The system is under pressure
BY DR OMAR KHORSHID, CHAIR, HEALTH FINANCING AND ECONOMICS COMMITTEE
The Australian health system is under pressure. Our population is ageing and people are living longer. A boy born in 2016 is expected to live to 80.4 years and girls to 84.6 years. Statistically, people aged 65 years or older are admitted more often and remain admitted for longer than younger cohorts. Australia’s population is also growing – on average increasing nationally by 1.6 per cent per annum and estimated to reach 25.2m in 2018. We are also getting sicker. Approximately half of all Australians now have a chronic condition – many have multiple chronic conditions.
Diabetes affects around 1.2 million Australians. Two-thirds of Australian adults are either overweight or obese. Alarmingly, more than 20 per cent of children are overweight or obese. Chronic respiratory disease and lung cancer combined affects seven million Australians (one in three).
There are signs and symptoms our health system is starting to crack under the pressure of an ageing, sicker population and an unrelenting squeeze on funding.
Public hospital performance continues to decline. Work on the 2019 AMA Public Hospital Report Card is underway, and the news is not good. The latest national data shows only 64 per cent of urgent emergency presentations were seen within the recommended 30 minutes and the proportion of patients that complete their emergency presentation within four hours is in decline.
Perhaps one of the most disturbing emergency statistics is the time that very sick patients wait to be transferred from the emergency department to an admitted ward bed. Across all hospitals, in all jurisdictions, Resuscitation and Emergency patients have a slightly better than one in two chance of transitioning from emergency care to a ward bed within four hours. On a bad day if the hospital is operating at over 100 per cent capacity, the very sickest patients categorised as Resuscitation and Emergency could wait 10 or 11 hours before they are transferred to an available ward bed.
Elective surgery performance is also in decline. Nationally, elective surgery waiting lists are growing at a fast rate than elective surgery admissions. In the twelve months to 2017-18 elective surgery admissions per 1,000 population was negative in all jurisdictions except NSW (0.1 per cent) and ACT (1.8 per cent). These statistics don’t take account of the time patients wait between the date of their referral to the public hospital outpatient specialist and the date of their specialist appointment (the hidden wait list).
Jurisdictions have started to publish some rudimentary hidden waitlist data, but it is not consistent across States and Territories. The planned AIHW publication on hidden wait lists will be very welcome indeed.
While the most urgent elective surgeries do happen quickly, too often we see media reports of patients waiting too long for their specialist diagnosis and subsequent elective surgery. Many wait in pain. Many wait while their health condition deteriorates, and while they wait their opportunity of an optimal health outcome also diminishes. Waiting too long for public sector elective surgery is especially consequential for children where optimal health outcomes are most likely if treatment is received before physical or developmental windows close.
The original raison d’être of subsidising private health insurance (PHI) was to take pressure off the public hospital system. But this pillar of our health system is also under stress. Since the June quarter of 2015 when PHI membership was at 47.4 per cent of the population, there have been 13 successive drops in membership per quarter. Young healthy members are leaving and over 65s are joining. This creates an older and sicker pool of insured members who are statistically admitted more often and remain admitted longer compared to younger cohorts. An upward spiral in the age profile of the insured population will take premiums with it.
We have a world class health system, in large part due to the skill of the Australian medical workforce, the excellence of our medical researchers and our robust economy. However, it is beyond time that governments act on the clear signs of unmanageable pressures that are mounting on public hospitals. Pressures that must be alleviated at the hospital coal face but also up steam. We need more funding for evidence-based health promotion and chronic disease prevention and more funding for general practice. We need to arrest the declining financial viability in private health before more private hospitals close and premiums become unaffordable for all.
Published: 14 Mar 2019