Productivity Commission Draft Report – Introducing Competition and Informed User Choice into Human Services: Reforms to Human Services

The productivity commission has released their draft report on competition and user choice in human services for comment by written submission by Friday 14 July and at public hearings


Sydney - Monday 24 July 2017

Canberra - Tuesday 25 July 2017

Melbourne - Thursday 25 July 2017

Perth - Monday 31 July 2017

The report makes a number of recommendations for improving the provision of  health care including caring for people at the end of their life as well as hospital and dental services.
Key point 
  • This inquiry is about finding ways to put the people who use human services, such as health care, social housing and family and community services, at the heart of service provision. This matters because everyone will use human services in their lifetime and change is needed to enable people to have a stronger voice in shaping the services they receive, and who provides them.


  • Competition and contestability are means to an end and should only be pursued when they improve the effectiveness of service provision.
    • This report sets out the Commission's proposed reforms for: end-of-life care services; social housing; government-commissioned family and community services; services in remote Indigenous communities; public hospitals; and public dental services.
    • The Commission's proposed reforms vary according to the purposes of the services in question, the settings where they are accessed and, importantly, the users themselves.


  • Each year, tens of thousands of people who are approaching the end of life are cared for and die in a place that does not reflect their choice or fully meet their end-of-life care needs. Most people who die do so in two of the least preferred places — hospitals and residential aged care.
    • More community-based palliative care services are needed to enable more people who wish to die at home to do so.
    • End-of-life care in residential aged care needs to be better resourced and delivered by skilled staff, so that its quality aligns with that available to other Australians.


  • The social housing system is broken. The current two-tiered system of financial assistance for people who live in social housing or the private rental market is inequitable, and limits tenants' choice over the home they live in. The system would be improved if a single model of financial assistance applied across social and private housing, based on an increase and extension to Commonwealth Rent Assistance.
    • Social housing should continue to provide a home for people who are not well placed to rent in the private market.


  • Family and community services are not meeting the needs of people experiencing hardship. The system is designed for the convenience of governments, not people. Practical changes to system planning, provider selection and contract management could shift the focus to improving outcomes for people who use these services.


  • Human services are not making the contribution they should be to improving the wellbeing of Indigenous people living in remote communities. Increasing contract lengths for service providers, developing better planning, evaluation and feedback systems, and improving processes for selecting and managing service providers would contribute to improving outcomes for Indigenous people living in remote communities.


  • Public hospital patients should be given greater control over the pathway leading to planned admissions. This requires removing barriers to patients choosing the outpatient clinic or specialist they initially attend when given a referral by their general practitioner. Improved public reporting on individual hospitals and specialists would support greater user choice and encourage performance improvements in hospitals.


  • Public dental patients have little choice in who provides their care, when and where, and most services are focused on urgent needs. Patients' choice and outcomes could be improved by a new payment and care model, with a focus on preventive treatments.


Grattan Institute Podcast  - Stephen Duckett discusses these recommendations and how they might impact health care in Australia ahead of Grattan’s written submission to the report.

  • Regarding choice of place to die.

    It might be unrealistic to expect too many more people to die at home. Many individuals do stay at home until a problem such as incontinence makes it difficult for families to manage. This is especially so in country areas where hospice & palliative care facilities are limited