Academic journal article Australian Health Review

Health Workforce Policy and Industrial Relations in Australia: Ministerial Insights into Challenges and Opportunities for Reform

Academic journal article Australian Health Review

Health Workforce Policy and Industrial Relations in Australia: Ministerial Insights into Challenges and Opportunities for Reform

Article excerpt

Introduction

The publication of the Productivity Commission (PC) study Australia's Health Workforce in 20051 led to a significant increase in political, bureaucratic and academic effort to resolve the complex policy challenge of health workforce reform in Australia. This was precipitated by an ever-increasing demand for health services and better outcomes from an increasingly health-literate public, coupled with workforce shortages across some key categories of healthcare professionals.2

The health and community services sector is Australia's largest industry, employing 9% of the workforce.3 It is growing at a faster rate than the population, and is predicted to increase by 35% over the next decade.3 Health expenditure increased by A$53 billion between 2000-01 and2010-ll, standing at A$ 130 billion annually; this is also predicted to increase.3,4

These figures reflect international data, with the healthcare sector in the European Union (EU) accounting for 8% of all employment, an increase of 21% during the period 2000-10.5 In the U S, health workers comprise 12% of the overall workforce.5,6 Growth in health sector employment is proj ected to increase along with expenditure.5,6 The World Health Organization has estimated a worldwide shortage of 4.3 million health professionals,6 and individual countries, as well as communities of nations such as the United Nations (UN), EU, G8 and G20, all have initiatives aimed at meeting the challenge of ensuring that demand for health services meets supply and economic capacity.5-7

Governments in all nine jurisdictions across Australia are seeking to rein in health costs without negatively impacting on the quality, safety or continued improvements in health outcomes. They are simultaneously seeking to minimise any political controversy or negative electoral repercussions associated with health reform.

Building sustainable health services into the future and 'preparing for a quickly ageing population',8 is a policy challenge perceived as being 'so complex that. . .[it]. . .could only be met by all governments working together.'8 The Council of Australian Governments (COAG) has initiated an expansive reform agenda, with health constituting one of the five themes identified as requiring specific policy reform in response to this challenge.8

The benefits of health reform falling under the auspices of CO AG include national consistency and the pooling of government, economic, policy, academic and human resources in Australia's federated structure, with its complex model of health service funding and delivery. In addition, it may assist continuity as jurisdictions progress through election cycles, leading to potential changes in government. It may also diffuse the political controversy often associated with health reform, thereby encouraging governments towards more bold health workforce reforms. Importantly, participation in COAG health reform does not preclude jurisdictions Horn progressing their own reforms concurrently.

Industrial relations as a pathway to health reform

Health workforce policy is a complex and contested area of policy formation, where well-resourced professional and industrial organisations, representing significant numbers of health professionals and, increasingly, consumer groups, seek to influence policy outcomes.

Certified agreements reflect outcomes of debates around health workforce structure and service delivery between significant stakeholders in health, such health services, governments and industrial associations. These agreements play a significant role in health workforce policy because they facilitate reforms at a workplace level. Task substitution, new categories of health professional, including assistants, new models of health service delivery, hours of work and opening hours of health services have all been on the health reform agenda and must generally be negotiated through agreements to be implemented. Union membership in health-related industrial associations is very high; the Australian Nursing and Midwifery Federation (ANMF) boasts a membership of over 220 000 nationally, conferring on it considerable resources and negotiating power. …

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