Canberra: Australia's Prime Minister Kevin Rudd threatened yesterday to ask voters to directly back his sweeping health reform plans as opposition from powerful state leaders threatens to hobble his re-election strategy.

Rudd has played down early polls, but said he would go ahead with a risky referendum alongside the election if state leaders rejected his health shakeup at a meeting on Monday. Australians have passed only eight out of 44 past referendums.

"I want to cooperatively reach a reform plan with the states and territories on the future of the health and hospital system," Rudd told local radio, "but I've always said if we can't get there we'd have to seek a further mandate from the people."

Rudd remains on course for victory in elections due later this year, but his popularity has been shaken by his inability to deliver key first-term promises, including difficult health, climate change and education reforms.

In a bid to counter critics and win back straying voters, Rudd in March proposed the biggest health shake-up for 30 years, promising to cut waiting lists for state-run public hospital surgery and take control of other health services.

At least two state leaders oppose the plan, however, because it would see the federal government seize control of 60 per cent of national consumption tax revenue reserved for states and inject it directly into funding for state-run health and hospitals.

State finance ministers had warned Rudd's plan could become a precedent for the national government to raid their tax revenue for future reforms in other areas of state control, eroding their power even further, The Australian newspaper said yesterday.