The first publication in the Occasional Papers Series, National Leadership through Performance Assessment, takes a critical look at Departmental frameworks for performance information and monitoring. It comprises two papers with a common theme and complementary purposes .

2. Mar 1998. Family and Community Services: When is Competition the Answer

Competitive tendering will continue to be introduced where it can deliver benefits. Even so, for the department, continued benefits are more likely to come from better management approaches under current funding arrangements, with the aim of improving the cost effectiveness and customer focus of services, and ensuring more rigorous monitoring and evaluation.

3. Nov 1998. A Healthy Start for 0-5 Year Olds

This policy recognises that to further diminish ill health and injury among 0-5 year olds, it is necessary to address the wider determinants of health – the psycho-social, physical and economic environments in which they live – and that this requires active coordination between the health and broader family services sectors.

4. Jan 1999. Compression of Morbidity Workshop Papers

The following papers by five prominent Australian researchers were presented at a workshop in Canberra in July 1998. The purpose of the workshop was to establish the current state of knowledge in relation to the hypothesis of ‘compression of morbidity’. The papers examine the issue from a range of viewpoints.

5. Sep 1998. An Overview of Health Status, Health Care and Public Health in Australia

Australia is now much better placed to describe patterns of health and health inequity than it was even five years ago. This capacity needs to be further developed especially in moving away from more traditional health indicators such as mortality, morbidity and risk factors to other dimensions of health such as community capacity, and locational disadvantage. There also needs to be more emphasis on developing process or intermediate indicators for strategies such as intersectoral action and healthy public policy goals such as improved food supply.

6. The University of Adelaide: Accessibility/Remoteness Index of Australia (ARIA). This publication has been superseded by OccasionalPaper (New Series) No.14.

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New Series Occasional Papers

1. Mar 1999. Reforming the Australian Health Care System: The Role Of Government

This paper begins (Section 1) with a review of why Australian governments are extensively involved in health, the ongoing challenges that involvement brings, and evolving views on how best to respond. The following three sections set the scene for a consideration of major recent reform to the system. Section 2 provides an international context, by comparing the overall performance of Australia’s health system with that of other OECD countries. Section 3 provides the domestic context, by describing the Australian health system in some detail. Section 4 provides the historical context, by identifying recurring reform themes as the system has evolved in response to powerful forces for change. Sections 5 and 6 then review some important health care reforms undertaken in the 1990s, describing major initiatives both for Medicare and for private health insurance. The focus shifts to population health in Section 7, where Australia has enjoyed some considerable successes (eg in combating the spread of AIDS). The paper concludes (Section 8) by turning to ongoing issues and the wider context of health in the Australian community.

2. Apr 1999 Gambling: is it a health hazard?
This submission largely addresses terms of reference 3(d) the social impacts of the gambling industries; 3(g) the impact of gambling on Commonwealth, State and Territory Budgets; and 3(h) the adequacy of ABS statistics involving gambling. It concentrates on only a few of the issues raised by the Productivity Commission’s Issues Paper: the definition of gambling; gambling as a health issue and the consequent costs to the Commonwealth; the need for governments to adopt a more active approach to preventing harm from problem gambling; the roles of government in relation to gambling, including hypothecation of gambling revenues to health related programs and projects; and areas for further research.

3. Jul 1999. Hospital Casemix Data and the Health of Aboriginal and Torres Strait Islander Peoples
The purpose of this paper is to provide a new perspective on the use of hospital services by Aboriginal and Torres Strait Islander peoples. It is also intended to encourage greater use of casemix-based information for both research and policy purposes.

4. Jul 1999. Private Health Insurance
The private health insurance industry is under pressure. Since the introduction of Medicare in 1985, the number of Australians with private health insurance has fallen. This drop in membership numbers has in turn created pressure on the public hospital system. The Federal Government is determined to arrest this decline in private health insurance membership and ease the burden on public hospitals. The main goal is to strike a better balance between the private and public sectors, ensuring Australians have a level of choice as well as universal access to excellent health care.

5. Jul 1999. Health Policy and Inequality
This paper will provide an examination of the nature of poverty and its relationship with health, including an exploration of the broad range of socio-economic factors associated with poor health and the identification of groups within the community facing particular disadvantage and vulnerability. The paper will then examine the current range of health strategies designed to counter the influence of these factors and highlight areas for further research or policy development.

6. The University of Adelaide: Accessibility/Remoteness Index of Australia (ARIA). This publication has been superseded by Occasional Paper (New Series) No.14.

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7. Aug 1999. The Ageing Australian Population and Future Health Costs: 1996-2051
This paper evolved from a collaborative data-linking project between the Commonwealth Department of Health and Aged Care and the Health Department of Western Australia. The three health systems that are the subjects of the paper are treated separately and the analysis does not depend on linked data. Furthermore, Western Australian hospital morbidity costs are not used in the paper but were imputed by the Department of Health and Aged Care using internal cost data. Therefore, the costs in this paper do not necessarily reflect actual hospital morbidity costs in Western Australia.

8. 1999. Some Characteristics of Hospital Admissions and Discharges: Older Australians
Based on Western Australian hospital data covering admissions and discharges during 1994-95 and 1995-96, this study focuses on the experiences of older Australians who were admitted to hospital: how they came to be admitted and why; and where they went afterwards (including the proportion who went into a nursing home). This is only a partial picture of older Australians use of health services because it is restricted to hospital admissions and discharges.

9. 2000. Insights into the Utilisation of Health Services in Australia based on Linking Administrative Data
Government health agencies have been rich in data, but poor in organised, useful information. This project, initiated in 1996, is a first step towards transforming isolated health data sets (such as the Medicare Benefits Schedule (MBS) data, Pharmaceutical Benefits Schedule (PBS) data and hospital morbidity data (HMD)) into information that may be used to inform policy. A joint project between the Commonwealth Department of Health and Family Services and the Health Department of Western Australia was established in February 1997. This project involved the exchange of Western Australian HMD and Commonwealth MBS and PBS data for Western Australia. As part of the 1997 Commonwealth Department of Health and Aged Care budget arrangements, funds were allocated to establish a research and analysis section within the then Portfolio Strategies Group to conduct this research into ‘cross program data.’
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10. Feb 2000. Ageing Gracefully: An Overview of the Economic Implications of Australia's Ageing Population Profile
The profile of the Australian population is ageing. Can Australia provide adequate living standards for the growing number of persons in the aged and other dependent groups without seriously undermining the living standards of the general community?

11. Jun 2000. The use of hospitals by older people: a casemix analysis
This paper uses national hospital morbidity data and the Australian Refined Diagnosis Related Groups (AR-DRG) classification to identify the casemix of different age groups. Major Diagnostic Categories (MDCs), Diagnosis Related Groups (DRGs), adjacent DRGs, DRG types and clinical profiles are all taken into account. Public and private hospitals are covered, but only acute episodes are considered in scope.

12. Aug 2001. The Australian Medical Workforce
This paper considers our medical workforce in light of the three objectives listed above. It describes its context, characteristics and significant trends. It reviews its geographic and structural distribution problems, analyses government workforce policy and planning, and outlines recent initiatives by the Commonwealth to influence workforce outcomes. For comparative purposes, the paper describes the workforce characteristics and policies of four broadly similar countries, and the final chapter highlights key issues and questions for future workforce planning.

13. Sep 2001. Health services in the city and the bush: Measures of access and use derived from linked administrative data
This paper evolved from a collaborative data-linking project between the Commonwealth Department of Health and Aged Care and the Health Department of Western Australia. The aim of the project was to create a linked resource from three administrative data sets which record services provided to state hospital inpatients as well as under the Medical and Pharmaceutical Benefits Schemes (MBS and PBS). A series of analyses was then undertaken based on the linked data set examining a number of health conditions for various geographically defined population groups.

14. Oct 2001. Measuring Remoteness: Accessibility/Remoteness Index of Australia (ARIA) - Document in 7 parts
The paper describes a geographic approach to measuring the concept of remoteness and the creation of a standard classification and index of remoteness that covers the whole of the country. The ARIA index is a valuable tool that can be used in policy development, implementation and evaluation to assist in targeting of programs to the various regions of Australia.

15. Jul 2003. Trends in Hospital Activity - Document in 7 parts
This paper explores the patient casemix of a number of known trends. That is, it uses the Australian Refined Diagnosis Related Groups (AR-DRG) v4 classifi cation to investigate trends in the utilisation of admitted patient services; the average length of stay (ALOS); the public/private balance (both in terms of patients and hospitals); and, finally, the use of hospitals by older people.
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Health Financing Series Occasional Papers

1. 1999. Health Financing in Australia: The Objectives and Players
This paper begins with an examination of the role of government in health systems and the rationale for that involvement. It then examines the objectives of the health system, looking in more detail at the four aspects of good health, low cost, equity and satisfaction, the relationships between them and the trade-offs that arise. The paper then discusses the different perspectives and competing preferences of various stakeholders. The paper closes by noting that while there may be broad acknowledgment of the value of the four objective mentioned above, conflicting preferences make it impossible to satisfy all stakeholders in the process of reform.

2. 1999. International Approaches to Funding Health Care
This paper provides an overview of health systems in 10 countries, demonstrating the range of present funding arrangements. It compares expenditures and some selected outcome measures and describes the major reforms that have been attempted.

3. 1999. Health Expenditure: Its Management and Sources
This third volume of the series examines health expenditure in Australia, the drivers of growth and the tools available to manage health expenditure. A description of the changes in the sources of funding over recent decades is also provided. Other papers in the series consider a range of health financing and related issues.

4. 1999. Public and Private - In Partnership for Australia's Health
This paper, “Public and Private – In Partnership for Australia’s Health” explores the impact of public and private sector participation in the funding and delivery of health services and market based approaches, including competition, on the overall objectives of the health care system: good health, low cost, equity and satisfaction.

5. Mar 2000. Technology Health and Health Care
This is the fifth volume in the series and examines the role of technology in health care in Australia. This paper does not attempt to provide a comprehensive coverage of all issues relevant to health technology. Instead, it attempts to examine some of the more significant issues in order to introduce the reader to the complexities of the area. It presents, where available, illustrative empirical information, examples and commentary from key researchers, and provides leads into the literature for further reading.

6. Mar 2000. The Quality of Australian Health Care: Current Issues and Future Directions
This is the sixth volume in the series and considers issues associated with the quality of Australian health care services. The paper canvasses some of the issues faced by government in intervening to best support high quality health care. A number of current Commonwealth government interventions are described across a range of regulatory, financing and research and development approaches. The range of national machinery to promote the quality of health care is also described.

7. 2001. Health Financing and Population Health
The paper seeks to establish firstly, that any comprehensive perspective on health care financing has to include consideration of the role of population health services and programs, and secondly that consideration of population health financing has to be in the context of financing for the health system as a whole.

For further information regarding the Occasional Papers Series, or if you are having trouble accessing any of these documents, please contact enquiries@health.gov.au.

Please note that the information and data in these papers, while accurate at the time of publication, may now be out of date. Care should therefore be taken in using them.