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    Ben Harris-Roxas

    Interesting points, and hard to disagree with most of them. It’s nice to hear someone arguing that bureaucrats do quite a good job given the difficulties of the systems they operate within.

    The idea of the Commonwealth taking full responsibility for all primary health care, broadly defined, and population health is an interesting one. I wonder if this might be the only way to ensure that money for prevention doesn’t get diverted.

    The challenge would be to make sure community health didn’t get dudded and that basic public health capabilities would be sustained – outbreak preparedness, surveillance, environmental health, health promotion, etc. It could facilitate more innovative approaches to working intersectorally on the determinants of health at regional levels, as opposed to state or national levels. My observation is that there has been some receptiveness by other sectors to working on the determinants at a regional level in a way that hasn’t necessarily been the case at state or national levels. I’m not entirely sure why – it may be because they’re closer to the issues, or because they’re accustomed to working with other agencies at a more operational level.

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    I think before the reform is implemented I would want a guarantee about what the role of the State health Departments is to be. We need a separation/distinction between the roles of funders, providers and service deliverers. If they are still in control of running services, nothing will change.The fair price casemix certainly needs to be out of their hands. it is difficult to believe that the few who currently control and operate our health system have the capacity to turn around and head in a completely opposite direction. I think the monitoring and evaluation of performance needs to be in the hands of someone independent of those bureaucracies as that role in terms of waiting times is currently achieved by reinterpretation of the rules to meet targets rather than managing effectively. We desperately need an investment in educating and developing a cadre of well qualified and experienced health managers to replace those lost , diminished and devalued in the past two decades. Fresh talent, new ideas and support for innovation and inter sectoral collaboration at the local level is where the action should be. DSB


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