Tasmania's Richardson Review: Engaging Communities in Health Care Reform

Health care reform is a key concern of governments throughout the world, as technical capacity and community expectations combine to increase the demand on public resources (Ham and Coulte1, 2001). While a number of important cross-national studies on health care reform have been carried out, such as that undertaken by the Organisation for Economic Cooperation and Development (OECD, 2004), they have generally focused on national ('macro') policy outputs and outcomes rather than the process of change management required to achieve health care reform at the community level. It can be argued, however, that the success of the national or international health care reform agenda depends on successfully managing both the 'meso' (professional, organisational) and 'micro' (individual) levels of community engagement (Shannon, Franz, Ryan and Hyland, 2001).

In studies where various methods of engaging communities in health care policy and reform have been considered, there appears to be no single outstanding approach that best captures public opinion in this area (Mullen, 1999). Generally, Australia has pursued an institutional approach to consumer participation in most states and at a national level (Palmer and Short, 2000). This brings the consumer into the policy area by formalising their position in an on-going fashion. In contrast, the New Zealand approach, through the National Health Committee, goes out to the consumer as required. This form of community engagement consults the public through focus groups, public forums, and written submissions responding to discussion documents developed by expert working groups (Edgal, 2000).

It is this latter approach to health policy that is the focus here. This article looks at the consultation process at the heart of the Tasmanian Richardson Review and argues that there are, in fact, two types of 'community' engaged in health reform initiatives: the health 'policy community' (Pross, 1986) and the local 'regional community'. These communities respond in ways that can be explained using a typology originally applied to conflict between 'land use policy' stakeholders (planning authorities, developers, conservationists) in the United States (Sabatier, Hunter and McLaughlin, 1987). Strategies to reduce conflict, and increase the level of community support, can be identified (Shannon, 2002), and lessons can be drawn to provide direction for future health care reform consultations aimed at increasing the sustainability of service provision in rural and regional areas