This year sees an opportunity for long-needed oral health reforms. Cancer patients, in particular, stand to benefit.

The long-standing divide in Australia between medicine and dentistry has left many with inequitable access to dental care. People with oral cancer, in particular, may have few options for dental rehabilitation after cancer treatment, even with private health insurance. However, 2024 could finally see health care reforms that address these inequities, with significant momentum building in Australia.

Using accountability for mental health to drive reform.

Greatly enhanced accountability can drive mental health reform. As extant approaches are ineffective, we propose a new approach. Australia spends around $7.

Hospitals should be exemplars of healthy workplaces.

As major employers and flagship health care organisations, hospitals can influence the norms of the communities they serve by adopting model policies and practices that promote the health of patients, visitors, employees, students and trainees. Hospitals must become healthy workplaces in every sense and extend their role to focus on health and wellness, not just illness. Reorienting hospital policies can: ensure the provision and stewardship of healthy, ecologically sound and sustainable environments; increase the focus on promoting health and prevention; foster interpersonal safety; and improve workplace safety.

Can we learn anything from health care in the United States?

Some aspects of health care in the United States would be beneficial to Australia and New Zealand, but others should be avoided. Positive aspects, which should be emulated, include: •health care reform that is focused on the continuum of care and patient-centred care •trials of new models to organise, deliver and pay for health care services, where quality of care is rewarded over quantity of services •an integral view of, and strong support for, health services research as a means of evaluating reforms aimed at improving patient outcomes and systems-level efficiencies •physician engagement in reforms--for example, participating in the Choosing Wisely initiative, and trialling and implementing new payment models that are not fee-for-service. Negative aspects, which should be avoided, include: •increasingly fragmented provider and financing structures (funding provided by state and federal governments, private insurance and out-of-pocket costs) that cause frustration in terms of access and care coordination and increase administrative waste •an overemphasis on technological solutions, with insufficient acknowledgment of the importance of addressing value in health care •a focus on hospital and doctor-based health care rather than environmental and social inputs into health.

Australian Government health advisory groups and health policy: seeking a horse, finding a camel.

Since its election, the Rudd Labor Government has created 10 new advisory bodies in the health portfolio, in addition to the 100 or more that were already established. An expansive and devolved advisory system could improve the health policy-making process, but only if it is integrated into the processes of government. We outline eight simple and practical measures that, if implemented, would make Australia's health advisory system more transparent and effective.

Preventive health reform: what does it mean for public health?

A revitalised public health strategy offers the most sustainable way to address current health inequalities and prevent chronic non-communicable diseases. Success in these goals requires a whole-of-government approach and long-term investments. A sizeable proportion of this investment must be outside the health sector, in the social, economic and environmental fabric of our society.

Challenges in health and health care for Australia.

The next Australian Government will confront major challenges in the funding and delivery of health care. These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services. The search for effective and lasting solutions will require a consultative approach to deciding the nation's priority health problems and to designing the health system that will best address them; issues of bureaucratic and fiscal responsibility can then follow.