THE PRODUCTIVITY COMMISSION (Productivity
Commission 2004) has nominated nationally
coordinated health sector reform as one of two
top priorities (along with natural resource
management) for extending the industry reform
agenda under the aegis of National Competition
Policy. This is in recognition of the importance of
these areas for the wellbeing of Australians, and
the level of resources they will require in future
years. The Commission states that ?an
independent review of Australia?s health system as
a whole is a critical first step in achieving
cooperative solutions to deep-seated structural
problems? (p. XI). The fragmentation in health
system governance that results from the national?
state split is mirrored in the lack of coordinated
care at many levels throughout the system. The
Commission?s proposal has been welcomed by
many in the health industry, no doubt with some
nervousness, because of the broad and deep
conviction that something has to change in the
apparently intractable problem of split funding
responsibilities.
?Today?s health-care delivery systems are not
organized in ways that promote best quality.
Service delivery is largely uncoordinated,
requiring steps and patient ?hand-offs? that slow
down care and decrease rather than improve
patient safety? (OECD 2004). Improving care
coordination is high on the list of issues to be
addressed in any reform of the health sector.
This issue of the journal features a collection of
papers which address the sometimes jagged
?seams? in the current system. They offer
insights into some of the consequences of the
structural problems the Productivity Commission
would like to see addressed, and document
an energetic search for methods of enhancing
the effectiveness of health care.
Community context of health system development: implications for health sector reform in Pakistan
