health reforms in australia 2011

8/7/2019 Health Reforms in Australia 2011

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A HeAltHier Future For All AustrAliAnsFinAl reportJune 2009

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7. ipeenng a naona pan orheah reor

There is no shortage o excellent health policies in the Australian health system

the problem is implementation, not policy.222

7.1 Cmmg hah mth ak mpmg maj m Aaa hah ym may m dag. B whcag ha h Cmmwah Gvm mpmd Mdca ha w ya ad hVca Gvm mpmd acvy-bad dg pbc hpa j v mh. i bhca, h gvm had a g cmmm m h ac a g d ac. Whav agd h p ha Aaa aga ac a g d m hah ym. ohah ca ym d p m may qa:

gca ca dmad , ad xpd , hah ca d may ac,cdg advac mdca chgy, a agg ppa, h ca chcda, ad h ca cm xpca;

accpab q hah cm, pacay h gap hah cm Abga ad t sa iad pp;

ack acc hah vc may pp, pacay pp wh a ma ,pp m ad a Aaa, ad w-cm pp d da ca;

gwg cc ab qay ad ay;

pbm wh h avaaby, mx ad db h hah wkc; ad

hgh v ccy, cdg admav ccy ( xamp, bpc ad bacacy), paa ccy ( xamp, p daa adma ad mdca ), ad acav ccy ( xamp, apppampha ac ca ad ack c cv v).223

Addg h p h qy, ccy ad aaby hah ym w qh adhp a Aaa gvm. A ca mag cmmda ha w d mv may aa hah ym, wh a aa appach may ky pc adgvac c. t achv m a a aa v, adhp a m qay wh haa gvm. B Aaa d hav a g gvm wh pby hahpcy, pgam ad dg, ad m hah ca w q h adhp ad cmmm h a a w. tha why w a w aa hah agm h Hahy Aaa Accd bw h Cmmwah ad a gvm a dama mpma may hm ha a dd gv Aaa h hah ym hy dv h 21 cy.

i h a chap, w h pacca adg ad maagg chag, ad cd a

mpma pa cmmdd m, ad h aca mpca , ad ga m, m agda.

7.2 impmg mo m cv a wd ag av dg dg mpma dcy m cad dg hah vc ach ad a hah pm, mpmg aaa -hah ym ad h Cmmwah Gvm akg pby pmayhah ca. Wh w ag h a amb m agda, w ha a hCmmwah Gvm a a gvm p av ac may d aamay wh a p. Gvm aa bdg dcm pvd vdc h.

222 NArgall(2008),Submission366totheNationalHealthandHospitalsReformCommission:FirstRoundSubmissions.

223 naa Hah ad Ha rm Cmm (2009), th Aaa hah ca ym ad h a fccy ga: A vw ha, a: www.hhc.g.a


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Fhm, h a cay d yp av wh m agda whch awd appach akg ac. F h pp mpma, m a hbad cag:

1. Reors whch are essenay whn he ab o one eve o governen xamp, hapg h Mdca B schd ad xpadg chc agd ca, bh whch a h pby h Cmmwah Gvm;

2. Reors whch reagn roes and responsbes beween he CoonweahGovernen and he sae governens, ch a h Cmmwah Gvm havg pby h pcy ad gvm dg pmay hah ca ad bacda ca. th m w b h w Hahy Aaa Accd; ad

3. Reors whch are onger er n naure ad q h vga ad/dvpm. th cd h xpa h dg, b, k ad aby adh pa mpma Mdca sc.

Wh h cag, h a m m ha a dpda h, ad d bmpmd qay. th va h m agd ca xamp, h agm bd ad ac cmmy ad da ca a cay pc awg ppga chc a whh h ca bdy a hm a da agd ca vc.

oh av a ay ad-a. udadg h dg cc bw avw hp pa mpma.

i Appdx G, w hav p wad a hgh v ac pa whch add ky m mpma. A m dad pag ad mpma wk dak, h may b da ag h pa. th pa:

vy cmmda gg a wh hd ad ga hm, wh hd b pb dg ad, m ca, h mg m;

d h cmmda ha q chag gvm pb ad/da dg aagm, a a gd wha w d b addd d h HahyAaa Accd;

d wh gav chag may b qd; ad

ga da m h aa m wh agg ac qd.

Gay, m mg, w bv ha whv pb p hd b ak cmmcdvpm ad ak ac ach m m h ya. impma hd bgadd a cmmcg wh gvm dm m. Fhm, w bv ha m h m w hav ppd cag 1 ad 2 ha , m whch a h ay whh amb v gvm (cagy 1), whch ag ad pb bwh Cmmwah Gvm ad h a gvm (cagy 2) cd b baayachvd wh h v ya, wh m ab b mpmd ha h. Wk dc m h m whch a wh h amb v gvm cd a

cmmc mmday.

7.2.1 ladg m

t gv c a aa hah ym, w a cag F M ag a w HahyAaa Accd ha w cay aca h agd ad cmpmay ad pb a gvm mpvg hah vc ad cm a Aaa.

th p wad h hd b h Cc Aaa Gvm (CoAG) ag 2009 dvp h w Hahy Aaa Accd c wh cmmda Chap6. th am hd b ag h Hahy Aaa Accd 2010. t acca h pac m, p wd b h Accd b a hgh v agm, ppd by m dad dvda

agm pcc m m. th wd aw ay ac m m wh hw bg dvpd.


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i paa, w cmmd ha v h x w ya h Cmmwah Gvm xp hccp Mdca sc cdg h dg, b, k ad aby dcg hahad hpa pa.

Fm xpc v h pa 16 mh, w a ca ha h a g d m Aaa hah ym. o xc a a Cmm, ad h dm m c by a gvm, dma gvm accpac ha mpvm Aaa

hah ym a dd. Mv, bad ca bh mg ad hgh hbm w hav cvd, w kw h cmmy, hah pa ad hah vc aa ady mbac m.

W g gvm c ca ad gagm wh h cmmy, hah paad hah vc cc mpma h m agda w dpd p . Chag m ay achvd, ad wh b , wh md by h vw ad wh h acvvvm h acd.

7.3 Accaby m

Accaby a cca cc chag. May h m w hav ppd a dd cay ad gh accaby h pmac h hah ym ad hah vc.th ppa chag h aca pb bw gvm; mpv mam vc pmac, wh dg b cagy kd pmac;ad mpv pbc pg qay ad pmac a h vc ad h ym v.

W bv h m a b ca accaby mpma m. F may m, h Hahy Aaa Accd pvd a ba h a h hgh v had gvm. Pg h m h Hahy Aaa Accd hd b md ad pbcypd by h CoAG rm Cc h dpd agcy abhd by h Cc Aaa Gvm m ad p h pmac gvm aga aam agm. F cmmdd m ha d q a -gvm agm,

w g h pb gvm gvm a mam h mpma adcmm pg aga h. i add, w pp ha h Cmmwah Gvm daw a aa Cca sa ( sc 5.2.1) pvd cg advc h mpma m ad apppa ma pmac ad cm. Hwv, accaby m gbyd g adhc h mpma agd m wh a pcd mam. tckg a agd m a hy a mpmd c.

th a ma cc w b a dmaby b hah ym, bh a chca ch a mpvd acc hah vc ad accdg h wh y ad h wh wkwh . tha why w bv ha h hd b h ma cc hah ym:ma h pmac h hah vc, h pbc cdc h hah ym, ad h aac h wkg wh .

Pmac aga h h ma hd b gay md ad pbcy pd.rpg hd b a h aa, a ad ca vc v. rpg hd a fc hw wh hah ym m h d h m vab pp ad h had ach, cdgpp vg a ad m aa, h cay ad cmcay dadvaagd, ad Abgaad t sa iad pp.

tapacy kd accaby. May pp maky bv ha h Mdca vy 1.5 p c axab cm d a Cmmwah xpd hah ca. B ac p ab 18 p c h Cmmwah a pdg hah ca, ad y ab 8p c h a pdg hah ca m a c cdg by gvm, hgh pvahah ac ad dcy by a dvda.224 A w dcd sc 4.3.3, bg pad ca ab hw mch c hav acc va hah vc wd hp ca gaapacy ad cmmy dadg ab pdg hah.

224 CommonwealthGovernment(2007),BudgetPaperNo.1,BudgetStrategyandOutlook2007-08,Statement5:Revenue,p.5-9;AustralianInstituteofHealthandWelfare(2008),HealthExpenditureAustralia2006-07,p.20(AustralianInstituteofHealthandWelfare:Canberra).


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7.4 ivg m ag h aca mpcath c cd h aca mpca ppd av , p ah way h vm qd achv m Aaa hah ym.

W cd h aca mpca ppd m m h ppcv:

h c ad capa c maj m; h mpac hah xpd v h mdm g m; ad

h ga ccy ad pdcvy.

7.4.1Recurrentandcapitalcostsofmajorreforms

W hav mad h dcav cg h m ha a gca addaxpd ( Appdx H). th adda c a ya h m Aaa hahym (xcdg Dca Aaa) a bw $2.8 b ad $5.7 b ( tab 7.1).

th g cd dcav c mpvd pbc da ca, b h Dca

Aaa chm whch cdd paay. oc y mpmd, Dca Aaa wd h a h Cmmwah Gvm pby dg $3.6 b p ya,whch cy p pvay hgh pva hah ac dcy by cm. W havggd h, ad a ca pdg m m d, cd b by a ca hMdca vy ab 0.75 p c axab cm. May pp wd pay da cad Dca Aaa.

i add, a vm capa v v ya bw $4.3 b ad $7.3 b wd bqd am h hah ym ac ab m ( tab 7.2). Capavm a cca ab a mb amav m cdg dvg a-hah agda, ghg pmay hah ca, ad mg da ca. Capa ca dvchag ad dama achvg h cc ad a h hah ca ym w

a cmmdg. sh m capa vm w b va hapg hw ca dvd, gvc gap, bdg w ym ad capab ad mag chag.

Appdx H h ba h ma. W daw a bw a mb mpap dadg h va ba ma:

c c a dcav ma ya xpd;

m cmmda hav adda c a gvm hav aady cmmd d ma aa c. F xamp, CoAG ha agd d a mb av ma h ppd d Hahy sa agy, ad h CmmwahGvm ha cmmd $1.58 b dg mpvd hah vc Abga ad t sa iad pp d h Cg h Gap agy;

wh w hav cmmdd h ca a xg acvy ha ha m mddg ch a h Aaa Cmm say ad Qay Hah Ca hecv sgy Wag l rdc Pa w hav cdd h gg c hacvy ma xpd; ad

hwv, wh h av w hav ppd d m a xg w c vc whch gvm ha cmmd w hav d h adda c. F xamp, cmmdd naa Hah Pm ad Pv Agcy ha a bad mha ha ppd by h gvm w hav mad h adda dg qd.


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Table 7.1: Indicative costs of reform recommendations

Reors

Range o coss(savngs/revenue)

$ $

Prevenon 100 100

naa Hah Pm ad Pv Agcy 100 100

sppg hahy wk*

Prary Heah Care 883 1962

Cwh pby dg & pcy pmay hah ca#

em yg am, idg pp, h chcay 341 682

PHC pv, acc ad qay pmac paym 252 800

Pmay Hah ca gaa 150 150

rhapg MBs 140 330

tagd aaa ca*

C cac chd & amy hah*

Hospas (138) 917

naa pmac pg & accaby amwk 12 12naa acvy-bad hpa dg (1330) (570)

naa Acc tag ad Hpa/eD 720 1015

ehacd b-ac ca vc/ad ad qpm 460 460

Aged Care 874 1323

expadg pv agd ca bd 530 838

M fxb ag cmmy agd ca bd 296 437

Mdca aagm wh da agd ca vc 48 48

Advac ca pag ag

Heah and heah care or indgenous peope 70 70

Abga & t sa iad hahy dg 12 12naa Abga & t sa iad Hah Ahy 58 58

Rura and reoe 217 514

eqvac dg m ad a aa 55 143

rm & a ach, hah & advc wk 50 100

ra wkc hacm packag 27 27

Pa av aac 85 244

mena Heah 356 356

Cmm yh vc 30 30

eay pych pv ad v vc 26 26

rapd ma hah p am 200 200sb-ac ma hah vc 70 70

empym pp pp wh ma 7 7

Ma hah ad dma pp d Aaa 23 23

Dena Care and Ora Heah 320 320

Da rdcy pgam 200 200

sch da xpa 100 100

oa hah pm 20 20

Workorce

nw cca dca ad ag amwk*

naa dca ad ag agcy*naa pa ga*

Abga & t sa iad hah ad pa ag*

icag ag pac m & a aa*


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Table 7.1: Indicative costs of reform recommendations (continued)

Reors

Range o coss(savngs/revenue)

$ $

One naona heah syse 167 167

Cca, hah vc ad hah pcy ach 100 100

naa hah va 8 8

Aaa Cmm say ad Qay Hah Ca 34 34

naa hah v & pva hpa ga 25 25

toa 2849 5729

* CoAG dg d

# ea h ab $4 b m a Cmmwah

Table 7.2: Estimated capital requirements (over 5 years)

Reors Range o coss ($)

Prary Heah CareCmphv PHC C ad svc 300 300

Hospas

ehacd b-ac ca vc 900 1500

Hpa hapg 1250 2500

mena Heah

Cmm yh vc 30 30

Dena Care and Ora Heah

Da dcy pgam 375 750

sch da xpa 125 250

Workorce

Cca dca & ag ac (ac a g ad cdg a) 100 150

One naona heah syse

naa -hah agda 1185 1865

toa 4265 7345

i cdg h c ad capa mpca m, mpa ha hvm wd b ac bh Cmmwah ad a gvm vayg x d m.

A chag h aca v xpd ay ya m m w dpd hpac h mpma h m. i phad v va ya, a w acpa, h mpac xpd ay ya cd b q md.

Fhm, a a h chap, h dcav ma h c c hpcc cmmda d ak acc h pa a mb h m cahah xpd ad ca pdcvy, wh mpvg pp hah ad pvdg a b,m cv mx vc. ova, mdg by h Aaa i Hah ad Wadca ha m ppd m w w gwh hah xpd hmdm g m.225

225 Aaa i Hah ad Wa (2009), ema h mac cd nHHrC m hah ca xd, 2003 2033,(AiHW: Caba).


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7.4.2 Ga m h vm

A ay vm, mpa kp md wha w a amg achv.

thgh h vm, w a amg am h Aaa hah ca ym by:

ackg h maj acc ad qy ha ac pp w;

dgg hah ym m mgg chag; ad cag a ag ad mpvg hah ym h .

Appdx H d h dcav c maj m. H w hghgh h ga m vm:

prevenon wd bcm a hgh py, wh dca, vdc ad ach dv byh naa Hah Pm ad Pv Agcy;

hgh pp h achvm Naona Access targes, pp my acc pbc hpa ad hah vc wd b mpvd ac h ca cm acca, mgcy ca, pca ca, pmay hah ca, cmmy hah vc, agd

ca, ad dagc vc; prary heah care wd b mbddd a h c hah ym,

cg pv, ay v, ad ccd ca;

yg am, Abga ad t sa iad pp, ad pp wh cmpx adchc d wd hav a heah care hoe hgh vay m wh a pmayhah ca vc;

a heahy sar o e a chd wd b ppd, hgh va adagd vc;

h m, unversa access o basc dena servces wd b pvdd, addga ky aa bh hah d ad hah qy;

peope wh a ena ness, mpv h hah ad wbg ad dc hd c ca, h c wd h ay v, b maagm mahah dd, ad b pp;

h appach dg hah vc Aborgna and torres Sra isanderpeope wd b adcay chagd, acvy pcha ad cmm h vy b ca;

mpvd vc, pp ad qva dg pp reoe and rura Aaawd b dcd, d a bac qy acc va vc m;

adqa, pv aged care servces wd b d h cag mb d pp;

hospas o he uure wd b cad, pca vc h cmmy wd bxpadd, ad b-ac vc h mg k wd b cad;

h educaon and ranng ad cg dca hah pa wdb mpvd;

a naona e-heah agenda, cdg a person-conroed eecronc heah record,wd b dvd ab pp ak a m acv maagg h hah admakg md hah ca dc, mpv cca dc makg, dc mdca, ad mpv pdcvy; ad

a mpvg hah ym wd b dv by h abhm a peranennaona saey and quay cosson, adqa dg research cdghah vc, pbc hah ad hah pcy ach ad h avaaby sardaa on cnca quay and heah syse perorance.

Wh w hav hghghd a mb maj vm, mpa mpha ha hv xpd cay a yadck h gcac a cmmdd m. F

xamp, ag dg ad pcy pby pmay hah ca m h a hCmmwah Gvm d q ca xpd. ov m, hwv, w bv w ab h ama h dvy pmay hah ca, pacay hgh mcmphv, b gad ad cdad ca.


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7.4.3 th mac hah xd v h mdm g m

emag h cad gvm c ad capa xpd way ag haca mpca m. B ha ma, cg j h mmda c. id ak acc h mpvm pmac ad ccy ha w b achvd hmdm g m hgh b pv m apppa vc a a h m.Ag h va h cmmdd m m cmpx, qg a dadg h

c ad b v h mdm g m.

t ak xamp: vg a hahy a ad ghg pmay hah ca a hda hah ca ym a ky ag bh g hah ca w adpv, ad baacg ad ccg ca pp v h m. th m wq gca xpd, pacay d h c adda vc am wh ygchd, Abga ad t sa iad pp, h chcay , ad pp wh dabhgh vay m.

B h j h c d h baac h. th vm pmay hah ca w mpv hhah ad wbg may, may had Aaa. F xamp, b acc pmayhah ca w ma dc by ad mkg ad a ad b am chc

da, ch a dab. i h mdm g m, h mpac w fw hgh dc h da, pacay cadvaca da, ad hc dc y may admbdy b a m xpv ac hpa ca. th, h mdm g m, hm w dc gwh pjcd hah xpd. idd, h Aaa i Hahad Wa (AiHW) ha mad ha h dc pa m wh a pmay hah cavc w av $380 m a ya by 202223 ad $635 m a ya by 203233.226

Wh cmpx amp y a h c ad b vm, w bv mpa d gv pp a m cmp pc ad dadg h ga m hadda vm w a cmmdg.

t d h, w cmmd h AiHW ma h mpac ky cmmdd m

hah xpd v h mdm g m. i mmay, mdg by AiHW gg mwd w c va h mdm g m. th mpac cdd w:

ghg pmay ca vc hgh pa m;

m b-ac ca ad bq dc v m h pp hpa bdday whch a ac ca;

ca agd ca pac;

mpvd am dab;

dcd a ca by a;

a dc mkg a;

mpma Dca Aaa;

mpma pa cc hah cd; ad mpvm ay ad qay ca.

th AiHW mad h mpac ky m ac ch a chag da a, mbad yp vc cvd ( xamp, admd pmay hah ca), ad h pp pp wh cv am.

tab 7.3 cmpa h AiHW c pjc hah ad da agd ca xpd 202223 ad 203233 wh h pjcd xpd a akg acc h mpac kym. Accdg h AiHW, ky m w dc pjcd pdg by $4 b a ya by203233. A a pp GDP, hah ad agd ca xpd w b 12.2 p c GDP 203233, whch ha h pjcd 12.4 p c.

226 Aaa i Hah ad Wa (2009), ema h mac cd nHHrC m hah ca xd, 2003 2033,(AiHW: Caba).


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Table 7.3: Estimated changes in projected health and residential aged care expenditure due to reforms

Expendure (ons o 200607 doars)

200203 202223 203233

Curren projecons o heah & resdena aged careexpendure ($)

85 063 167 729 246 056

Curren projeced expendure as per cen o GDP 9.3% 10.6% 12.4%

less ne savngs due o pac o reors ($)

Improvedavailabilityofsub-acutecare -127 -190

Reducedrateofincreaseinobesity -624 -2 566

Fasterdeclineinsmokingrates -363 -262

Patientenrolmentwithaprimaryhealthcareservice -380 -635

Reformstoagedcare -519 1 412

Improvedaccesstobasicdentalcare -73 -110

Improvedtreatmentofdiabetes -125 -188

Implementationofpersonalelectronichealthrecords -430 -627

Improvedsafetyandqualityofcare -660 -976toa -3 301 -4 142

Revsed projecons o heah & resdena aged careexpendure ($) 85 063 164 428 241 914

Revsed projeced expendure as per cen o GDP 9.3% 10.4% 12.2%

Fg 7.1 hw h gaphca m.

Fgure 7.1: Esaed changes n oa expendure as a resu o seeced reors, n 202223and 203233, ($ ons)

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0

1,000

2,000

202223 203233

$m

Safety & quality

Diabetic ttmt

Tobacco

Aged care

Elec HRDental

Medical home

Obesity

Sub-acute


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lkg bhd h g gv a b dadg h mad mpac m. Fg7.2 a h mpac cd m h baac xpd bw vc, hwg, xamp, ha xpd pmay mdca ca (GP) ad da agd ca a xpcd ca a a m, wh xpd admd pa ca, h mdca vc(cdg pca mdca ca d hpa) ad phamacca w dca, av pjcd pdg h abc h m.

ova, h a h h baac xpd m admd ca pmay hah ca ad/da agd ca, mpvg h acav ccy h hah ym.

Fgure 7.2: Shs n projeced expendure beween servces by 203233, fowng ro aspecso our recoended reors ($).

-5,000

-4,000

-3,000

-2,000

-1,000

0

1,000

2,000

$m

Area of expenditure

Admitted GP Other medical Pharmaceuticals Residential aged care(high care)

ova, h AiHW aay dca ha h c m wd b dc hbd da ad dv a b mx m accb ad cv vc a a w c

ad hgh pdcvy wh ( d) h pjcd ca xpd ha wd ccwh h m. i h wd, vg h m w w dv ga va hcmmy h .


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7.4.4 Ga fccy ad dcvy

Ah way ag h aca mpca m c h ga ccy.A h backgd pap ccy ppad h Cmm :

The efciency o the health care system is important, not only because it is key

to delivering an aordable and sustainable health system, but also because itcan be an ethical issue in terms o equity and airness. I waste occurs whether

through duplication, poor processes, unnecessary high cost inputs, errors, too much

administration, spending on treatments that were not needed or unlikely to improve

outcome or could have been provided with an equivalent or better outcome in a

lower cost way it will adversely impact other peoples access to health care in a

system with fnite fnancial, capital and human resources.227

W hav ppd a mb m mpv h ccy h hah ym, aby:

g acvy-based undng dv h c dvy pbc hpa, pbc hahvc ad cca dca;

g econoc assessens o he cos eecveness o nervenons dg g h v ha w dv h b cm a gv v c;

perorance-based payens cag ad wad b pacc ad hghqay cm;

a rebaancng o he ype o nervenons dvd ha w pp bcm ad ha wh pp d ca hy ca cv h m apppa vc; ad

deverng an e-heah agenda bad pa cc hah cd, b daa, cmmca ad kwdg-d dc pp.

i ga, h ccy ga h m hav b paay dd. Hwv, w dhav ma w m: h dc acvy-bad dg ad h mpma pa cc hah cd. lkg m cy a h w av a h gcac h ccy ga Aaa hah ym m m.

th dc acvy-bad dg w achv ccy ga bca w dv chag bhav, by:

xpcy kg d acad h vc pvdd;

makg pb cmpa ma/p hpa;

makg a dm bchmak hav b m; ad

hpg maag ad cca dy c pacc, aca m c d-dd acv, c c, ad ag cay hgh c.228

W hav mad ha, wh y mpmd, acvy-bad dg pbc hpa adpbc hah vc, a cmmdd h p, cd av a mad $570 m $1,330 m a ya.

227 naa Hah ad Ha rm Cmm (2009), th Aaa hah ca ym ad h a fccy ga: A vw ha, Backgd a ad h naa Hah ad Ha rm Cmm.



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i m h mpma pa cc hah cd, cc a xpcd bdvd ac a hah vc g. ecc wd b gad by mmg h d :

acb mdca cd;

wa pap cd b dvd; ad

-d ad dagc magg h ad x-ay/ca cd b aachd h pa cc hah cd.

Adv v a a xpcd b dcd a, wh a pa cc hah cd, wb a maag mdc (ad h ac) ad mdca h (cdg, xamp,ag).229 th AiHW ha mad ha h dc pa cc hah cd wdav a mad $430 m 2022-23 ad $627 m 2032-33 ( tab 7.3 abv).

Acvy-bad dg ad cc hah cd ag paa ccy ha , hy mpac h c h pdc ad dvy vc. Acav ccy a vympa hah ca ccd wh g h b aca c ha h pacad h hah ym yd h b pb cm.230

A mb m a ccd wh mpvg acav ccy cdg cag hpv b-ac ca, mg agd ca pv, mpmg advac ca pag, adhg wad pv ad ay v.

o way mag h ga acav ccy by mag h mb adda bdday mad avaab m avdg dcg h m p hpa. Cdg h mpac h m cad b-ac vc, mpvd acc agd ca, ad advac ca pag h wd b gca adda bd day mad avaab hpa, mad a a mmm 1,064,000 a maxmm 1,341,000 bd day ( Appdx H). th m wd aa g p ab 2,900 hpa bd h m apppa , cdg mg vanaa Acc tag. th pvd h capacy pvd 160,000 m pd ac ca a pp qg a vgh hpa ay.

7.5 Ccth chap ha cd pacca mpma, cdg a mpma pa cmmdd m, ad h aca mpca h m. W hav hghghd hgcy m ad agd ha h mpma m hd bg mmday. W hava mad h c ad capa c m, wh pg ha, v h mdm g m, m a mad dc pjcd gwh pdg hah ad agd ca.

sm may qy h wdm dakg gca m hah ca, ad cg cadxpd, a a m wh Aaa cmy ad gvm ay a d p m agba aca dw.

B a hahy ppa ad a c ad cv hah ca ym a a maxmg hwbg a, ad h pdcvy cmy ad wkc.231 o cmmda m a amd a achvg a mpvd db c pvd m cad cv hah ca v h x v ya. impvg h pmac a c hap a h cmy ad whch xpcd gw bcm a ghh cmy h x wy ya a pp cmc maagm.


230 s Dck (2008), th Aaa hah ca ym: m, a ac?, Aaa Hah rvw 32(2): 322-329.

231 B Cc Aaa (2009), sbm 233 h naa Hah ad Ha rm Cmm: scd rd sbm.


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Fhm, w bv ha h a a c pg cmmda a c m h g mpvm hah a ad qy hah cm, ad a c, pv hah ca ym, ha a w ppad h chag h .

A h m pa h d ad p ac, w gy g ha gvm c c wh ad vv hah vc, hah pa ad h cmmy m wdy. th a ham ad ad chag ha, ccvy had, ca Aaa

c jy h b hah ym h wd.


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health reforms in australia 2011

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