Primary Health Care Reform in Australia National Health and Hospital Reform Commission Professor Justin Beilby University of Adelaide

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1 Primary Health Care Reform in Australia National Health and Hospital Reform Commission Professor Justin Beilby University of Adelaide

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4 } 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

5 } } } } 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 illequipped 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

6 Households Businesses Funders/Purchasers taxes (and medicare levy) taxes compulsory premiums compulsory premiums State/territory governments Various payment methods General revenue assistance & health specific payments Commonwealth Government MBS rebates PHI rebates appropriation Consumers (patients) premiums Private health insurance funds Department of Veterans' Affairs Third party insurers - motor vehicle, workers' compensation Service Providers (in some cases purchasers are also providers) Public dental services (including hospitals) Public hospitals (including outpatients) Private/NFP hospitals Various payment methods Public community health services (including HACC) Various payment methods Aged care (including HACC) Private/NFP community health services PBS Incentive payments Co-pay Pharmacy GP practices Medical & surgical practices Private dental Allied health practices Various payment & purchasing arrangements Various payment & purchasing arrangements Production inputs/factors Capital infrastructure and buildings plant and equipment Labour allied health professionals dentists general practitioners managers and administrators nurse practitioners/nurses/midwives specialists support staff Consumables pharmaceuticals medical devices/aids & appliances prostheses other supplies - medical/surgical, food, linen, office electricity, gas, water

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8 A HEALTHIER FUTURE FOR ALL AUSTRALIANS Final Report of the National Health and Hospitals Reform Commission Themes Key Reform Directions Principles Taking responsibility Connecting care Facing inequities Driving quality performance Individual and collective action to build good health and wellbeing by people, families, communities, health professionals, employers and governments 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 Comprehensive care for people over their lifetime 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 record Invest in a healthy start to life from before conception through the early years Reshape hospital roles for emergency and planned care and fund accordingly Complete the missing link of sub-acute services Hospitals National Access Guarantees and Targets Expand choices for care and accommodation in aged care Improved palliative care and advanced care planning Recognise and tackle the causes and impacts of health inequities 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 Better use of people, resources, and evolving knowledge 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 infrastructure Permanent 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 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 8

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11 Network of influence Primary care reform engine

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13 Population 520, LGAs, 26 SLAs 220 GP practices 830 GPs + 45 GP Registrars 205 PNs Allied Health Professionals 98 RACF (5735 beds) 9 public hospitals 13 private hospitals 156 pharmacies

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

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16 Planning and more planning! 16

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19 Questions