Richardson Jeff Rj
Centre for Health Economics, Faculty of Business and Economics, Monash University, Clayton Victoria 3800, Australia.
Aust New Zealand Health Policy. 2009 Nov 30;6:27. doi: 10.1186/1743-8462-6-27.
Commentary on health policy reform in Australia often commences with an unstated logical error: Australians' health is good, therefore the Australian Health System is good. This possibly explains the disconnect between the options discussed, the areas needing reform and the generally self-congratulatory tone of the discussion: a good system needs (relatively) minor improvement.
This paper comments on some issues of particular concern to Australian health policy makers and some areas needing urgent reform. The two sets of issues do not overlap. It is suggested that there are two fundamental reasons for this. The first is the failure to develop governance structures which promote the identification and resolution of problems according to their importance. The second and related failure is the failure to equip the health services industry with satisfactory navigation equipment - independent research capacity, independent reporting and evaluation - on a scale commensurate with the needs of the country's largest industry. These two failures together deprive the health system - as a system - of the chief driver of progress in every successful industry in the 20th Century.
Concluding comment is made on the National Health and Hospitals Reform Commission (NHHRC). This continued the tradition of largely evidence free argument and decision making. It failed to identify and properly analyse major system failures, the reasons for them and the form of governance which would maximise the likelihood of future error leaning. The NHHRC itself failed to error learn from past policy failures, a key lesson from which is that a major - and possibly the major - obstacle to reform, is government itself. The Commission virtually ignored the issue of governance. The endorsement of a monopolised system, driven by benevolent managers will miss the major lesson of history which is illustrated by Australia's own failures.
对澳大利亚卫生政策改革的评论往往始于一个未阐明的逻辑错误：澳大利亚人的健康状况良好，因此澳大利亚卫生系统也很好。这或许可以解释所讨论的选项、需要改革的领域与讨论中普遍自满的语气之间的脱节：一个好的系统只需要（相对）进行一些小的改进。
本文评论了澳大利亚卫生政策制定者特别关注的一些问题以及一些需要紧急改革的领域。这两组问题并不重叠。有人认为造成这种情况有两个根本原因。第一个原因是未能建立起治理结构，以根据问题的重要性来促进问题的识别和解决。第二个也是相关的原因是未能为卫生服务行业配备与其作为该国最大行业的需求相称的、令人满意的导航设备——独立研究能力、独立报告和评估。这两个失误共同剥夺了卫生系统——作为一个系统——在20世纪每个成功行业中取得进步的主要驱动力。
对国家卫生与医院改革委员会（NHHRC）进行了总结评论。该委员会延续了在很大程度上缺乏证据的论证和决策的传统。它未能识别并正确分析主要的系统故障、其原因以及能够最大程度降低未来犯错可能性的治理形式。国家卫生与医院改革委员会自身未能从过去的政策失败中吸取教训，其中一个关键教训是，改革的一个主要——甚至可能是最主要——障碍是政府本身。该委员会几乎忽视了治理问题。由善意管理者推动的垄断系统的认可将错失历史的主要教训，而澳大利亚自身的失败就说明了这一点。
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