Health system strains make it time to act

Australia’s health system is under strain and in urgent need of transformation to strengthen consumer-centred and community-based primary health services a new report has found.

This is the view of a roundtable of national health and consumer leaders who have urged political leaders to recognise and act now on the many calls for primary health care reform that have been made in recent years.

The growing burden of chronic disease, an ageing population, unsustainable funding and perverse incentives are among key factors making change imperative, the report finds.

It has proposed the staged implementation over five years of a series of changes aimed at removing funding barriers to quality health care, moving away from largely fee-for-service medical care and enabling regionally, integrated health services through combined funding contributed by all levels of government.

The report, Snakes and Ladders: The Journey to Primary Care Integration, results from an expert roundtable of consumers, clinicians, academics, government and private providers. The roundtable was convened by the Consumers Health Forum, The George Institute for Global Health and the University of Queensland MRI Centre for Health System Reform and Integration.

Australia has begun significant reforms in establishing Primary Health Networks and trials of Health Care Homes but these remain overshadowed by public and media attention to hospitals and institutional care. We need accelerated action on primary care reform the report says.

“While Australians generally enjoy some of the best health outcomes in the world, it is widely recognised the current health system is under increasing strain.  Yet there is much we can do to future proof it. We need to start by making better use of the skills of our health professionals by developing systems that reward coordinated, consumer-focused care rather than the current episodic fee-based system,” 

says Leanne Wells, CEO of the Consumers Health Forum of Australia

Professor Claire Jackson, from the University of Queensland’s MRI Centre for Health System Reform and Integration, says:

“We have had a number of national reports in recent years urging reforms that would more effectively focus care on patients, particularly those with complex and chronic conditions.  But, a combination of factors have frustrated change. These include Commonwealth-state funding rules that perpetuate siloed care, historic payment systems that reward episodes rather than continuity of care, and structural barriers to clinicians working in more coordinated teams across sectors.” 

Professor David Peiris from The George Institute for Global Health, says:

“Our report builds on established evidence from Australia and other countries with comparable health systems. This evidence clearly shows that strong primary health care systems are fundamental to increasing efficiency, reducing hospitalisations, lowering health inequalities and ultimately improving health outcomes. Australia has an opportunity to be a global leader in primary health care system reform and this report provides clear recommendations for how we can take action to achieve this.”

The report identifies 10 priorities for action including boosted funding for a revised model of the existing Health Care Homes program, which is aimed at providing better-co-ordinated care for people with chronic and complex conditions. It also recommends strengthened Medicare funding and combined federal and state/territory funding for the existing Primary Health Networks and Local Hospital Networks to prioritise prevention and integrated services with mandated consumer participation and decision-making.

Other recommendations include:

• A Consumer Enablement Portal to bring together and better promote access to a broad range of high-quality consumer literacy, self-management, decision-making tools and other information resources to empower consumers to participate in decisions about themselves, the services they receive and the systems they connect with.
• Recognition of the importance of professional collaboration and team-based care across all levels of health care, and funding models which promote joined-up models of health service delivery, including incentives for pharmacist advisers in general practice and specialist liaison staff to help patients reach the care they need.  
• A demonstration project to empower consumers with complex chronic diseases to plan and manage their health by providing them with flexible funding packages – personalised budgets – providing for a choice of services and providers.
• The establishment of a government-led National Centre for Health Care Innovation and Improvement to lead us into the future by testing and scaling up new ways of delivering care and paying for them as well as supporting the primary health care sector to excel in implementing new policy into services on the ground.

Read full report: Snakes and Ladders: The Journey to Primary Care Integration (PDF 2 MB)