Sticky or stuck: the role of policy networks in creating path dependency in Australia’s health care financing system

Policy change does not exist in a vacuum. This research explores the role of a network of actors in locking down the financing mechanisms in the health system in Australia. The aim is to gain a better understanding of the influence of the network of policy actors (advocates, lobbyists) on the health care system.

Structural changes have been implemented in other countries, however, attempts to alter the financing rules that would incentivise greater integration in Australia have not been successful. This research analyses three major attempts to vertically integrate healthcare, reduce fragmentation and increase the efficiency of the system through altering what funders can pay and how they can pay for it.

Based on a unique application of the concepts of path dependency, resource dependency and network methods, this research found that actors formed coalitions that established two broad roles: those attempting to alter the payment and access rules, or those attempting to cement them. Across the three attempts, the structure of the network altered, however key players remained in control of their coalition. The coalition that prevented change consistently demonstrated an ability to control the system, demonstrating that regulation of the rules sat outside government.

Successive governments appear to have been constrained from reforming the financing rules and seem to have lost interest in major reforms in this space. This is unfortunate for consumers who have indicated that they want an integrated system but did not coalesce as one group to find a voice to make a clear 'ask' of any government on how this could be achieved.

To effect policy change the research suggests that a number of criteria should be present:

a. develop a set of policies that can clearly fund the cost of the change for medical providers, funders and consumers;

b. ensure consumers are supported to find a voice to develop a position during the debate;

c. and either have the AMA, or a very strong coalition supporting.

This is Jodette's final presentation of her doctoral candidature.

About the speaker

Jodette Katz has over 25 years' experience in both the public and non-government sectors. She was previously the CEO of Parkinson's Australia and is now currently advising the Government on funding strategies for the Aged Care system. She has extensive knowledge and practical skills in policy development and analysis, advocacy, strategic communications planning, political relations and social media. She is passionate about improving health outcomes in Australia and globally.

Jodette has a Master of Public Health (Research) from the Australian National University.

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Image credit: Illustration of stylized human figures in networks, by opensource.com from flickr, (CCBY-SA 2.0) licence.