A PROMINENT health expert has accused the federal government of having a "policy vacuum" on health, and of a "failure of leadership" for failing to immediately press on with implementation of key reform proposals.
Psychiatrist Ian Hickie claimed the final report of the National Health and Hospitals Reform Commission had been "watered down" from the interim document published in February, and the changes had "let the government off the hook" by opening the door to a more gradual implementation.
Professor Hickie, who is executive director of the Brain and Mind Research Institute at the University of Sydney, said a governance reform option in the interim report that was initially seen as too timid to warrant much mention -- that Canberra assume control of those parts of primary healthcare not already in its remit -- was "now being seen by the states as a bridge too far", despite repeated pledges that the government wanted to end cost-shifting between states and the commonwealth.
"We have a policy vacuum -- what is the government's policy?" Professor Hickie said.
"The previous government's policy was clear-cut: the average person pays more, or takes out private health insurance.
"This government's policy is not clear.
"They could take over primary healthcare tomorrow; it doesn't need a referendum. They could make hospital funding far more efficient; that doesn't need a referendum either.
"What's going on here is political spin ... We're being told there will be discussions with the states, but Western Australia and Victoria are already saying 'no way', so if it's left to the states, we will be stuck with what we have got now."
Professor Hickie said that, despite the 16 months of consultation and deliberation that led to the report, the Prime Minister was now embarking on a round of "photo opportunities in hospitals" instead of implementing the much-needed reforms.
However, doctors at the first of Mr Rudd's hospital visits, in Sydney's Royal North Shore Hospital yesterday, praised the government's interest in their reactions to the report.
Emergency physician Clare Skinner said the recommendations were "very, very solid" and the most encouraging element was the report's recognition of the need to ease workforce pressures, improve clinical training and free up more beds.
"A little bit of me worries that we have had 16 months of experts talking, and now we are going to roadshow it -- the problem is that the time has come to do some work."
Other experts and health groups praised the report's push for more collaboration between doctors and other health workers through the establishment of comprehensive primary healthcare centres, a greater emphasis on prevention, the expansion of allied health worker services and an acceleration of e-health initiatives.
The National Heart Foundation, Australian Health Care Reform Alliance, Australian General Practice Network and Australian Medical Association all backed the report, and in particular its support for primary care.
This includes a recommendation that between $250 million and $800m be spent annually on performance bonuses for all primary health workers, with the current limited number of incentives possibly doubling or even trebling in number.
However, the cost would be offset by the scrapping of existing incentives schemes, worth about $300m annually.
The report was criticised for "entrenching vested interests" by the Doctors Reform Society, and attacked by the Rural Doctors Association of Australia for failing to articulate a plan for attracting more doctors, nurses and other health workers to the bush.
