Best practice and enterprise bargaining

The Australian Council of Trade Unions (ACTU) and its affiliated health unions have strongly supported and actively participated in the Federal Government Best Practice in Health initiative over the past two years. We believe the initiative has been an important vehicle in fostering the development of the Best Practice approach in this vital sector of the economy. Healthcare expenditure in this country runs to some $34.3 billion (1992/93 figures) annually, financed by a mix of Commonwealth, State and private sources and constituting approximately 9% of GDP. Hospital expenditure alone absorbs just over a third of the total at $11.8 billion (1990/91). At the same time, we have developed one of the most accessible and equitable healthcare systems in the world and an increasing source of valuable export dollars. The Australian trade union movement, like others in the community, recognizes that real cost constraints exist on governments in healthcare as elsewhere. Those constraints can lead to a variety of responses, such as to withdraw money from the system, combined with total reorganization of financing through the introduction of casemix and hospital reorganization, to see whether the system survives. The alternative is one epitomized by a Best Practice type approach. It is these types of approaches and their relationships with enterprise bargaining on which I intend to focus. However, I hasten to add that the issue of context is all important. Whilst it may be possible to create a microcosm of Best Practice change in a particular healthcare setting, it is unlikely to be maintained. The interface with the socio-ecomonic and political context cannot be avoided and it is this context which will determine the continuing success of Best Practice initiatives--whether in health or elsewhere.