The Australian Government has established a major health reform agenda to address the significant challenges facing the health system. The Australian Bureau of Statistics predicts that the proportion of the population aged 65 years and over could increase from 13.5 per cent in 2009 to 22.3 per cent in 2051. Apart from the implications for health service demand, this trend is producing an ageing workforce, which, when combined with existing health workforce shortages, will make it even more difficult to meet increasing demands. The shortages occur across a number of health professions, but most concerning is the supply of GPs given their central role in primary health care. As the Australian population ages, there is an increasing number of people living for many years with chronic medical conditions such as heart disease, diabetes and arthritis. Of concern is that many of these chronic diseases are largely preventable and can be attributed to modifiable risk factors such as smoking, excessive alcohol, obesity and lack of physical exercise. Without any policy change, expenditure on health and aged care in Australia is forecast to rise sharply from 9.3 per cent of GDP in 2002-2003 to 12.4 per cent within two decades.
Three major reports were commissioned by the Government through its health reform process and were released in the latter half of last year. An outline of the broad recommendations of each of the reports is presented in the boxed information below.
The National Health and Hospitals Reform Commission was chaired by Dr Christine Bennett and deliberated for 16 months through debate, consultation and research before releasing its final report. The report provided over 120 recommendations to transform the Australian health system, identified under three broad reform goals.
1. Addressing major equity and access issues that affect health outcomes for people
- Improve health outcomes of Aboriginal and Torres Strait Islander people through aggregating funding under a national authority, improving nutrition in Indigenous communities, and training appropriate workforces
- Improve access and equity of care for people with serious mental illness through expanding sub-acute services in the community and equipping all acute mental health services with a rapid response outreach team
- Support people living in rural and remote areas through: more equitable funding arrangements; increased funding for patient travel and accommodation; and strategies to improve health workforce supply and clinical training opportunities
- Improve access to dental health care by introducing a universal scheme for access to basic dental care and a national expansion of preschool and school dental programs
- Improve timely access to quality care in public hospitals, particularly emergency and planned surgical/medical care, through increased funding for beds and reduced waiting lists
2. Redesigning the health system so that it is positioned to respond to emerging health challenges
- Embed prevention and early intervention into every aspect of the health system by: establishing a National Health Promotion and Prevention Agency; ensuring children and parents get access to universal and targeted services to keep healthy; and encouraging good mental health in young people through national services providing mental health and sexual health information and screening, and early psychosis services
- Connect and integrate health and aged care services over the course of people's lives through: redesigning health services around people; enabling first contact of health care through strengthened, multidisciplinary primary care services; separating elective and emergency services in public hospitals; providing more outpatient hospital services in community settings; expanding sub-acute health care services; and enabling primary care to provide palliative care support Develop the ‘next generation' of Medicare by: creating a comprehensive primary care platform; offering a broader range of services funded through a range of different payment mechanisms; and reshaping the scope of services and practices for health professionals delivering services
3. Creating an agile and self-improving health system for long-term sustainability
- Strengthen consumer engagement and voice through building health literacy, fostering community participation and empowering consumers in health choices
- Create a modern, learning and supported workforce through: fostering clinical leadership and governance by establishing ‘clinical senates'; introducing a new framework for education and training of health professionals which fosters a multidisciplinary approach; developing dedicated funding for clinical placements; and establishing a National Clinical Education and Training Agency to promote innovation and advise on training requirements and standards
- Introduce smart use of data, information and communication, including a transforming e-health agenda and a person-controlled electronic health record for every Australian
- Develop well-designed funding and strategic purchasing, including the use of blending funding models in primary care involving a mix of fee-for-service payments, grants for multidisciplinary services and care coordination, outcome payments, and payments for episodes of care
- Aim for knowledge-led continuous improvement, innovation and research through actions targeted at the national and local level of individual health services
The Draft Strategy was prepared by the Department of Health and Ageing, assisted by an External Reference Group chaired by Dr Tony Hobbs, and informed by submissions to a Discussion Paper. The Draft Strategy sets out the building blocks for the future of the Australian primary health care system and identifies four priority areas.
1. Improving access and reducing inequity
- Improve access and reduce disparities in access to services for disadvantaged populations and in under-serviced areas
- Develop and implement integrated models of care
- Support and encourage greater flexibility in service provision including through opportunities afforded by technology
- Develop infrastructure to support and expand comprehensive primary and ambulatory health care
2. Better management of chronic conditions
- Introduce voluntary enrolment arrangements to encourage greater continuity of care
- Develop clinical governance protocols to guide effective multidisciplinary team care
- Support adoption of evidence-based practice
- Improve assessment tools and processes to target available services according to individual clinical need
- Make the most effective use of the available workforce and support tools based on community need
3. Increasing the focus on prevention
- Encourage evidence-based approaches including whole-of-population preventation and targeted initiatives
- Make optimum use of the workforce and improve education and training arrangements
- Improve adoption of electronic tools and information systems by primary health care practitioners
- Consider more flexible funding arrangements including possible voluntary patient enrolment schemes
4. Improving quality, safety, performance and accountability
- Improve mechanisms for measuring service delivery outcomes and consumer experiences
- Development appropriate accreditation systems
- Develop performance indicators
- Develop systems to collect data on reflective practice
- Introduce pay-for-performance arrangements linked to improvement in health outcomes
- Develop high quality primary health care research
The Taskforce, chaired by Professor Rob Moodie, developed the National Preventative Health Strategy following extensive evidence gathering and consultation. It provides a blueprint for primary prevention to tackle the burden of chronic disease currently caused by obesity, tobacco, and excessive consumption of alcohol. The first phase of the Strategy for 2010-2013 sets urgent priorities across each target area.
1. Obesity
- Drive environmental changes to increase levels of physical activity and reduce sedentary behaviour
- Drive change within the food supply to increase the availability and demand for healthier food products
- Embed physical activity and healthy eating in everyday life
- Encourage improved levels of physical activity and healthy eating through comprehensive social marketing
- Reduce exposure of children to marketing of nutrient-poor foods and beverages
- Strengthen and skill the primary care and public health workforce to support people in making healthy choices
- Address maternal and child health
- Support low-income communities to improve their levels of physical activity and healthy eating
- Reduce prevalence of obesity among Indigenous Australians
- Build the evidence base for interventions
2. Tobacco
- Make tobacco products significantly more expensive
- Increase social marketing campaigns
- End all advertising and promotion of tobacco products
- Eliminate exposure to second-hand smoke in public places
- Regulate manufacturing and further regulate packaging
- Ensure all smokers in contact with health services are encouraged and supported to quit
- Work in partnership with Indigenous groups to boost efforts to reduce smoking and exposure to tobacco
- Boost efforts to discourage smoking among people in other highly disadvantaged groups
- Assist parents and educators to discourage tobacco use and protect young people from second-hand smoke
- Ensure that the public, media, politicians and other opinion leaders remain aware of the need for sustained action
3. Alcohol
- Improve the safety of people who drink
- Increase public awareness and reshape attitudes to promote a safer drinking culture in Australia
- Regulate alcohol promotions
- Reform alcohol taxation and pricing arrangements
- Improve the health of Indigenous Australians by increasing access to alcohol services and supporting local initiatives
- Strengthen, skill and support primary healthcare to help people in making healthy choices about alcohol
- Build healthy children and families through community-level approaches to manage alcohol issues
- Strengthen the evidence base for interventions
The full reports can be accessed from the Australian Government's yourHealth website (www.yourhealth.gov.au).