Affordability and equity must be balanced against competition, contestability and choice in human services

Monday, December 5, 2016

‘Affordability and equity should not be forgotten in the rush to the “three Cs” of competition, contestability and choice in human services’, Australian Healthcare and Hospitals Association Chief Executive Alison Verhoeven said today.

Ms Verhoeven was responding to today’s release by the Productivity Commission of its study report, Introducing competition and informed consumer choice into human services: identifying sectors for reform.

‘The Commission has named public hospital services, public dental services and end-of-life care as three of its six areas best suited to reform.

‘While the three Cs have their place in these services, and may deliver improvements in the ‘E’s of efficiency, effectiveness, and even equality, it should not be at the expense of the fourth ‘E’ of Equity.’

‘If a group of people were trying to see over the crowd to watch a footy match, it’s not necessarily the right thing to make sure everyone has the same size box to stand on, which is equality. Some people need only a small box, while others will need a much bigger box in order to see the match—that’s equity.

‘The same principle should be applied to affordability and access to human services. In particular we should remember to ‘keep it real in rural settings’—the principles of competition, contestability, and choice do not work out in the bush in the same way as in urban centres. Indeed, sometimes there is effectively no choice at all.

‘At the AHHA we support many of the principles put forward by the Productivity Commission, such as placing people at the heart of informed choices about health care that best meets their particular needs. But we have to remember that not everyone has the same access to knowledge or understanding of the choices available and nor do they have the same incomes and needs.

‘And when the Commission cites examples of what has worked overseas in the delivery of human services, they should remember the unique population distribution we have in Australia, and the tyranny of distance.

‘Also, unsurprisingly, businesses providing services will tend to focus on services that deliver the most profit in the quickest time. You can’t blame private enterprise for that. But in human services such as health care, short-term profit does not always lead to the best long term outcome.

‘For example, in dental services, expensive restorative treatment might be more profitable than low cost preventive services that will help prevent bigger problems down the track.

‘If we want equity in human services, all of these potential variations have to be factored in when making changes to encourage the three Cs of competition, contestability and choice’, Ms Verhoeven said.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, community and primary healthcare services, and advocates for universal, high quality and affordable healthcare to benefit the whole community.

For more information on AHHA, visit

Media enquiries: Alison Verhoeven, Chief Executive, Australian Healthcare and Hospitals Association, 0403 282 501