Clinical Governance and Health Reform

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A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, for the Australiasian college for Emergency Medicine 27th Annual Scientific Meeting - Canberra

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Clinical Governance and Health Reform

  1. 1. CLINICAL GOVERNANCE and HEALTH REFORMAUSTRALIASIAN COLLEGE FOR EMERGENCYMEDICINE 27th ANNUAL SCIENTIFIC MEETING CANBERRA – 23 November 2010 Professor Jim Bishop AO Chief Medical Officer Australian Government Department of Health and Ageing
  2. 2. OECD HEALTH DATA 2010 How Does AUSTRALIA Compare Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)8,000 75387,0006,000 50045,000 4627 4210 4079 4063 39704,000 3793 3737 3696 3677 3540 3470 3359 3353 3129 3060 3008 2902 28703,000 2729 2687 2683 21512,000 1801 1781 1737 1437 1213 999 8521,000 767 0 1 Refers to insured po pulatio n rather than resident po pulatio n. 2. Current expenditure. 3. 2006. 4. 2007. So urce: OECD, OECD Health Data, June 201 . 0 Public expenditure on health Private expenditure on health
  3. 3. AUSTRALIA’S RANKING AMONG OECD COUNTRIES 1987-2006 Source: AIHW Australia’s Health 2010
  4. 4. Projected Burden of Major Disease Groups, 2010Source: AIHW Australia’s Health 2010
  5. 5. BROAD CAUSE MORTALITY TRENDS IN AUSTRALIASource: AIHW
  6. 6. CANCERS WITH REDUCING DEATH RATES 1997 to 2006 – ALL AGES 0 -5-10-15cancers, -13.8 All Breast, -13.8 -7.9-20 Lung, -18.5 Bladder, -18.5 Colon, -19.6Rectum Prostate, -19.7 Bowel -19.0 , -19.9 , -19.7-25 -19.0 Leukaemia, -23.7Head and Neck, -23.7 , -18.9 Unknown, -24.8 , -15.2 , -24.3 Kidney , -21.1 , -24.1-30 Stomach, -29.4 -18.5 NHL, -25.1-35 -31.9-40 Cervix, -38.3 Testicular, -42.2-45 Male Female Source: Tracey et al, Cancer Institute NSW
  7. 7. AGED ADJUSTED DEATH RATES From CVD, 1907 - 2006 Source: AIHW Australia’s Health 2010
  8. 8. CHRONIC PULMONARY DISEASE MORTALITY 1980 to 2007Source: AIHW Australia’s Health 2010
  9. 9. PREVALENCE OF CURRENT ASTHMA 2007-08Source: AIHW Australia’s Health 2010
  10. 10. DEATH RATES FROM INFECTIOUS DISEASES, 1922-2007Source: AIHW Australia’s Health 2010
  11. 11. NSW POPULATION AGE DISTRIBUTIONS, MALE (1977 – 2036)Source: Cancer Institute NSW
  12. 12. TOTAL CANCER CASES & DEATHS per year (1972 to 2036)Source: Cancer Institute NSW
  13. 13. TRENDS IN LEADING CAUSES OF DISEASE BURDEN 2003-2023Source: AIHW Australia’s Health 2010
  14. 14. Commonwealth Government Health& Hospital expenditure under the NHHN Source: Commonwealth Budget Papers, DOHA and PMC Analysis
  15. 15. HEALTH REFORM Increasing expenditure to $15 billion 2010/11 Additional $7.3 billion over 4 years Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching) Medicare locals (100% Federal funds) GP Super-clinics – multi disciplinary teams (100% Federal Funds)
  16. 16. MEDICARE LOCALS OBJECTIVES Identification and response to local health needs Integrated and coordinated care for the patient Support clinicians to improve care Implement new primary care initiatives Accountable for efficiency and quality
  17. 17. BUDGET 2010-11e-Health – connecting patients, providers and informationsystemsThe Government will establish a personally controlled electronic healthrecord system ($466.7m)The system will:  Enable people – and their chosen health provider - to access online their key health information when and where it is needed, for their care across the health system.  Allow people to register online to establish a personally controlled electronic health record from 2012-13  Rigorous governance  Privacy maintained
  18. 18. HEALTH REFORM KEY NEW STRUCTURES National Performance Authority Independent Hospital Pricing Authority Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)
  19. 19. CLINICAL GUIDELINES SUPPORTS FOR CLINICAL DECISION MAKING Evidence Base Highest Impact Range of best practice tools Successful implementation methods Monitor and report
  20. 20. CLINICAL GUIDELINES Highest Impact Greatest Burden of disease Greatest harm from poor practice Greatest demonstrated need: - New Standard of Care - Proven variation in practice Greatest time spent/cost to health system
  21. 21. REVIEW OF CLINICAL GUIDELINES N – 313 N %CANCER 17 5%CARDIOVASCULAR 18 6%RENAL 22 7%MENTAL ILLNESS 22 7%NEUROLOGICAL 0 0%INJURIES 13 14%CHRONIC RESPIRATORY 0 0%DIABETES 11 4%OTHER 173 67%TOTAL 313 100%Buchan et al 2006
  22. 22. NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004 (A$ per CAPITAL)Source: Eckhouse et al (2007), ABS
  23. 23. NHMRC STRAGEGIC PLAN 2010 -12
  24. 24. NHMRC Support for National Health Priorities Areas
  25. 25. Percentage of Expenditure by Broad Research Area (2000 and 2010)
  26. 26. NHMRC SUPPORT FOR TRANSLATIONAL RESEARCHTranslational funding mechanisms  Partnership Projects for Better Health  Partnership Centres for Better Health  Centres of Clinical Research Excellence  Centres of Research Excellence in Population Health Research, & Health Services Research  National Health Research Enabling Capabilities Scheme  Industry Development awards
  27. 27. NHMRC PROJECT GRANTS Clinical Trials Expenditure $70 300Millions $60 250 $50 200 $40 150 $30 100 $20 50 $10 $0 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Total Expenditure Number of Grants
  28. 28. Harmonization of Multi-centred Ethical Review (HoMER) National Statement for Ethical Conduct of Human Research (2007) Process supported by AHMAC conducted by NHMRC Certification of ethical review processes – first round Roles, responsibilities, templates published NHMRC working with States and Territories
  29. 29. HEALTH WORKFORCE Established Health Workforce Australia $1.2 billion in training more GPs and specialists, nurses and allied health 1375 more GPs by 2013, 5500 by 2020 680 more specialists by 2020 4600 practice nurses by 2013, 7500 rural nurses by 2020
  30. 30. GP Training Places per Year 2004 - 2014 Source: 2010 NHHN
  31. 31. CONCLUSIONS Increasing burden of chronic diseases especially cancer, dementia and diabetes New reform structures offer opportunities to set new clinical guidelines and standards Opportunities for more coordinated care through medicare locals, local hospital networks and lead clinician groups Increased health workforce provides opportunities for greater depth in general practice and in specialist training Increased need for greater evidence base as a framework for improved guidelines and decision tools

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