RURAL AND REMOTE IMPLICATIONS OF A NEW

STRUCTURE FOR AUSTRALIA’S HEALTH

SYSTEM

Andrew Podger

Presentation to National Conference on Rural Health

Albury, March 2007

INDICATORS OF PERFORMANCE

• Australia ranks third amongst comparable OECD countries for life expectancy, sixth for healthy life expectancy and third in overall health system effectiveness;

• relative to Canada, the UK and the US, a higher proportion of Australians see a doctor promptly when they need to, and rate their care as very good or excellent;

• waiting times for emergency departments are shorter than for the US, Canada and the UK;

• waiting times for elective surgery are shorter than for Canada, NZ and the UK; but

• life expectancy of Indigenous Australians is about 17 years below that of non-indigenous Australians.

Changes in mortality rates 1907 to 2000

Changes in mortality rates 1907 to 2000

5–49

5–49

5–49

50-64

50-64

50-64

65-79

65-79

65-79

80+

80+

80+

0–4

0–4

0

200

400

600

800

1,000

1,200

1907 1970 2000Year

Mo

rtali

ty r

ate

(death

s/1

00,0

00 p

eo

ple

)

80+

65-79

50-64

5–49

0–4

Many fewer people dying under age 50

Many more people living

over 50More people living

until very old (80+)

Fewer people dying from 50 to 79

Age at death

Useful Incremental Measures in Recent Years

• Strengthening of General Practice

• Enhanced Primary Care for chronically ill

• Mental health initiatives

• Expansion of community aged care, and ‘ageing in place’

• Some (slow) improvements in health information system

System Problems

• Fragmentation

- reinforced by separate funding responsibilities

• Program and provider focus, rather than patient/consumer focus

• Poor allocative efficiency

• Limited information connectivity

• Cost shifting and blaming

Rural and Remote Issues and Developments

• Additional challenges – Access– Workforce– Costs

• Additional importance of flexibility / agility (connectedness)– and primary care

• Substantial but incremental initiatives over the last decade and more e.g.– Workforce incentives– MPS’s or Regional Health Services– Rural Primary Health Care– More Allied Health Services– Primary Health Care Access Program (for Indigenous

communities)

Mo

de

l for

Sin

gle

Co

mm

onw

ealth

Fun

der

He

alth

Sys

tem

Potential Benefits for Rural and Remote Communities

1. Transparency over allocation of resources across regions

- ability to highlight regions receiving less than their population needs

2. Greater flexibility to find local solutions to regional problems

3. Informed choice about services to be provided locally

(and greater allocational efficiency)

Incremental Measures in line with Systemic Reform

• AIHW to prepare independent regional health reports• Increased, highly flexible Australian Government funding

for primary care and prevention, focussed on regions with well below average healthcare spending relative to need

• Long-term commitment to steady increase of primary care funding for Indigenous communities

• Use additional primary care funding to promote greater cooperation between C’wlth and states within regions

• C’wlth to take full and direct responsibility for all non-acute aged care services

• Continue investment into integrated patient information systems

Conclusions

• Many aspects of my proposals are debateable

- I am not wedded to all the details• Systemic changes do not automatically

deliver benefits – they must be complemented by good

management and practical measures to address real health care issues on the ground

Conclusions (cont’d)

• But we do need a more integrated national health system

- with a single funder• We also need to ensure incremental reform in

the meantime will make such a move easier in the future

• There would be particular benefits in rural and remote Australia– so long as the system genuinely allows greater

flexibility in those areas– and delivers a more equitable share of resources