John dwyer UNSW - Social Determinants of Health conference 2013


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John dwyer UNSW - Social Determinants of Health conference 2013

  1. 1. Real Health System Reform will focus on Prevention and Equity; major components of the social determinants that influence health. • Professor John Dwyer AO • Emeritus Professor of Medicine UNSW • Social determinants Conference 2013.
  2. 2. Workforce and Health Care Reform • • • • Genuine health care reform has stalled Ignored during the recent Election Politically “Done and Dusted”. The system remains sickness and hospital centric and provider focused. • Structural inefficiencies and increasing inequity produce poor health outcomes.
  3. 3. Workforce and Health Reform • Our National (Public) Health System needs to be driven by a clear vision of what contemporary Australia needs and can afford. • Need to agree on a detailed affordable model of care and then focus clinical education on the provision of the professionals who can implement the plan
  4. 4. From Vision to Goal • “Our health care system should be charecterised by its resourcing of strategies to prevent avoidable illness and provide in a timely manner to those who are ill, cost effective quality care available on the basis of need not personal financial wellbeing. • In 2012 personal contributions exceeded $29B
  5. 5. COAG’s love affair with hospitals • Hospitals continue to struggle to provide quality timely care with demand (3% more sicker and older patients each year) exceeding budget growth. • Quality hospital care is only possible with a reduced demand for hospital care i.e. having fewer patients who need hospital admission.
  6. 6. Needed focus on Community Care • Productivity Commission report: • 750,000 hospital admissions could be avoided with a community intervention in the three weeks prior to hospital presentation. • So what are the structural and ideological impediments to us responding to all we have discussed?
  7. 7. Impediments to Reform • The Three “Biggies” • Vested interests, a provider rather than patient focused system • The wretched jurisdictional division of government responsibilities. • “Blame Game”, 9 DOH, MCLs, fractured care etc. • No political leadership to take us on our reform journey.
  8. 8. At the end of the road • Australia’s health system in 2013
  9. 9. At the end of our reform journey we find that ----• The Commonwealth has become the single funder of our public health system. • Australian Health Care Authority • Regional Health Authorities • Funding includes “needs” analysis • Borders no longer a problem.
  10. 10. Destination Delights • RHAs contract with a series of providers to to supply patient focused seamless integrated hospital, community and primary care services. • Quality data are collected and published. • Most importantly a new model of Primary Care has been established
  11. 11. The organisation of Primary Care • Medicare Locals have become PHOs • Hub and spoke model established • PHOs offer direct services to patients but offer support services to affiliated smaller practices. • “Secondary” services 23 hour wards. • IT, CPD, Quality audit, Bulk buying etc.
  12. 12. Integrated Primary Care. • What are the characteristics of our Primary Care (Medicare supported) system? • An emphasis on prevention and early diagnosis. Patient enrolment. • “Secondary Care”, acute care • Management of C and C diseases by in-house team • Community outreach
  13. 13. Prevention Strategy • Not neglecting the social determinants of health but— • No longer do people only visit a medical practice when they are ill, they attend to work with appropriate health professionals I( Medicare funded teams) to help themselves and their families stay well. • Positive reports attracting doctors to PC
  14. 14. Education revolution • Inter-professional learning implemented • “Team learning to prepare for team practice”. Silo mentality disappeared. • Rural medical schools for genuine rural students. Less dependent on OTDs. • Medical education shortened, less hospital centric. • Internship replaced by accelerated VT
  15. 15. Better outcomes • IPC and Community care reducing hospital admissions. • Planned surgery efficient and reliable. • Abolition of PHI subsidy has had positive effects. • Mutually beneficial partnership between public and private hospitals.
  16. 16. Public Hospitals • Owned and run by States under contract with RHA. • “Role delineation” sees each hospital having a specified service profile • No longer islands in an ocean of health care • Universal electronic health record
  17. 17. How do we start the Journey? • Community (voter) support for changes • Convince Politicians to establish “proof of concept” trials of these suggested approaches. • As of today health reform is stymied and any journey is circular and unrewarding.
  18. 18. The Challenge • Health professionals and informed consumers must present a clear readily understandable and evidence based vision for better, equitable and more affordable health promotion and care in future Australia.
  19. 19. Final thought • Health, Happiness and Productivity are inextricably linked.