Australia s primary health care system: Focussing on prevention & management of disease Lou Andreatta PSM Assistant Secretary, Primary Care Financing Branch Australian Department of Health and Ageing Recife, Brazil December 2007
Primary health care in Australia Agenda 1. Australia s health system an overview 2. Primary health care in Australia 3. Issues facing primary health care in Australia 4. Recent primary health care reforms preventing & managing disease 5. Primary health care indicators 6. Future developments and challenges
Australian States and Territories (Land area = 7.7 million sq km) WA 2 million NT 200,000 SA 1.5 million Qld 3.8 million NSW 6.7 million Total = 20 million 2.4% Indigenous Vic 5 million ACT 300,000 Tas 500,000
Context Australia Brazil Population 20.9 million 190 million Area 7.7 million km 2 8.5 million km 2 Median age 36.6 yrs 28.6 yrs Infant mortality rate 4.69 per 1,000 live births 27.6 per 1,000 live births Fertility rate 1.76 children/woman 1.88 children/woman Health as % GDP 9.5% 8.8% Public % of health exp. 67.9% 54.1%
Australia: Federalism in Health Commonwealth Health policy Health research Regulation Pharmaceuticals Medical benefits Aged care States/Territories Hospital services Mental health Dental health Community care Licensing & monitoring
Commonwealth Government Health Expenditure Capital $271 m 1% Other $3,017m 8% Research $1,275m 3% Public hospital services $10,105m 27% Medications $6,117m 16% Public health $798m 2% Community health and other $419m 1% Dental services $480m 1% Total $37,229m Medical services $12,239m 34% Private hospitals $2,507m 7%
Health funding arrangements Long-standing commitment to public financing and substantial public delivery in health care Universal access to health care Government (public) health insurance through Medicare Blended with privately-funded health care
Public health Disease prevention and population health promotion is a shared responsibility across governments Receives around 2% of total health $$ Covers eg infectious disease control, including HIV/AIDS, immunisation, tobacco use, broad public health messages
Medicare: Australia s Universal Health Insurance Scheme MBS medical Services Free public hospitals PBS medicines
2. Primary health care in Australia
Primary health care A definition: Provision of curative first level care by trained workforce Together with promotion, prevention, rehabilitative care by multidisciplinary teams Socially appropriate, universally accessible, based on scientifically sound care Supported by referral systems, and enables prioritising, self-reliance, participation and collaboration
Primary Health Care in Australia Australia's health workforce Other health, 58,567 Complementary therapies, 8,533 Medical w orkers, 33,636 Medical im aging workers, 8,111 Dental w orkers, 25,862, Allied health w orkers 39,457, Pharm acist w orkers 13,899, Nursing w orkers 244,456
Primary Care in Australia GP Financing (2005-06): Medicare Benefits Schedule (MBS): $3.8bn Patient Co-Payments - $385m Practice Incentive Payments (PIP) & General Practice Immunisation Incentives (GPII) - $300m Other Government Programs - $400m
Practice Incentives Program Financial incentives to encourage general practices to improve the quality of care provided to patients Complements and compensates for the limitations of fee for service arrangements Practices must be accredited against the RACGP Standards for general practices
Practice Incentives Program Payments are currently made through the PIP: for better use of information management and technology (IM/IT) to ensure patients have access to after hours care to support rural practices to encourage rural practices to provide procedural services to support practices to employ practice nurses to encourage practices to provide teaching sessions for medical students for participating in educational activities to improve prescribing behaviour to encourage cervical screening to ensure appropriate treatment of asthma and diabetes
Australian s health Australians are living longer More people are surviving cancer Fewer dying from heart disease Less people are smoking Immunisation rates have increased Dental health has improved - Australian Institute of Health and Welfare
Australian s health Prevalence of disability (PYLD) due to selected broad cause groups for both sexes combined by age, Australia, 1993 and 2023 Source: The Burden of Disease and Injury in Australia 2003
Access to Care rural challenges
Access to Care rural challenges Australia s land area = 7.7 million sq km 30% of the population live outside the 10 major cities Rural Australians have a higher burden of disease Living in rural Australia involves travelling longer distances to fewer services Indigenous Australians need access to culturally appropriate services
Workforce Shortages Shortage of doctors, nurses and allied health professionals, reliance on overseas trained doctors. Medical workforce distribution not matched to population distribution.
Primary Health Care Reforms Prevention health assessments Chronic disease management & prevention care planning & case conferencing National Health Priority Areas Commonwealth / State reforms - eg mental health care and ABHI
National Health Priority Areas Cardiovascular health Cancer control Injury prevention and control Mental health Diabetes mellitus Asthma Arthritis and musculoskeletal conditions
National Health Priority Areas Example: Diabetes Increasing prevalence Prevention and good management to avoid or minimise complications Incentives through the PIP New measures for risk modification
Diabetes cycle of care
National Health Priority Areas Example: Cancer The Strengthening Cancer Care Initiative. $189.4 million to 2008-09 $13.7 million to establish Cancer Australia. An estimated $99.3 million to be spent in 2006 on cancer research. New Medicare items for multidisciplinary cancer care case conference (GPs or specialists)
Immunisation Commonwealth Government funds vaccines states and territories are responsible for delivery Delivery through GPs, community clinics and Aboriginal health workers Commonwealth Government expenditure $283 million in 2006-07. Childhood immunisation coverage rates have increased to an all-time high, with over 90% of children at 12 months of age fully immunised. This is up from 53% recorded in 1989-90.
Indigenous Health
Indigenous Health Programs to improve access to primary health care services Encouraging use of mainstream health services by improving Indigenous Health Worker employment Addressing substance abuse, particularly petrol sniffing COAG Mental Health Improving the capacity of workers in Indigenous communities
Joint Commonwealth-State Reforms Australian Better Health Initiative National Call Centre Network Move to electronic health records National Action Plan on Mental Health Health workforce reform package Diabetes type 2 prevention
Australian Better Health Initiative (ABHI) Joint Commonwealth/State Government initiative focused on prevention and health promotion - $500m/4yrs total Commonwealth funding $250m ABHI aims to promote good health and reduce the burden of chronic disease for all Australians
Mental health Council of Australian Governments (COAG) national action plan for mental health in 2006 Commonwealth mental health package commitment of $1.9 billion over 5 years (18 initiatives) Better Access initiative $538 million over 5 years; costs to be revised following strong initial uptake
Key indicators for primary health care Commonwealth Fund s recent report uses: Access (affordability, responsiveness) Coordination of care (tests, specialist care) Patient-centred care (quality, communications, time) Chronic care & safety (written plan for care, reminder for follow-up care, number of errors)
How does Australia compare? Based on survey in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States, Australia rates: High on regular doctor/place of care Low on some aspects of care coordination Poor to mid ranking on out-of-pocket costs and patient access Low on reminder for preventive/follow-up care High on patient-rated quality of care
OECD Health at a glance 2007 Australia s performance 5 th lowest on adult daily smoking rates 5 th highest adult obesity rate Health spend/gdp at 9.5% is higher than OECD average (9%) (2004) Total health spend per person (US$3,128) also higher than OECD average (US$2,759) (2004)
Primary Health Care: Ongoing challenges Long term trends ageing, chronic disease, labour costs and shortages, new technology costs Costs and inefficiencies generated by different government responsibilities Services based on government responsibilities, not patient needs Failure to intervene early & fully to maximise productivity and workforce participation
Government s agenda Primary care activities: National Primary Health Care Strategy: preventative health managing chronic disease multidisciplinary primary care teams Review MBS to reduce red tape Range of specific initiatives eg Teen dental plan Healthy Kids Check
For more information www.health.gov.au