System reform in the human services: What role can health promotion play?

In late 2016 the Productivity Commission released a report about introducing competition and informed user choice into the human services.1 The main thrust of this report suggests that increased ‘competition’ and ‘contestability’ (i.e. more organisations – particularly in the private sector – attempting to deliver human services, including some health services) achieves greater economic efficiencies. In these circumstances low-cost service provision is favoured, in contrast to higher cost and potentially higher quality service provision. Within a health context, introducing an increased level of competition may reduce the quality of service provision and affect who is able to readily access services. History suggests that movement towards ‘competition’ favours neo-liberal ideals of economic rationalism, in contrast to positioning health and well being as a priority.2 Unfortunately, there has been a persistent erosion of funding and resources within the human services sector under the leadership of the current Australian Government over the past few years. This means there is no room for ‘competition’ without seriously jeopardising population health outcomes in Australia. In short, a shift towards ‘competition’ is about as anti-health promotion as it gets.