HEALTH-CARE REFORM UNDER PRESIDENT CLINTON - ISSUES, IDEAS AND IMPLICATIONS

President Clinton's proposals to reform health-care in the United States have stimulated unprecedented levels of discussion amongst stakeholders, commentators, policy analysts and the media. It seems obvious that there is a need to reform a system that consumes 14% of gross domestic product, yields only OECD-average morbidity and mortality rates and fails to provide coverage to millions of people. Nevertheless, forces against change are marshalling considerable resources in opposition to Clinton's proposals, and now that the November 1994 mid-term elections have routed the democrats in both the House of Representatives and the Senate, the belief is that his reforms will never be adopted in their original format. Some of the issues and ideas emanating from the American debate parallel trends in Australian health-care. Elements in transition include the switch from an input- to an outcomes-orientation, improving the quality of care, focusing on the customer and securing greater value-for-money. Unlike America, Australia has a limit on national health-care spending and this poses different challenges. However, the American debate is of vital interest to Australia. Australian and American hospitals are increasingly in competition to export services to South-East Asia. Of particular importance to Australia are: the extremely public nature of the American debate, which should be emulated, the fact that explicit rationing is now clearly on the international health-care agenda, the need to reconceptualise western culture's preoccupation with immortality, the need to alter economic incentives to health-care providers and the shift to outcomes measurement and effectiveness. Despite the comparatively healthy state of the Australian system, complacency should not be allowed to set in. Lessons for Australia from America are numerous, and it behoves us to monitor closely developments, trends and options arising from the Clinton-inspired debate.