Ferguson M
J Qual Clin Pract. 1995 Dec;15(4):195-201.
The Australian Council of Trade Unions (ACTU) and its affiliated health unions have strongly supported and actively participated in the Federal Government Best Practice in Health initiative over the past two years. We believe the initiative has been an important vehicle in fostering the development of the Best Practice approach in this vital sector of the economy. Healthcare expenditure in this country runs to some $34.3 billion (1992/93 figures) annually, financed by a mix of Commonwealth, State and private sources and constituting approximately 9% of GDP. Hospital expenditure alone absorbs just over a third of the total at $11.8 billion (1990/91). At the same time, we have developed one of the most accessible and equitable healthcare systems in the world and an increasing source of valuable export dollars. The Australian trade union movement, like others in the community, recognizes that real cost constraints exist on governments in healthcare as elsewhere. Those constraints can lead to a variety of responses, such as to withdraw money from the system, combined with total reorganization of financing through the introduction of casemix and hospital reorganization, to see whether the system survives. The alternative is one epitomized by a Best Practice type approach. It is these types of approaches and their relationships with enterprise bargaining on which I intend to focus. However, I hasten to add that the issue of context is all important. Whilst it may be possible to create a microcosm of Best Practice change in a particular healthcare setting, it is unlikely to be maintained. The interface with the socio-ecomonic and political context cannot be avoided and it is this context which will determine the continuing success of Best Practice initiatives--whether in health or elsewhere.
在过去两年中，澳大利亚工会理事会（ACTU）及其附属卫生工会大力支持并积极参与了联邦政府的卫生领域最佳实践倡议。我们认为，该倡议一直是推动这一重要经济部门发展最佳实践方法的重要工具。该国每年的医疗保健支出约为343亿澳元（1992/93年数据），由联邦、州和私人资金共同资助，约占国内生产总值的9%。仅医院支出就占总额的三分之一以上，为118亿澳元（1990/91年）。与此同时，我们建立了世界上最便捷、最公平的医疗保健系统之一，并且医疗保健成为了越来越重要的出口创汇来源。与社区中的其他群体一样，澳大利亚工会运动认识到，政府在医疗保健方面与其他领域一样，面临着实际的成本限制。这些限制可能导致各种应对措施，比如从系统中撤资，同时通过引入病例组合和医院重组对融资进行全面重组，以观察该系统能否存续。另一种选择是以最佳实践类型方法为代表的方式。我打算重点关注的正是这些方法类型及其与企业谈判的关系。不过，我要赶紧补充一点，背景问题至关重要。虽然在特定的医疗环境中可能创造出最佳实践变革的微观世界，但这种变革不太可能持续下去。与社会经济和政治背景的衔接无法避免，而正是这种背景将决定最佳实践倡议——无论是在医疗领域还是其他领域——能否持续取得成功。
