Australia is one step closer to an integrated health system | Jennifer Doggett

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CPD health expert, Jennifer Doggett, takes a look at the introduction last week into Federal Parliament of legislation to establish the National Health and Hospitals Network (NHHN). It’s a step closer to an integrated health system, but she points out a number of challenges Gillard’s minority government will need to overcome if we are to realise a more efficient, responsive and consumer-focused health system.

Australia is one step closer to an integrated health system, due to the introduction last week into Federal Parliament of legislation to establish the National Health and Hospitals Network (NHHN). The NHHN will put into effect COAG’s agreement on handing responsibility for 60% of hospital funding and 100% of primary care to the Commonwealth and will form the foundation of the planned reforms of our health system.

The reforms aim to address some of the fundamental problems with health care in Australia today, including the division of funding and service delivery responsibility between Federal and State/Territory governments resulting in both gaps and duplications in services and creating barriers to the provision of coordinated care.

The introduction of the legislation is a crucial step in realising the goals of health reform for a more efficient, responsive and consumer-focused health system. However, there remain a number of implementation challenges which will need to be overcome to ensure these goals can be met. Three of these are as follows:

Consumer input: the success of any health system can be measured by the degree to which it meets the needs of consumers. For the planned health reforms to deliver the promised gains of improved health outcomes, they need to address the needs and concerns of consumers. The Government has made a promising start to obtaining input from the community during the initial stages of the health reform process. This needs to be sustained during the implementation of the reforms, in particular, in relation to the planning and delivery of community-based health services, such as Super Clinics.

Consumer consultation needs to occur at all levels of the planning and implementation process and involve consumers in a range of capacities. These include appointing trained and skilled consumer representatives to relevant boards and committees, seeking feedback from clients of health services on the care they have received and obtaining the views of the broader community on the values and principles that should underlie our health system. A particular challenge will be to obtain input and feedback from consumer groups which often feel marginalised from traditional general practices for financial, social or cultural reasons, including young people, Indigenous Australians and people who inject drugs illicitly. Partnering with peak consumer bodies and groups that already work with and are trusted by these groups will be the key to obtaining input from a broad consumer base.

Integration: a central aim of the planned reforms is to deliver a more integrated health system. A better integrated health system will mean that consumers experience their health care as a coordinated and seamless process, even when provided by multiple professionals in different locations. It also means that consumers can receive timely health care in the most appropriate setting. For example, people at risk of developing chronic diseases can be identified and treated in their community before their problems become more serious and require hospitalisation. This will reduce the current high incidence of preventable hospital admissions and take pressure of our stressed public hospital system.

Currently, while there is a stated commitment to greater integration of the health system through the reform process, no specific mechanism has been identified to achieve this aim. This needs to be addressed through specific strategies which build on current successful models already working in local areas to enable their expansion and adoption more broadly. For example, the Australian Healthcare and Hospitals Association has proposed that regional entities be funded to develop integrated models of care, against national guidelines. This would support the development of models which best fit the needs of local consumers and service providers, rather than imposing a rigid one-size-fits-all model which will not suit the diverse health care needs of our population.

Evaluation: without a robust evaluation of the health reform process it will be difficult to know whether, and to what extent, the changes have achieved their stated aims. Our health system should be constantly evolving and improving to meet the changing needs of the community and this can only occur where there is an ongoing evaluation process to inform future changes.

Clearly, consumers must play a central role in any evaluation process. A key challenge will be to include the views of consumers who have (or are at risk of) a health problem but who are not currently accessing care. It’s relatively easy to obtain the views of clients of a particular health service but much harder to locate potential clients in order to identify why they are not accessing care. While the Government has indicated that it plans to evaluate elements of the reform process (for example, the Super Clinics), no plan has been put into place for an overall evaluation. This needs to be addressed through the development of a comprehensive evaluation strategy which identifies and measures the key outcomes of the reform process and which is implemented independent of government and driven by consumer needs.

Finally, it should also be noted that a major gap in the reform process is the omission of oral and dental health services. The failure to include dental health within the scope of the reforms will increase the incidence of health and social problems related to dental issues and further entrench the inequities in access to dental care in our community. If the Government is genuinely committed to comprehensive health reform it will stop treating the mouth as separate from the rest of the human body and ensure that all Australians can access affordable dental care in their local communities.

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