title: Governance, transparency and alignment in the Council of Australian Governments (COAG) 2011 National Health Reform Agreement.
abstract: OBJECTIVE This article provides a policy analysis of the Australian government's National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. METHODS The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. RESULTS The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. CONCLUSIONS It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms.
authors.affiliation: Leeds University Business School, The University of Leeds, Maurice Keyworth Building, Leeds, LS2 9JT, UK.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Faculty of Health Sciences, Cumberland Campus C42, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia. Email: ;
authors.forename: Kirsten
authors.initials: K
authors.lastname: Harley
authors.affiliation: Centre for Health Stewardship, The Australian National University, Building 131, Canberra, ACT 0200, Australia. Email:
authors.forename: Paul
authors.initials: P
authors.lastname: Dugdale
authors.affiliation: Faculty of Health Sciences, Cumberland Campus C42, The University of Sydney, PO Box 170, Lidcombe, NSW 1825, Australia. Email: ;
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Short
mesh_terms: D001315:Australia; D032921:Consensus; D003695:Delivery of Health Care / Q000458:organization & administration; D030881:Disclosure; D035082:Federal Government; D018166:Health Care Reform / Q000458:organization & administration*; D011050:Policy Making