MEDICUS FEBRUARY 2016

O P I N I O N

government's call for innovation with social purpose in mind. What lessons for us in the 21 st century when there is opportunity and obligation for similar boldness (Box)? Our modern burdens are budget deficits, intergenerational debt and, as described by The Economist , preoccupation with ‘small bore’ policy. Yet these burdens are just as much an affliction for our common weal as were those high rates of shipwrecks in the 17 th century for their loved ones, families, employers and governments. Health expenditure in WA now gobbles up 28 per cent of the state’s coffers. Without strategic policy, this will run rampant. Annual Commonwealth allocations to health exceed $75 billion. Currently, Commonwealth expenditure is under scrutiny through MBS and primary healthcare reviews on top of an internal review of the performance of the Commonwealth Department of Health, itself completed in 2014.

evidence that health system performance must improve. Through the Longitude Act, the government of the day created the incentive for relevant worthwhile innovation. Imagine that possibility to drive better health system safety and productivity. Governments everywhere including Australia acknowledge that the rate of potentially preventable hospitalisations is the pathognomonic symptom of deeply dysfunctional health system performance. How might governments keep everyone’s eye on the prize and explicitly reward improved performance as measured at systems level by this rate? A PERFECT STORM FOR POLICY REFORM

Wreck: The Batavia Gallery at WA Museum – Shipwreck Galleries, Fremantle. © Western Australian Museum.

marking and micromanaging these plans. Operational budget allocations by PHNs no longer need to be sieved or sanctioned by Canberra. Centralised co-ordination from Canberra is abandoned for the false hope it has become. Instead governments agree to unclutter the health system in order to allow achievement to flourish. It is simply the outcome of interest that is rewarded – and rewarded handsomely. The Longitude Act 1714 was promoted far and wide by the Astronomer Royal. There was a buzz in the streets. Public attention was focused on meaningful success. Although it is PHNs which could be best placed to systematise and secure the necessary local reforms and investments to deliver reductions in potentially preventable hospitalisations, entities other than PHNs could receive the financial fillip on offer by governments in order to drive still deeper social and system change. Imagine if shires, regional development commissions or Aboriginal corporations were explicitly slated upon their PHN’s success to receive a sizeable financial sum to reinvest as they see fit in further developing social, economic and environmental prosperity? Give the bounty triggered by the WHO, WHEN AND HOW MUCH?

Figure 1 (overleaf) shows the latest

Consider issuing a mobilising incentive

that elicits autonomous sustainable local action. Each Primary Health Network (PHN) in Australia already is preparing a plan to remedy rates of potentially preventable hospitalisations as measured at population level in their geographic footprints. Why not reward those who set and succeed in achieving a pre-specified rate? Government bureaucracies are relieved from the machinery of receiving,

Game changer: Portrait of John Harrison by James King, about 1766. Credit: Science Museum, Science and Society Picture Library, London

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