Conclusion: Reflections on Past Healthcare Reform and Future Directions

The twelve chapters of this book highlight the massive changes that have occurred in the Australian healthcare sector since the early 1990s and their impact on the employment relationships of healthcare workers. In common with many other countries these changes have had a number of drivers, mostly linked to concerns over rising healthcare costs. Dramatic increases in information and changes in technology have led to increased demand and rising costs of both capital and medical services. At the same time consumers have higher expectations of access to the latest and the best techniques, and the ageing population has exerted pressure on service delivery and raised fears of unsustainable future costs. As Chapter 1 demonstrated, Australian state and federal governments have responded to these developments by placing an increased emphasis on attaining improvements in efficiency, productivity and effectiveness of healthcare delivery. They have done this largely through the introduction of neo-liberal policies with a focus on cost saving and a belief in the benefits of New Public Management. In the healthcare sector at the organizational level, decision making is strongly influenced by government policy. The government not only provides the majority of funding but also determines how it will be spent through its funding policies.