Values and value--a vision for the Australian health care system.

The Australian health care system is at a crossroads. Status quo is not a sustainable option for the future. Rising consumption, spiralling costs, the decline of private health insurance and a public sector 'bursting at the seams' threaten our traditional values of a universal, affordable, accessible, equitable, high-quality system. As a result, we believe that major reform of the health care system is both necessary and inevitable in order to ensure that the values of the system are maintained and to extract maximum value from limited health resources. In this article we lay out our vision for the Australian health care system. It is a vision characterised by transformational change--shifting of risk from patients and taxpayers to providers, downsizing of acute care capacity, integration of services across the system, rationalisation of State and Federal responsibilities and a 'shakeout' of providers and insurers resulting from intensified, but bounded, competition. We believe that the direction for health care players needs to be clarified so that, as a country, we can continue to have a best practice model of health care delivery. We present this vision as a 'stake in the ground' to set parameters around which this debate can emerge. It may be provocative and challenging, but it is our vision into the future.