Productivity Commission recommends big changes to health system
Australians are living longer than people in most other developed countries, but they are also spending longer periods in ill health.
That is one finding of the Productivity Commission’s five-year review, released in October and titled Shifting the Dial.
It also found that most Australians have great confidence in the health care they receive.
The report has recommended, however, a dramatic adjustment to the nation’s health system, with reforms that could save more $140 billion over 20 years.
Poor communication between healthcare professionals – GPs and public hospitals in particular – has contributed to problematic issues faced by patients, the report finds.
And it suggests supervised vending machines could replace community pharmacy roles in dispensing medicines in some locations.
“Australians are living longer, with less disability than ever before. Australia outranks most other highly developed economies in health outcomes,” the report states.
“It has the third greatest life expectancy at birth among OECD countries in 2015 at 82.8 years and a high absolute number of years spent in good health (though a lower than expected number given our life expectancy)…
“Indeed, Australia has one of the highest obesity rates in the world, and it appears to be still rising. And while Australians have high life expectancy, they also have the highest number of years spent in ill-health compared with other OECD countries.”
According to the review, the overwhelming share of Australians had confidence they would receive quality and safe medical care, effective medication and the best medical technology if they were seriously ill.
Australia is faring comparatively well by international benchmarks in certain areas of preventative health — most notably in reducing rates of smoking and transport accident deaths.
“On face value, the cost effectiveness of Australia’s health system also appears relatively high compared with other OECD countries, with Australia spending less on health than many countries for comparable or better outcomes in life expectancy,” it states.
Yet Productivity Commission chairman Peter Harris described a “non-existent communication” between different parts of the health system that has led to many problems.
He has recommended to the Federal Government that it undertake a significant overhaul of how the sector functions.
“A simple indicator of service integration is the proportion of a hospital’s patients whose GPs are provided with a discharge summary within 24 hours of discharge,” his report states.
“Currently, Australia’s performance appears poor. Less than 20 per cent of Australian GPs were always told when a patient was seen in an emergency department compared with 68 per cent in the Netherlands, 56 per cent in New Zealand and 49 per cent in the United Kingdom.
“Clinicians, patients and researchers operate under a veil of ignorance posed by inadequate information flows and haphazard data collection. Private health insurance sits uneasily with a system of public insurance, with their respective roles weakly defined.
“The imperative is therefore better coordination of the system, giving a greater weight to the role of public health, and acceptance of people themselves as partners in their own health management.”
GPs are the clinicians that Australians most frequently see and are highly trusted, the report states.
It says all Australian governments should re-configure the healthcare system around the principles of patient-centred care, and implement changes within a five-year timeframe.
Australian governments are urged to cooperate to remove the current “messy, partial and duplicated presentation of information and data” and provide easy access to healthcare data for providers, researchers and consumers.
And the review recommends the Federal Government end community pharmacy as the vehicle for dispensing medicines and move towards a model that anticipates automatic dispensing in a majority of locations.
This would be supervised by a suitably qualified person. In clinical settings, pharmacists should play a new remunerated collaborative role with other primary health professionals where there is evidence of the cost-effectiveness of this approach.
An alcohol tax system that removes the current concessional treatment of high-alcohol, low-value products, primarily cheap cask and fortified wines, should also be embraced.
The uptake of technologies that could lower costs and increase convenience and quality has often been slow, the review found.
“Telehealth is still in its infancy, and restrictions in payment models frustrate its diffusion,” it states.
“More generally, the adoption of eHealth has had a protracted and troubled history in Australia that is only now beginning to be resolved. The old chestnuts — the anti-competitive regulation of the professions and the incongruities presented by retail pharmacy regulations have proved resistant to repeated calls for reform.”
The imperative for policy action is justified on many counts, according to the review. It says such action will produce better health outcomes and wellbeing, provide more voice to and choice for patients, and result in greater efficiency.
“Wasteful expenditure means that resources are being used in the wrong places to no or little effect on health outcomes,” the report says.
In launching the Productivity Commission’s findings, Federal Treasurer Scott Morrison said the review would make governments and the health sector consider the effectiveness of the health system.
“Improving the health of Australians is not just about enhancing our quality of life; it’s an economic growth strategy,” Mr Morrison said.
“Healthy and happy people are naturally more productive people.”
The full report can be found at: https://www.pc.gov.au/inquiries/completed/productivity-review/report
Published: 02 Nov 2017