Abstract:
The strategic public governance of health services in Australia, as a
federation of states and territories is shared between three levels of
government and the public, private and not-for-profit sectors. While
national and sub-national governments hold the legitimate authority for
most strategic decision-making and service delivery, many powerful
actors with vested interests influence policy agenda-setting processes.
Unlike the broader public governance systems in Australia, which are
founded largely on the market-based model of neo-classical economic
principles, the health governance system is more socially oriented.
However, there is evidence that suggests that continuing moves by
governments towards a more competitive model of governance with
greater private sector involvement could impact negatively on health
outcomes. At the same time, it is equally apparent that the structural,
instrumental and dynamic aspects of the strategic health governance
system, as they stand, could create more adverse indicators of public
health. In fact, some trends in the health care system put state capacity
for strategic governance in doubt.
This paper will use the basic principles and assumptions of the now
largely universal neo-liberal economic public governance model, based
on market principles, to examine how these ideas are reflected in the
conceptual and practical approaches to health services management in
the Australian context. In this sense, the focus is on the ill health,
treatment svstem rather than on the governance of public health broadly
interpreted. First, to provide a more global context of health governance
in Australia, some comparative analysis relating to Anglo-American
polities will he presented. Second, the fundamental value of health as a
market product or merit good will he considered. Third, the structural,
instrumental and dynamic aspects of the health governance system in
Australia will he explored. Filially, the paper examines whether the
Australian state is "unsmart" or incapacitated in relation to strategic
governance of health.
