that at its core the AMA has “the desire to promote and advance ethical behaviour”. She says that the organisation’s role is to make considered responses to government initiatives.

Issues the Association covers include: public hospitals; waiting times; access to and funding for beds; general practice issues; junior doctor training and working conditions. The AMA also seeks to protect the integrity and independence of the doctor/patient relationship and to promote and advance public health, amongst other things.

Changing Australia’s health and medical environment

AMA President, Dr Andrew Pesce, welcomed the Council of Australian Governments’ (COAG) April agreement to reform national health care, as well as the Prime Minister’s positive response to the AMA’s calls for new funding, a single funding pool, and more real hospital beds.

The National Health and Hospital Network Agreement (NHHN) incorporates structural reforms as well as additional investments in hospital, primary and aged care services, and preventive care in mental and diabetes health care.

Further initiatives were announced in the Commonwealth Government’s Budget in May 2010, including improved primary care infrastructure and the roll-out of electronic health records, bringing the total new health investment over the next five years to $7.3 billion.

The position of the AMA

As an organisation of registered medical practitioners and medical students, the AMA and its members will be greatly affected by the reforms. The AMA supports the momentum for reform, and wants all governments to work with the medical profession to ensure that these reforms are effective.

However, under the present environment, it only has a preliminary idea of the role it will play in implementing the reforms and supporting its members.

“There are still many questions that remain unanswered,” Dr Pesce said. “It’s time for the Government to provide more detail about how the reforms will work

in practice.”

Tony Steven, CEO of the Tasmanian branch of the Association, provides some insight about the reforms from the AMA’s perspective.

Local Hospital Networks

Steven says the AMA will be highly involved on issues such as the placement of the Local Hospital Networks (LHN), how they are run and how they integrate with the state government departments.

Under the NHHN, LHNs will be responsible for hospital management and hospital performance. State governments will remain the system managers for public hospitals, and will be responsible for negotiating and implementing service agreements with LHNs.

In response to the changes, the AMA has emphasised that realistic, transparent and achievable hospital-level targets and standards need to be set. It also cautioned that state control would need to be monitored to ensure that the spirit and intent of the agreement is not compromised.

The activity-based funding system

“Medical staff all over the country will find their roles changing so that Local Hospital Networks can report their activity in thousands of procedures and degrees of procedures to the Federal Government,” Steven says.

The new system has been introduced to provide clear accountability mechanisms and transparent information about national, state and local performance of the health system.

Steven says that the change will have a big effect on AMA members, adding that many people do not realise the extent of the work that will be involved in introducing the new system.

The new e-Health system

Under the NHHN, $467 million will be invested in e-Health funding to establish electronic health records for every person who wants one by July 2012.

The AMA supports this investment, however it has also stressed for the need to support medical practices with information technology capabilities, so that medical professionals can participate fully in the new e-Health environment.

Steven reiterates this position, saying that new procedures surrounding the changes to e-Health will mean significant investment in training for staff.

More change to come

A work plan for implementing the reforms is under development and (at the time of printing) was due for COAG agreement by 30 June 2010.

Brill predicts that details relating to many of the NHHN reforms, including how some of these changes will actually be implemented, will be clarified over the coming months in the lead up to the next election.

While many details are not currently clear, Brill says that she will “watch this space” with interest to ascertain the role that the AMA has to play in delivering these changes and in supporting its cohort of medical members.

Tony Steven, CEO Australian Medical Association Tasmania

I started with the AMA in Tasmania in March 2009, after 20 years in association management. Most recently I held a role as the CEO of the Council of Small Business of Australia and over the past twelve years I have also owned and run an association management company in Hobart called Association Offices.

My role is to guide the association out of a time in which membership has fallen and to implement procedures to ensure that it maintains a clear financial picture.

The biggest medical issues facing the medical profession today…

The main issue is ensuring the funding system is conducted in a way that ensures efficiencies – health can never completely be left to market forces. Consequently, there are often regulatory effects that impact disproportionally on the sector, and need to be adjusted so that people and the economy do not suffer.

The benefits of working with the medical profession are…

The medical profession is a very complex area and the learning curve is very steep to start with.

The main attraction, however, is making a positive difference in the medical sector and working with evidence-based people.

Christine Brill, CEO Australian Medical Association ACT

I’ve been with the AMA ACT for a long time. I originally applied for the position because I enjoyed working with medical practitioners in a previous job and because I have an interest in politics. This position allows me to work with dedicated doctors within that medical-political framework.

My principal role is to develop and implement strategies to deliver the Board’s strategic objectives. These obviously cover a broad spectrum, and include:

  • Acting in the interests of the medical profession
  • Ensuring that the association is listened to for the benefit of patients
  • Influencing health policy development
  • Managing the association itself.

The biggest medical issues facing the medical profession today…

There are many issues and interesting challenges, including the cost of new medical technologies, an ageing community and ageing medical workforce.

I’ll just highlight the challenge of medical education and the growth in both medical schools and graduates.

This means that hospitals will face real challenges to provide funded training places. We cannot deny our new medical graduates access to good training in the first critical years after graduation, and we need to ensure that access to specialist training programs keeps up with the demand.

The benefits of working with the medical profession are…

For the most part, medical practitioners want to improve the health system for the benefit of the patients they treat.

The constant juggling of meeting patients’ needs and funding the system to provide for this creates an interesting and ever changing environment.

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