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Keynote Presentation: “Strengthening primary care in Australia: challenges and opportunities for system reform.”

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The Keynote Speaker: Associate Professor Dr Suzanne Robinson, who is Director Of Health Policy and Management and Health Information Management at the School of Public Health within the Faculty of …

The Keynote Speaker: Associate Professor Dr Suzanne Robinson, who is Director Of Health Policy and Management and Health Information Management at the School of Public Health within the Faculty of Health Sciences at Curtin University. Dr Robinson presented on “Strengthening primary care in Australia: challenges and opportunities for system reform.”

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  • Spain increased to 27.20France increased to 10.60 percent in the fourth quarter of 2012 UK 7.26 US 7.60 percent New Zealand decreased to 6.90 percent china 4.10
  • Government funding of health expenditure as a proportion of total health expenditure was 68.1% for Australia in 2009 compared to the median for OECD countries of 75.0%.
  • While government health spending tended to be maintained at the start of the economic crisis, cuts in spending really began to take effect in 2010. This was particularly the case in the European countries hardest hit by the recession. In Ireland, cuts in government spending drove total health spending down by 7.6% in 2010, compared with an average yearly growth rate of 8.4% between 2000 and 2009. Similarly, health spending in Iceland fell by 7.5%, as a result of a 9.3% reduction in public spending. In Estonia, following an average growth rate of nearly 7% per year from 2000 to 2009, expenditure on health dropped by 7.3% in 2010, driven by reductions in both public and private spending. In Greece, estimates suggest that total health spending fell by 6.5% in 2010 after a yearly growth rate of more than 6% on average since 2000.
  • Obesity is a key risk factor for many chronic conditions, with severely obese people dying up to 10 years earlier than those of normal weight. Health at a Glance 2011 shows that obesity rates have doubled or even tripled in many countries since 1980. In more than half of OECD countries, 50% or more of the population is now overweight, if not obese. The obesity rate in the adult population is highest in the United States, rising from 15% in 1980 to 34% in 2008, and lowest in Japan and Korea, at 4%.
  • Great work was undertaken through the previous GP Divisions, eg increased immunisation rates, greater uptake of computerisation of practices, more work with chronic diseases, and indigenous health etc. However, the remit of the ML's is much broader, and includes stronger engagement across the whole primary health spectrum, with linkages to the acute and aged care sectors. ML Program funding often allows for gap filling in regions, eg extra funding for After Hours for gaps, and also is more flexible in its usage to allow for locally responsive needs and solutions. Extra funding for regional eHealthetc is also very positive.
  • Transcript

    • 1. Strengthening Primary Care in Australia: Challenges and Opportunities for System Reform Suzanne Robinson Associate Professor and Director of Health Policy and Management at Curtin University Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 2. Associate Professor Suzanne Robinson  Director of the Health Policy and Management and Health Information Management at the School of Public Health, Curtin University  WA Health Systems policy and Research Network  Research interests include health policy and systems research, economic evaluation Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 3. Outline of presentation  Australia health system performance – national and international  Health system reform – The role of Primary care The MCL vision The MCL reality The MCL possibility Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 4. The Facts: Australia at a glance 64% of people live in capital cities 15% of indigenous live in remote areas and 49% in very remote areas. WA 2.45 million 2012 annual increase of 3.4 per cent In 30 yrs the proportion of the population over 65 yr will almost double to around 25 per cent. Australia top 20 most expensive cites Sydney 7th Melbourne 8th Perth 13th Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Unemployment Rate in Australia increased to 5.60% 2013 Average life expectancy male 79 yrs female 84 yrs Australia was around 12t- 14h wealthiest among OECD countries Average LE Indigenous pop male 59.4, female 64.8
    • 5. A Typical Day in Australia Patient Complexities Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J Source: BEACH (Bettering the Evaluation and Care of Health) Survey
    • 6. Australia health system performance  Expenditure on health in Australia was estimated to be $130.3 billion in 2010-11, up from $77.5 billion in 2000-01  The two largest components of the increase in health expenditure were public hospital services, which grew by $2.2 billion in real terms, followed by medications ($2.1 billion).  In 2009–10, the estimated national average level of expenditure on health was $5,251 per person.  Western Australia ($5,128 per person) was 2.3% below the national average,  Northern Territory’s ($6,549 per person) was 24.7% higher than the national average. T  The average annual real growth per person was highest in South Australia and the Northern Territory (4.3%) compared with the national average of 3.9. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 7. Disease statistics  Cancer is Australia’s leading broad cause of disease burden (19% of the total), followed by cardiovascular disease (16%) and mental disorders (13%).  Around 1 in 5 Australians aged 16–85 years has a mental disorder at some time in a 12-month period, including 1 in 4 of those aged 16–24 years.  The burden of Type 2 diabetes is increasing and it is expected to become the leading cause of disease burden by 2023. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 8. Disease statistics  Tobacco smoking is the single most preventable cause of ill health and death in Australia.  Rates of sexually transmissible infections continue to increase, particularly among  The perinatal death rate of babies born to Indigenous mothers in 2007 was twice that of other babies.  It is estimated the number of people living with dementia is projected to triple to around 900,000 by 2050. Dementia is one of the major reasons why older people enter residential aged care or seek assistance from community care programs. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 9. Performance: How are we doing internationally?  Australia’s health system is amongst the best in the world  However, there is still room for improvement  Australia’s economy remains strong in comparison to others – especially Europe and USA  WA does well economically  Evidence suggests that it is often difficult to make changes during times of plenty! Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 10. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 11. Achieving reductions in spending  Ireland, achieved through cuts in wages or the fees paid to professionals and pharmaceutical companies, and through actual reductions in the number of health workers.  Estonia cut administrative costs in the ministry of health and also reduced the prices of publicly reimbursed health services.  Investment plans have also been put on hold in a number of countries, including Estonia, Ireland, Iceland and Czech Republic  Efficiency gains pursued through mergers of hospitals or ministries, or accelerating the move from in-patient hospitalisation towards outpatient care and day surgery. The use of generic drugs has also been expanded in a number of countries.  Increase in out of pocket payments. For example, Ireland increased the share of direct payments by households for prescribed medicines and appliances, while the Czech Republic increased users’ charges for hospital stays. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 12. Australian Health Outcomes: OCED data suggests:  In-hospital case fatality rates within 30 days of admission for acute myocardial infarction (heart disease) are significantly lower than the OCED average (3.2% vs 5.4% in 2009).  Australia had a higher rate of death in hospital following ischaemic stroke (5.6% vs OECD average of 5.2%)  Avoidable hospital admissions for (Chronic obstructive pulmonary disease) COPD and asthma complications are higher in Australia than the OECD average. For COPD Australia rate was 312 per 100,000 adults (OECD average 198) and asthma admissions, Australia was 67 (OECD average of 53). Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 13. Rising obesity pushing up healthcare spending % of obese among adults Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 14. Comparison of seven nations Davis, K. Schoen, C. and Stremikis, K. (2010) Mirror, Mirror on the wall, how the performance a ofCurtin University isCode 00301J of Curtin University of Technology compares internationally 2010 update, The Commonwealth the U.S. trademark care system health CRICOS Provider Fund
    • 15. Why the growth in demand for primary care?     Increasing availability of medical cures and technology (surgical techniques, anti-depressants, etc) Rising need for community-based care to support people with long-term health problems (chronic disease management) Desire to contain costs and avoid hospitalisation Changes in hospital care leading to shorter stays and associated need for more community support Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 16. Why strengthen primary care  PC orientation is proportional to health outcomes The more PC orientated, the higher the health indicators rankings  Countries that are more PC orientated have lower overall costs for their health services Their efficiency is higher  Unplanned primary care – out-of-hours care, emergencies, links with unplanned care in other sectors  The desire for better access – longer opening hours, more providers, patient choice, better pathways and diagnostics  Improving care for people with long term conditions – better pathways, managed care approaches, reducing hospital admissions Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 17. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 18. So what did are the overall policy and management challenges facing primary care?  Dealing with the increasing levels of chronic disease  Responding to changing societal and policy demands re access and choice  Developing more integrated forms of care that are community based and yet supported by specialist services  Addressing profound workforce pressures, especially in rural and remote areas  Assuring quality of care  Addressing issues around equity and access to services Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 19. Health Care Reform: why? In 2008, the Australian (Labor) Government set up the National Health and Hospital Reform Commission (NHHRC) to conduct the most comprehensive review of the health system in 20 years (MCL part of wider reform) The current health care system was identified as being: • • • • • • fragmented, contributing to cost-shifting between different levels of government involved too much waste resulted in long waiting times for patients. Services are provider rather than patient led Inequities in health outcomes System can’t continue with increasing pressures and demands Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 20. Health Care Reform: why?  Unlike hospitals primary care  There are also gaps and often lacks the investment to take inequities in access to services a system approach. and variations in health outcomes between different  patients often feel that population groups their journey through a complex health system could be better coordinated and many patients, particularly those who are socially disadvantaged. - For these patents the system we have come to rely on doesn't meet their needs. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J  A failure of the system to focus more seriously on disease prevention and health promotion activity.
    • 21. Health Care Reform: why?  GPs and other community providers need more support so they can have an effective, central and ongoing role in patient care.  For many GPs balancing day to day practice responsibilities and trying to reform PC and they system more widely is singularly impossible.  MCL reform allows focus on system reform. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J  MCL can better support GPs and their practices.  This support needs to be locally or regionally based because that's where most services are provided.  The increased demand of an ageing population is unsustainable over the longer term.
    • 22. Medicare Locals: the vision  Medicare Locals (MLs) New organisations first phase 2011  61 nationally; 8 in WA  Formed as key primary health organisations as a result of COAG (Council of Australian Governments) National Health Reforms agreed to by both the Commonwealth and State Governments  MLs build on previous work of the Divisions of General Practice, (working with GPs) BUT broader than GPs  Broader primary health focus - including allied health, pharmacists, specialists, nursing, mental health, preventative health  Also better linking with the hospital and aged care sectors Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 23. Health Care Reform Cont. 120 - Divisions of 61 – Medicare Locals General Practice Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 24. Medicare Locals: the broader role  Can build on the work of GP divisions Work with Broader system -stronger engagement across the whole primary health spectrum  Linkages – acute and aged care  Extra funding – fill service gaps  Community specific needs solutions  Help support research and development in PC Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 25. MCL Five strategic objectives:  Improving the patient journey through developing integrated and coordinated services  Provide support to clinicians and service providers to improve patient care  Identification of the health needs of local areas and development of locally focused and responsive services  Facilitation of the implementation and successful performance of primary health care initiatives and programs  Be efficient and accountable with strong governance and effective management. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 26. Medicare Locals: the reality  Young organisations just finding their own role and identity  It is all about relationships Variation across MCL’s – some engaging well others less well  Various stages development, but the momentum is significant in  What’s gone before matters! places  Lots of mixed feelings about MCL  Some misconceptions about what the reform is attempting to do and poor communications on what the reform is about- by  Lack of understanding of the role of MCLs  Issues around competing interests of stakeholders  Other system incentives – e.g. funding mechanisms Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J reform– from GPs, NGOs and other groups
    • 27. Medicare Locals: the reality Examples of local solutions that are strengthening General Practice in some regions  Health Pathways – 10 MCLs working in this space  Diabetes planning  Work around out of hours,  Use of spatial information planning to identify gaps in services  Provision and support of important but often underresourced or less profitable services- e.g. street Doctor Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J How close to medical practices is the population older than 65 that need assistance?
    • 28. Opportunities for MCLs and primary care 1.Demonstrate leadership and promote innovation in primary health care. 1.Work in partnership with key stakeholders to improve the quality of primary health care. 2.Improve the coordination and integration of primary care activities. 2.Help to drive system reform 3.Identify needs and gaps in the local community with a focus on social inclusion. 4.Develop locally focussed and responsive services. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 29. Delivering on the reform: what will this take?  Strong and effective leadership that can negotiate the complex and often difficult healthcare terrain  Engagement with key stakeholder groups from across the health system  Understanding of the different cultures and incentives that operate in the system  Clarity of role and communication on this  Support of the primary care sector Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J  A passion to succeed  Commitment to improving public and patient health and a way to communicate this to the wider community
    • 30. The cost of not moving forward  At best we keep the status quo  Primary care continues to lack capacity to really influence system reform  Fragmentation and inequities grow  The evidence base around efficient and effective high quality service provision in primary care remains low  MCL experiment fails and opportunity is lost  Other? Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J
    • 31. Curtin University is a trademark of Curtin University of Technology CRICOS Provider Code 00301J

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