Sticky or Stuck: the role of policy networks in constraining change to Australia's healthcare financing policy

Abstract

In Australia, there has been a considerable change in the burden of disease with a reduction in morbidity and mortality from infectious diseases and an increase in chronic conditions, placing increasing pressure on the healthcare system. Chronic conditions generally require coordinated treatment by a team of health professionals due to their complex causality and comorbid complications. The structure of the financial system in Australia, however, does not support coordinated care. This is a significant issue for the sustainability of the system and for improving patient care.

Previous research in Australia has found that the mix of incentives determining who can pay for services and how - known as the 'payment and access rules' - creates a barrier to the integration of care needed to treat chronic conditions. While there have been numerous attempts at reforming the payment and access rules in Australia, none have succeeded. Thus, it is crucial to improve understanding of where the barriers and blockages lie to improve efficiencies and care coordination.

While much is known about the design of the system, and its flaws, there is little empirical evidence available to understand how we got here and the interests at play in shaping Australia's healthcare financing system. Furthermore, while the literature on healthcare policymaking points to the importance of understanding policy networks, power and legitimacy, these approaches have not been applied to this area.

This research aims to improve understanding of the role that collectives of organisations (actor networks) have played in constraining change in Australia's healthcare financing policy over time and identify lessons for how these barriers may be overcome. In doing so, it develops a conceptual theoretical framework drawing on network, resource and path dependency theories to interrogate the role of the actor network: its interests, use of power, legitimacy and resources in key attempts where private health insurers have dueled with medical practitioners to reform (or constrain reform) of Australia's payment and access rules.

This research aim was achieved by employing a mixed methods design with a case study approach, focusing on three case studies in Australia where reform of the payment and access rules was considered by the parliament.

This dissertation advances our understanding of how actors within Australia's health policy network have progressed their strategic interests using resources, power, legitimacy, and influence to constrain changes to the payment and access rules. It also uncovers the inner operations and strategic interests of the key players in Australia's health policy network and how these have changed over time. It shows how actors have set norms for debating health policy by slowly constricting reformers' ambitions during each policy event. Moreover, it demonstrates the role of actor networks in cementing Australia's healthcare financing policy, showing the coalescing of network resources to build legitimacy for constraining change. Finally, it concludes that consumers have not had a strong voice in the policy process for several decades and better consumer outcomes may result if there was a strong and independent consumer group participating in health financing policy development.