What matters most in health care?

If Australians need evidence of our national health crisis, we should look no further than the Census. Eight million of us, nearly one-third of the entire population, now have a long-term health condition. The question we must ask ourselves as a nation is whether we’re willing to accept this high level of chronic illness, or whether we’d rather plan for a healthier and more resilient future?

Of the eight million Australians battling long-term health conditions, over two million have more than one chronic disease. These conditions include mental health, diabetes, heart conditions, arthritis and lung and kidney disease – conditions that are often first identified in, and managed by, primary care practitioners.

The Census data is hard evidence that the need to reform our primary care system is now urgent. The current crisis in Australia’s emergency system is also compelling evidence for reform. This week Victoria was reportedly plunged into a “code red” scenario where there were no available ambulances.

To say that people expect to have access to an ambulance and a hospital bed if they need emergency care or become seriously unwell is stating the obvious. But the crisis in emergency departments across the country is being exacerbated by significant strain across the health system, particularly in primary care.

Primary health care – services provided by GPs, nurses, pharmacists, allied health professionals and others in the community – is where most treatments and preventive health occurs. It is this setting where common ongoing conditions such as diabetes, heart disease and depression are managed. It’s here where the effects of loneliness, poor housing, unstable employment, inadequate access to good food and green spaces on health become acutely apparent. So, it is no surprise that what matters most to the community is accessible and affordable primary health care close to where they live and work.

People continually tell us they are frustrated when made to repeat their story and pay unnecessarily for duplicate tests because providers fail to communicate and share information.  More than anything else, people want their health care to be accessible and affordable. Unfortunately, it is all too clear that our health system is no longer the universal one it once was. The sobering fact is that our health system has become less accessible and more focused on treating the sick rather than building healthy and resilient communities.

Sadly, investments in hospitals are significantly outpacing investment in primary health care such that the proportion we spend on hospitals is ballooning compared to the spend on primary health care: the very investments which prevent us from getting sick. At the same time, out-of-pocket costs are on the rise, making our health system less equitable and a far cry from universal.

Consumers are alarmed by this: they know their health system is close to breaking point because they experience it every day. The Consumers Health Forum of Australia’s latest health consumer sentiment survey of over 5,000 people found that while the quality of health care services is high, there are growing gaps in affordability and accessibility, and Australians commonly experience care that is fragmented and disconnected.

It does not happen often, but there is currently unprecedented consensus among national leaders and health stakeholders that primary health care reform is urgently needed – that we must look beyond hospital funding arrangements to reshape the whole system.

The Consumers Health Forum of Australia and the nation’s 31 Primary Health Networks (PHNs) hosted a Summit in May 2022 to continue the momentum for change. Clinicians, consumers, researchers, practice managers, PHN executive leads, and representatives from major peak and professional health bodies came together to agree on a range of priority actions to be taken under the government’s Primary Health Care 10 Year Plan.

The summit highlighted three necessary measures for delivery within the next 12 months: introduction of voluntary patient registration to promote a long-term relationship with a practice and a preferred GP; expansion of the guidelines and funding for the Workforce Incentive Program; and the introduction of local ‘healthcare neighbourhoods’. Taken together these foundations will boost integrated, coordinated, multidisciplinary care.

We have the potential for a new era of reform and cooperation between the Commonwealth, state Premiers and Chief Ministers to shift the dial on health services and health outcomes.

Australia has a long history of health system transformation and innovation. We have seen astounding innovation in medicines and medical devices, most recently with the advent of the COVID-19 vaccine and anti-viral medications.  There is far less innovation in health service delivery, but now is the time to start ambitious primary health care innovation and reform.

Watch the video of the Primary Health Care Reform Leader’s Summit that summarises the success of the event and the key discussion points around primary care reform.

A report, Strengthening Medicare and Investing in Primary Health Care: a Roadmap for Reform, has now been published based on the input and advice of participants and presented to the government.

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About the author

Ray Messom

Ray Messom is Chief Executive Officer of WentWest, the Western Sydney Primary Health Network. 

Leanne Wells

Leanne Wells

Chief Executive of the Consumers Health Forum of Australia