Community Consultation and Engagement in Health Care Reform
McBride, Tony, Korczak, Viola, Australian Health Review
In advocating for significant reform of the health care system, the Australian Health Care Reform Alliance (AHCRA) supports a process of citizen engagement that will allow the wider community to have a say in the future direction of their health care system. Models that have engaged community opinions have been successful overseas, and this article calls for similar processes in Australia.
Aust Health Rev 2007: 31 Suppl 1: S13-S15
COMMUNITY ENGAGEMENT TECHNIQUES have been carried out in Australia on a small scale. Government commitment is required to establish a rigorous and systematic national consultation process. This is especially important when crucial decisions about the future of our health care system need to be made. We believe this is the first step in the journey to health reform.
The need for reform
There is a chronic shortage of doctors, nurses and other health professionals, especially in rural and remote areas. Australia has the resources to train more health professionals, yet we are increasingly relying more on overseas-trained doctors and nurses. Twenty five per cent of all doctors working in Australia are trained overseas and, increasingly, nurses from overseas are relied on to address Australia's skills shortages.1,2 There is sound evidence that we have the resources to train more health professionals. According to the 2005 United Nations Human Development Report, Australia is ranked third of 177 countries in economic performance.3
The Australian health system has insufficient focus on prevention and primary care, but, most critically, we have an increasingly fragmented system with inefficient allocation of government resources due to the state-federal funding structure. The reform which the Australian Health Care Reform Alliance (AHCRA) advocates involves adopting a new approach which considers these failings and engages stakeholders which have previously not been consulted. It involves undertaking a holistic approach instead of small sectoral changes. The nature of the reform needs to consider the views of consumers and the community to ensure reform meets communities' needs.
Why consult the community?
AHCRA considers that reform of the health care system needs to consider the views of those who use health services and whose taxes are used to support the system. The community contributes to the government's purse and should have a say as to how that money is spent.
As articulated by the Health Canada Policy Toolkit, citizen engagement is described as the "public's involvement in determining how a society steers itself, makes decisions on major public policy issues and delivers programs for the benefit of the people".4 (p. 16) AHCRA believes informed debate from a broad spectrum of the community will ensure that underlying principles and priorities such as equity and access underpin the health care system of the future, and enhance the transparency and accountability of funding decisions.
Other benefits which flow from the community engagement process include the building of consensus and greater community trust. Community engagement can minimise the fear that can accompany change and increase understanding and trust in government processes.
Experience from Canada
The Commission on the Future of Health Care in Canada (Romanow Commission) used a method of citizen consultation to engage the public before decisions were made.5 Using the Choiceworks model of consultation (Public Agenda, New York, USA), twelve sessions were organised across Canada with 40 participants in each session who were over 18 years of age and not employed in the health care sector. The participants were given two main tasks: the first was to develop their own vision of the health system and the second was to make choices and trade-offs to realise that vision.5 This dialogue cost CA$1.3 million and was financed by the Commission on the Future of Health in Canada. …