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Primary Health Care Reform in AustraliaNational Health and Hospital Reform Commission
Professor Justin Beilby University of Adelaide
Framework (1) National Health and Hospital Reform Commission background
(2) Final Outputs
(3) What actually evolved
(4) Positive Developments for Primary Care
Background (1) Political background
(2) Commissioners – Primary Care (2), State Health Politicians (2), Policy experts (4), Hospital (2),
(3) Australia wide process with a real energy
(4) Health care in crisis – quality and safety, hospital pressure, workforce morale, blame game, leadership confusion
Fragmentation between Commonwealth and state funded services
Complexity of funding, governance and reporting arrangements
Poor coordination of service planning and delivery
System inadequacies including workforce shortages and maldistribution
4
Challenges
The case for health reform was then and still remains compelling:
“While the Australian health system has many strengths, it is a system under growing pressure, particularly as the health needs of our population change. We face significant challenges, including large increases in demand for and expenditure on health care, unacceptable inequities in health outcomes and access to services, growing concerns about safety and quality, workforce shortages, and inefficiency.
Further, we have a fragmented health system with a complex division of funding responsibilities and performance accountabilities between different levels of government. It is ill-equipped to respond to these challenges.
We believe we can do better, and now is the time to start.”
A Healthier Future for All Australians. Final Report page 13.
5
Australia’s health system
S e rv ice Pro v ide rs( in s o m e ca s e spu rch a s e rs a rea ls o pro v ide rs )
C o m m o n w ealthG o v er n m en t
P r iv a te h ea lthin s u r an c e f u n d s
Ho u s eh o ld s
P r iv a te /N F Ph o s p ita ls
S ta te / te r r ito r yg o v er n m en ts
tax es ( an d m ed ic ar e lev y )Fu n de rs /Pu rch a s e rs
C o n s u m a ble sp h ar m ac eu tic a ls
m ed ic a l d ev ic es /a id s & ap p lian c esp r o s th es es
o th er s u p p lies - m ed ic a l/s u r g ic a l, f o o d , lin en , o f f ic ee lec tr ic ity , g as , w ater
f ees
c o m p u ls o r yp r em iu m s
P HI r eb ates
G en er a l r ev en u eas s is tan c e &h ealth s p ec if icp ay m en ts
P BS
f ees
P u b lic c o mmu n ityh e a lth s e rv ic e s
(in c lu d in g H A C C )
P u b lic h o s p ita ls( in c lu d in g
o u tp atien ts )
P u b lic d en ta ls e r v ic es
( in c lu d in gh o s p ita ls )
T h ir d p ar ty in s u r er s -m o to r v eh ic le ,
w o r k er s ' c o m p en s atio n
Var io u s p ay m en t m eth o d s
Bu s in es s es
tax es
p r em iu m sC o n s u m er s( p atien ts )
M BS r eb ates
I n c en tiv ep ay m en ts
c o m p u ls o r y p r em iu m s
Pro du ct io nin pu ts /fa cto rs
P h ar m ac y G P p r ac tic esM ed ic a l &
s u r g ic a lp r ac tic es
D ep ar tm en t o fVeter an s ' Af f a ir s
C a pita lin f r as tr u c tu r e an d b u ild in g s
p lan t an d eq u ip m en t
P r iv a te /N F Pc o m m u n ity
h ea lth s e r v ic es
L a bo u rallied h ealth p r o f es s io n a ls
d en tis tsg en er a l p r ac tit io n er s
m an ag er s an d ad m in is tr a to r sn u r s e p r ac tit io n er s /n u r s es /m id w iv es
s p ec ia lis tss u p p o r t s ta f f
P r iv a te d en ta l
ap p r o p r ia t io n
f ees f ees
f ees f ees
f eesf ees
f ees
f eesf ees
C o - p ayf ees
Var io u s p ay m en t & p u r c h as in g ar r an g em en ts Var io u s p ay m en t & p u r c h as in g ar r an g em en ts
Var io u sp ay m en tm eth o d s
A g e d c a re(in c lu d in g
H A CC )
f eesf ees
Var io u sp ay m en tm eth o d s
Allied h ea lthp r ac tic es
f ees
Medicare Local position.
8
Final Report of the National Health and Hospitals Reform Commission T
hem
esK
ey R
efo
rm D
irec
tio
ns
Individual and collective action to build good health and wellbeing – by people,
families, communities, health professionals, employers and
governments
Comprehensive care for people over their lifetime
Recognise and tackle the causes and impacts of health
inequities
Better use of people, resources, and evolving
knowledge
Healthy Australia 2020 Goals National Health Promotion and
Prevention Agency – education, evidence and research to make prevention a top priority
Greater personal responsibility for improving health supported by policies that make healthy choices easier
Health literacy in National Curriculum for all schools
Better information about creating healthy local communities – ‘wellness footprints’
Workplace health promotion and wellness programs
Strengthen and integrate primary health care through:
• Commonwealth responsible for all primary health care
• New Comprehensive Primary Health Care Centres
• Voluntary enrolment for young families and complex and chronic patients with primary health care services (including general practice)
Personal electronic health recordInvest in a healthy start to life from before
conception through the early years Reshape hospital roles for emergency and
planned care and fund accordinglyComplete the ‘missing link’ of sub-acute
servicesHospitals – National Access Guarantees and
TargetsExpand choices for care and accommodation
in aged careImproved palliative care and advanced care
planning
Make real the universal entitlement to health services with targeting on the basis of health need
National Indigenous Health Authority – expert purchasing to achieve better Indigenous health outcomes
‘Denticare Australia’ – restorative and preventive oral health care for all Australians
Remote and rural health – equitable and flexible funding, innovative workforce models, telehealth, patient travel support
Mental health – early intervention for young people, rapid response teams, sub-acute care, linked health and social services
National reporting on progress in tackling health inequities
Options for better governance of the health system
National leadership for national functions such as health technology assessment
Activity based funding with payments for performance and quality
Better use of workforce capabilities - framework for competency based practice
Improved clinical training infrastructurePermanent national body to promote,
monitor and report on quality and safety
Public reporting on access, efficiency and quality for public and private hospitals
Build a culture of continuous improvement, research and innovation with clinical leadership
Taking responsibility Connecting care Facing inequities Driving quality performance
A HEALTHIER FUTURE FOR ALL AUSTRALIANSP
rin
cip
les
People and family centred | Equity | Shared responsibility | Promoting wellness and strengthening prevention | Comprehensiveness | Value for money Providing for future generations | Recognise broader social and environmental influences shape our health | Taking the long term view | Quality and safety
Transparency and accountability | Public voice and community engagement | A respectful, ethical system | Responsible spending A culture of reflective improvement and innovation
Primary Care (1) Fundamental building block for the Commission to deliver effective coordinated, team based community based care
(2) General practice is vital
(3) “health care home” – enrolment, bundled financial payments linked to good performance supplementing episodic payments for acute care
(4) GP Super Clinics, Diabetes Care project, Medical Locals , PECHR
What evolved (1) Commonwealth withdraw taking full responsibility in Heads of Agreement – National Reform of February 2011
(2) Concerns from States re local responsiveness and flexibility of services
(3) Activity based funding changes in Commonwealth contribution %
(4) Establishment of National Organisations
(5)Medicare Locals were established
Medicare Locals Network of influence
Primary care reform engine
CAHML Geography
CAHML Snapshot 2013
• Population 520,000 • 12 LGAs, 26 SLAs• 220 GP practices• 830 GPs + 45 GP Registrars • 205 PNs• 400 + Allied Health Professionals• 98 RACF (5735 beds)• 9 public hospitals • 13 private hospitals• 156 pharmacies
Refined Priorities 2013-14• Population Health Planning• Comprehensive Chronic Disease Management - COPD• After hours care• Mental Health • ATAPS, • PIR• NewAccess
• Young people and mental health• Headspace• EPYC
• Aboriginal health• Immunisation• eHealth• Consumer Engagement• Healthy weight• Aboriginal Communities• CALD Communities
• Care of the Elderly – community based• health assessments of the elderly• Falls prevention• Oral health
• Palliative Care• Preventative screening
High or very high distress (K-10)
Health Workforce Australia
Planning and more planning!
16
17
Medical Workforce Modelling
18
Nursing Workforce Modelling
Questions