(Re)form with Substance? Restructuring and governance in the Australian health system 2004-05

The Australian health system has been the subject of multiple reviews and reorganisations over the last twenty years or more, and the year 2004-05 was no different. Mark Rix, Alan Owen and Kathy Eagar review the reforms, (re)structures and governance arrangements in place at both the national and state/territory levels in the past year. At the national level some progress has been made in 2004-05 through the Australian Health Ministers\u27 Council and there is now a national health reform agenda, albeit not a comprehensive one, endorsed by the Council of Australian Governments (COAG) in June 2005. Quality and safety was an increasing focus at both the national and jurisdictional levels, as was the need for workforce reform. Although renewed policy attention was given to the need to better integrate and coordinate health care, there is little evidence of any real progress this last year. More progress was made on a national approach to workforce reform. At the jurisdictional level, the usual rounds of reviews and restructuring occurred in several jurisdictions and, in 2005, they are organisationally very different from each other. The structure and effectiveness of jurisdictional health authorities are now more important. All health authorities are being expected to drive an ambitious set of national and local reforms. At the same time, most have now blurred the boundary between policy and service delivery and are devoting significant resources to centrally \u27crisis managing\u27 their service systems. These same reasons led to decentralisation in previous restructuring cycles. While there were many changes in 2004-05, and a new national report to COAG on health reform is expected at the end of 2005, based on current evidence there is little room for optimism about the prospects for real progress