School of Public Health, Queensland University of Technology Executive Director of Medical Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Emerg Med Australas. 2010 Oct;22(5):384-90. doi: 10.1111/j.1742-6723.2010.01329.x.
The proposals arising from the agreement reached between the Rudd government and the States and Territories (except Western Australia) in April 2010 represent the most fundamental realignment of health responsibilities since the creation of Medicare in 1984. They will change the health system, and the structures that will craft its future direction and design. These proposals will have a significant impact on Emergency Medicine; an impact from not only the system-wide effects of the proposals but also those that derive from the specific recommendations to create an activity-based funding mechanism for EDs, to implement the four hour rule and to develop a performance indicator framework for EDs. The present paper will examine the potential impact of the proposals on Emergency Medicine to inform those who work within the system and to help guide further developments. More work is required to better evaluate the proposals and to guide the design and development of specific reform instruments. Any such efforts should be based upon a proper analysis of the available evidence, and a structured approach to research and development so as to deliver on improved services to the community, and on improved quality and safety of emergency medical care.
该协议提出的建议之间的罗得政府和国家和地区（西澳大利亚除外）在 2010 年 4 月代表最基本的重新调整的卫生责任自 1984 年创建医疗保险。他们将改变卫生系统，并将工艺的未来方向和设计结构。这些建议将对急诊医学有重大影响;不仅从系统的影响，这些建议，但也从那些派生的具体建议，以创建一个基于活动的资金机制的 EDs，实施四小时规则和开发 EDs 的绩效指标框架。本文将研究的建议对急诊医学的潜在影响，告知那些在系统内工作，并帮助指导进一步的发展。需要更多的工作来更好地评估这些建议，并指导具体的改革工具的设计和开发。任何此类努力都应建立在对现有证据进行适当分析的基础上，并采用结构化的研究和开发方法，以便为社区提供更好的服务，并提高急诊医疗的质量和安全性。
