There is a need for a public debate on how Australia’s health care financing and funding can play a constructive role in delivering more efficient and equitable care, and in ensuring equity in the financial contributions made towards that care. Any reforms need to be underpinned by the recognition that no single entity is currently accountable for the delivery of a patient’s health care needs and that the incentives facing the agents of health delivery do not reward them for providing better patient outcomes and improved system efficiency.

The current debate (principally the GST debate) is framed in terms of the States and Territories’ need to support growth in public hospital costs, in the context of falling Commonwealth contributions. However, higher GST revenue will not provide incentives for integrated care, rather reinforcing existing structures and the separation of funding for public hospitals separately from primary care. An argument about whether this is a State or Commonwealth responsibility is futile when what is needed is a new approach to integrating care. For this reason, decisions about how to best raise revenues and how to allocate these to different parts of the health care system should be considered separately from whether they lie within the jurisdiction of the Commonwealth or the States and Territories.