Where can human services reform offer the greatest improvements in individual wellbeing?

Not an easy question to answer.

That’s why the Productivity Commission is doing so in stages, gathering feedback in an extensive consultation process which is about to enter its second stage.

Increased government stewardship and a stronger user orientation are two of the key elements shaping this process. The second stage of the inquiry is to make reform recommendations following the findings which appear in its recent publication: Introducing Competition and Informed User Choice into Human Services: Identifying Sectors for Reform, Study Report.

This publication assesses the following six services as best suited to reform:

- Social housing;
- Public hospital services;
- End-of-life care;
- Public dental services;
- Human services in remote Indigenous communities; and
- Commissioning family and community services.

In our recent article concerning the Commission’s earlier Preliminary Findings Report we considered the pressure on public hospitals and the importance of patient satisfaction and selection of appropriate performance data for publication. We also noted the Commission’s interest in ensuring that state and territory governments entertain contestability or outsourcing of public hospital services and develop more rigorous assessments as to whether the status quo provides value for money.

The Commission clearly feels well-designed reform, underpinned by strong government stewardship, could improve the quality of public hospital services and increase access to those services. The Study Report also demonstrates the Commission’s desire to give people greater transparency  on available public hospital services and the providers. These are services for the public, shouldn’t they know more about  who provides them?

The Commission makes it clear that high-quality data is central to improving the effectiveness of human services.

In terms of stewardship this will require government to:

- ensure public hospital services meet standards of quality, suitability and accessibility;
- give people the support they need to make choices;
- ensure that appropriate consumer safeguards are in place; and
- encourage and adopt ongoing improvements to service provision.

On the issue of data, the Commission considers that:

- user-oriented information allows consumers to make better choices and for providers to tailor their service offerings to better meet users' needs; and
- the transparent use of data drives improvements in the performance of the system and increases accountability to funders.

The potential to progressively augment the MyHospitals website to provide more information to consumers on the performance of hospitals and clinicians is mentioned in the Study Report[1]. It goes on to observe that this will require the support of government and healthcare providers. 

A more complex undertaking is the shaping of demand management across the diverse supply of public and private hospital services within the broader health system. This is another area of focus for the Commission.

The work of the Commission continues to provide stakeholders with an opportunity to participate in the reform process. It has been an ongoing process. The recent roundtables concerning public hospital services involved the following participants:

- Australian Commission on Safety and Quality in Health Care
- Australian Healthcare and Hospitals Association
- Australian Government Department of Health
- Australian Medical Association
- Australian Nursing and Midwifery Federation
- Australian Private Hospitals Association
- Bupa
- Catholic Health Australia
- Consumers Health Forum
- Medibank Private
- National Rural Health Alliance
- NSW Ministry of Health
- NT Department of Health
- Private Healthcare Australia
- Royal Australasian College of Surgeons
- Royal Australian College of General Practitioners
- SA Health
- St Vincent’s Health
- Tasmanian Department of Health and Human Services
- Victorian Department of Health and Human Services
- Woods, Prof. Mike; Centre for Health Economics Research and Evaluation, University of Technology Sydney

It doesn’t stop there. The Commission is inviting further participation by interested parties and will release an issues paper. The paper will outline areas where the Commission is seeking particular feedback and provide information to assist participants to prepare a submission to the inquiry.

The Commission will then use this feedback to prepare reform recommendations. The objective is to ensure that all Australians can access timely, affordable and high-quality services, appropriate to their needs, delivered in a cost-effective manner. This ambition is worthy and desirable. So what could the future look like? Embracing richer performance reporting, maintaining accessible information and strong linkages, and ensuring there is no “wrong door” so that patients can navigate the system seamlessly. 

The final inquiry report is due to be submitted to the Australian Government in October 2017.