Healthcare Systems, Regulation, and the Big Picture
Healthcare professionals and policymakers contribute enormously to our society, often with a level of dedication and competence that is nothing short of extraordinary- and rarely seen outside of healthcare. Our public health systems — and the regulators that support them — are staffed by trained public servants. It’s important to recognise that their work is challenging, within the context of a large modern bureaucracy in a modern liberal democracy.
That said, I believe we need to be able to have an open and constructive conversation about the systemic challenges that can make it difficult for these organisations to succeed in their core mission: improving the health of the population. These conversations do not undermine the reputation of medicine or the institutions of healthcare – quite the contrary.
The health outcomes of a population reflect the efficacy of the public health systems and regulatory structures. While incoming leaders, including the new CEO of AHPRA, acknowledge challenges in implementation and resourcing, I’m not sure we’ve fully recognised that systems errors — not just surface-level or budget-driven issues — may be at play. If these deeper structural issues remain unaddressed, it becomes harder to fix the symptomatic problems that we all see.
From my perspective, the difficulties faced by healthcare regulators are not unique. They reflect a broader malaise affecting many Western democratic institutions — large, managerial, and procedurally driven systems – centralized and under constant pressure from interest groups. Many practitioners, like me, believe the organised lobbying efforts from large corporate healthcare players causes distortions and real harm.
My aim in discussing these topics is not to criticise individuals or undermine the extraordinary work being done by individuals within the system. Rather, it’s to promote dialogue about how we can build systems that work better — for practitioners, for patients, and for society as a whole.