Medicines and medical research headline Ley legacy

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Sussan Ley departs the health portfolio with unfinished business but also responsible for one of the Coalition's only successful major policy reforms since its election in 2013. She also played a major role in creation of the $20 billion Medical Research Future Fund.

Ms Ley's decision to resign late last week following criticism of her use of taxpayer-funded travel entitlements follows just over two years in the portfolio.

She was appointed in December 2014, succeeding former minister Peter Dutton, inheriting a portfolio still battling disastrous political fallout from the National Commission of Audit and the contentious 2014-15 Budget.

Her tenure was 'anchored' by this political reality.

Some of the causes of this reality remain unresolved, including the proposed increase in PBS co-payments and safety-net thresholds, with Ms Ley having to work within the dual constraints of government's deteriorating fiscal circumstances and intractable political and stakeholder opposition.

Ms Ley's political 'inheritance' was a sisyphean task compounded by more recent policy decisions during her own tenure, not least the decision to extend the freeze on indexation of Medicare rebates.

This challenge was fully manifested in last year's election where Labor's health-focussed 'Mediscare' campaign contributed to the Coalition's near defeat after just one term in office.

Ms Ley's challenge was not unlike that of most recent health ministers, Coalition and Labor, with central agencies led by the Department of Finance exerting significant policy influence over the portfolio.

The extent of this challenge was essentially recognised by Prime Minister Malcolm Turnbull after last year's election when he appointed Ms Ley to Cabinet's all-important Expenditure Review Committee.

The shame for the now former minister is that, while clawing back political ground in the portfolio during the second half of 2016, not least on the basis of access to new medicines and medical research, she will miss any opportunity to directly realise a future political dividend.

Yet there is no doubt Ms Ley will leave a significant legacy.

On medical research, she played a major role in securing parliamentary support for creation of the MRFF. She also announced a $7 million commitment to reforming the operating environment for clinical trials.

She was responsible for the 2015 PBS Access and Sustainability Package, which incorporated the Sixth Community Pharmacy Agreement, the first strategic agreement between government and the off-patent sector, as well as over $6 billion in budgeted savings.

Can any other minister in the current government point to a reform process with anything like the policy complexity, level of savings, stakeholder and political support?

Some of the commentary following her resignation has simply failed to mention the PBS reforms, presumably because they were not really politically contentious. Yet surely that reflects her success and that of the officials advising and supporting her?

Ms Ley will also be remembered as the health minister responsible for securing the multi-billion dollar reimbursement of the direct-acting antivirals for hepatitis C - in simple terms, a once-in-a generation policy outcome that could see the eventual eradication of a virus impacting over 250,000 Australians.

She also oversaw government's response to the review of medicines and medical device regulation, announcing a range of reforms including introduction of a 'fast-track' process for breakthrough medicines.

Some issues remains unresolved, with many thought to be impacted by interventionist central agencies - an ongoing reality the new minister will need to confront.

Unfortunately for the now departed minister, she will not have the opportunity to replicate successes in medicines by 'landing' any reforms associated with the other policy reviews initiated during her tenure.

As described in a speech in the US by Department of Health Secretary Martin Bowles PSM late last year, government is currently engaged in a raft of reform-focussed reviews covering a significant share of government health spending.

In his speech, Mr Bowles pointed to primary health, including health care homes, the review of the Medicare Benefits Schedule, digital health, private health and prostheses, aged-care and medical research.

Only time will tell whether Ms Ley's legacy extends to any actual reforms associated with these processes.