Making our health system better for all

This week’s new Report on Government Services indicates that Australia’s publicly-funded health services are performing passably well in meeting demand - but could do better.

It provides yet more evidence highlighting the need for changes in primary health care that the Consumers Health Forum have been calling for in recent years.

The report shows once more that while most people can get the health care they seek in reasonable time and at moderate cost, a significant minority face barriers that should not be acceptable in an equitable, universal health system that we wish for in Australia.

For instance, the report, compiled by the Productivity Commission, finds that overall 19.2 per cent of people who saw a GP waited longer than they felt was acceptable.  Waiting times for public dental care remain painfully high for those in need - in some states almost two years.

Four per cent of people said they delayed or did not visit a GP in the past 12 months because of cost, also a reason seven per cent cited for not getting medicine they were prescribed.

Cost is also likely to be a factor in why there were 2.9 million visits to public hospital emergency departments in 2017-18 which were potentially avoidable and could have been managed in the primary and community health sector.

Health budgets have continued to rise but failings like those above continue to exclude many Australians from the care they need.

These figures provide the evidence if any more were required to make the case for change.

CHF has worked with expert groups and consumer advocates to press for reforms that while requiring some additional investment would deliver healthier and happier outcomes for consumers and taxpayers at a not unreasonable cost, and potential savings in reduced care costs longer term.

Australia needs reforms to our primary health care system that include provision of accessible and affordable care for chronic illness, available afterhours care and more support for self-management of care.

Last year, CHF in partnership with The George Institute for Global Health and the University of Queensland-MRI Centre for Health System Reform and Integration, produced a report based on the results of roundtable discussions involving Australian leaders in primary care and quality medicine.

The report, Snakes & Ladders – the Journey to Primary Care Integration, calls for a consumer-centred approach, providing integrated services meeting the needs of individuals, families and communities through clear care pathways.

It proposes a shift away from the present fee-for-service system of payment to doctors towards the patient and family health care home model of integrated and team-based care, particularly for the chronically ill, a model now being trialled in Australia to focus payments more directly on outcomes of care.

One of the great hurdles to a better health system in Australia is the funding divide between federal and state and territory governments.  Our 2018 report suggests strengthening Medicare through the development of regional budgets combining funding from all levels of government.

The ten priorities set out by our report advance a variety of other reforms which include empowering Primary Health Networks and Local Hospital Networks or equivalent bodies, to improve regional performance and consumer-centred services.

The report recommends a Consumer Enablement Portal: an online resource to promote access to promote consumer knowledge and empower them to get the best out of the health system.

CHF has further developed that theme in proposals for change in its submission to the 2019 Federal Budget. This includes the development of Co-Creating Health Australia and other initiatives to support people with chronic conditions to actively manage their own health; to equip those at risk of chronic disease with practical steps to lower that risk; and to support doctors, nurse practitioners and other practitioners to engage with parents to support healthy early childhood development.

The evolution we seek is to invigorate not only consumer-centred care but also the role individual consumers can play in becoming better informed and confident to manage their disease and not feel quite so compelled to go to the hospital ED, particularly if their GP is not open.

By becoming more knowledgeable about their own disease and what services are available, consumers should become aware of such services as the Healthdirect nurse triage line and know about local services such as nurse-led walk-in centres.

Not least, Australia urgently needs a national strategy to counter the modern-day challenge of obesity that will curb consumption of unhealthy food and drink and convince us of the importance of healthy diet and lifestyle.

The evolution we seek is outlined in our White Paper: Shifting Gears where we outline eight fundamental shifts needed for better patient and person-centred care.    

Empowering us all to know more about our health and how to keep it will make for a better Australia.

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About the author

Leanne Wells

Leanne Wells

Chief Executive of the Consumers Health Forum of Australia