Colton Caroline, Faunce Thomas
J Law Med. 2014 Mar;21(3):561-71.
The use of commissions of audit as vehicles to drive privatisation policy agendas in areas such as health service delivery has become popular with conservative federal and State governments. Such commissions have characteristically been established early in the terms of such governments with carefully planned terms of reference and membership. The policy directions they advocate, unlike election policies, have not come under the intense scrutiny, wide public debate or the opportunities for (dis)endorsement afforded by the electoral process. Governments do, however, anticipate and often accept recommendations from these reviews, and use them as justification to implement policy based on their findings. This highlights the power entrusted to review bodies and the risks to the public interest arising from limited public consultation. An example can be seen in the proposed privatisation of important aspects of Australia's public sector, particularly including those related to health systems delivery, currently entering a new iteration through the work of the National Commission of Audit appointed in October 2013. The NCA follows on from various State audit commissions which in recent years have directed the divestment of government responsibilities to the private and not-for-profit sectors. Through a discussion on the formation of policy frameworks by the NCA and the Queensland Commission of Audit, this column examines the ideological thrust of the commissions and how they synergise to produce a national directive on the future of public sector health services. The practical impacts on health service procurement and delivery in critical areas are examined, using the case of the federally contracted out medical service for asylum seekers and two hospitals in Western Australia, a State which is well advanced in the privatisation of public hospitals. The column then examines the release to the media early in the NCA's process of the submission to introduce a $6 general practitioner co-payment as a means of testing the response of the medical profession and public. The column also examines how the civil conscription clause in s 51 (xxiiiA) of the Australian Constitution may serve to protect practitioner and patient rights should some of these privatisation changes to Australia's health system be challenged in the High Court of Australia.
将审计委员会用作推动诸如医疗服务提供等领域私有化政策议程的工具，已受到保守派联邦和州政府的青睐。这类委员会的典型做法是在这些政府任期之初设立，其职权范围和成员构成经过精心规划。它们所倡导的政策方向，与选举政策不同，并未受到严格审查、广泛的公众辩论，也没有经历选举过程中所提供的（不）认可机会。然而，政府确实预期并常常接受这些审查的建议，并将其作为依据，根据审查结果来实施政策。这凸显了赋予审查机构的权力以及因公众咨询有限而对公共利益产生的风险。一个例子可见于澳大利亚公共部门重要方面的拟议私有化，特别是那些与医疗系统提供相关的方面，目前正通过2013年10月任命的国家审计委员会的工作进入新的阶段。国家审计委员会承接了各个州的审计委员会，近年来这些州审计委员会已将政府职责剥离给私营和非营利部门。通过讨论国家审计委员会和昆士兰审计委员会政策框架的形成，本专栏审视了这些委员会的意识形态倾向，以及它们如何协同作用以产生关于公共部门医疗服务未来的国家指令。利用联邦外包给寻求庇护者的医疗服务以及西澳大利亚州的两家医院（该州在公立医院私有化方面进展显著）的案例，审视了在关键领域对医疗服务采购和提供的实际影响。本专栏接着审视了国家审计委员会在其进程早期向媒体公布提交的文件，其中提议收取6澳元的全科医生诊疗费，以此作为测试医疗行业和公众反应的一种手段。本专栏还审视了如果澳大利亚医疗系统的这些私有化变革在澳大利亚高等法院受到质疑，澳大利亚宪法第51条（xxiiiA）中的义务征兵条款如何可能用于保护从业者和患者的权利。
