For years, the chorus of voices calling for fundamental reform of Australia’s health system has been growing bigger and louder.

The expectations of the new Health Minister and Government are huge. Will they have the guts and the savvy to bring about real changes to a system famously described by the Productivity Commission as inefficient, inflexible, wasteful, fragmented, and full of perverse funding and payments incentives?

Many change advocates breathed a sigh of relief after learning that one of the country’s most experienced health administrators, Mick Reid, started work last week as chief of staff to Nicola Roxon. He is straight into the fray at a COAG working group meeting today between treasurers and health ministers in Brisbane.

Reid, 59, knows the system’s problems better than most, not just from his years running the NSW Health Department but from the consultancy work that he has done right across the country and abroad. He knows that our system is focused on providing high-tech specialist medical care rather than primary and preventive health care. He also knows that it is least focused on looking after those who need it most, whether Indigenous Australians, those with mental illness or other disadvantaged groups.

At a University of Sydney seminar last year, titled “Private health for the rich and Medicare for the poor?”, Reid made it clear he thought the time had passed for incremental change. He argued the need for genuine reform, and declared himself “somewhat supportive of the big bang model”.

It’s not surprising that many public health advocates are delighted by Reid’s new gig.

Mike Daube, Professor of Health Policy at Curtin University of Technology in Perth, calls it “an outstanding appointment”, and says Reid is “exceptionally smart…knows health backwards… understands government, (is) tough when needed, and knows how to make things happen.”

Stephen Leeder, Professor of Public Health at the University of Sydney, says it’s an “inspired” choice, and adds that Reid has also shown himself as an exceptional teacher during his stints teaching health policy “because of his non-pompous sharing of knowledge”.

Not everyone is likely to be happy about the idea of an effective, well-connected change agent in such an influential role. Some powerful interests have much to lose – the Productivity Commission report, for example, made it abundantly clear that the system’s biases towards rewarding procedural medicine are unhealthy.

And no-one who knows Mick Reid expects him to be a fan of the current private health insurance incentives, which have been widely decried as both inefficient and inequitable. That industry must be watching with some trepidation.

So too must aspirants to the job of running the Federal Department of Health and Ageing (assuming rumours about “secretary overboard”* Jane Halton’s job-hunting have some basis, something she rejected today: “I have no interest in job hunting”). Departmental chiefs will face an unusually savvy operator in the Minister’s office who is familiar with all the ways and whiles of the bureaucracy. Some will see this as a threat, others as an opportunity.

Colleagues call Reid a tough negotiator, a thinker and a doer, a straight shooter, and a political animal. His own CV (at least the version I saw back in 2003 when interviewing him for my book, Inside Madness, about the murdered psychiatrist, Dr Margaret Tobin, who was a member of his informal “kitchen cabinet” in NSW) claims “a demonstrated sense of purpose with flexibility, persuasiveness, facilitation, diplomacy and sensitivity”.

He will need all these skills and more if meaningful change is to be achieved. The New York City marathon, which Reid ran just a few months ago, may seem a breeze compared to the job ahead.

*See pp 204-205 of David Marr and Marian Wilkinson’s Dark Victory for an account of Halton’s role in the “children overboard” scandal (Allen & Unwin, 2003)