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FUTURE DIRECTIONS IN PUBLIC HEALTH CARE

FUTURE DIRECTIONS IN PUBLIC HEALTH CARE. Paula Bowman Queensland Health Thursday 30 October, 2008. Health Policy Drivers. Current system is unsustainable Weight of expectations Demand greater than supply and capacity Change in burden of disease System complexity Technology

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FUTURE DIRECTIONS IN PUBLIC HEALTH CARE

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  1. FUTURE DIRECTIONS IN PUBLIC HEALTH CARE Paula Bowman Queensland Health Thursday 30 October, 2008

  2. Health Policy Drivers Current system is unsustainable • Weight of expectations • Demand greater than supply and capacity • Change in burden of disease • System complexity • Technology • Ambivalence – costs, lifestyle, self interest • Past policy • Evidence of inefficiency, quality & safety issues • History and industry culture, entrenched interests Inequalities in outcomes

  3. Drivers for new models of care • Technology • Workforce • Cost • Sustainability • Broader focus than inpatient, hospital based care • Consumer engagement and involvement

  4. What is good health? • Physical wellbeing • Social wellbeing • Emotional wellbeing • Spiritual wellbeing • Social determinants of health • Individual and societal perception

  5. How healthy are we as nation? • In Australia chronic diseases cause 9 out of every 10 deaths and reduce workforce participation by up to 40% • There are around 400,000 preventable hospital admissions every year attributable to chronic disease • In the 15 years to 2005 the prevalence of diabetes almost doubled. Australian children now suffer from type 2 diabetes, previously an adult disease • Australia is now one of the most obese nations in the world • The social costs of alcohol abuse are estimated to be over $15b each year • Mental Health problems cost $9.6b in lost productivity • Life expectancy of Indigenous people is 17 years less than for non Indigenous Australians

  6. How healthy are Queenslanders? • 4300 Queenslanders die every year from preventable diseases and 2.4 million live with some form of chronic disease • Preventable conditions like type 2 diabetes, emphysema and kidney failure cost an estimated $6b every year;; 1 in 4 aged over 25 years have type 2 diabetes • Qld has the highest % of men who smoke, are overweight or obese and who do not take regular physical exercise • With no change to diet and exercise habits this generation of children will be the first to die younger than their parents • 6 out of 10 men and 4 out of 10 women are considered overweight or obese

  7. How healthy are Queenslanders? • Queenslanders rank second worst Australia for drinking alcohol at risky levels • Indigenous peoples life expectancy is on average 19 years less than non Indigenous Queenslanders • People who live in remote areas live around 6 years less than other Queenslanders • More than 22% of Queenslanders live with a mental illness and 1 in 4 are alcohol or drug induced. The rate of suicide in higher than the national average • Queensland children have higher rates of tooth decay than the national average • Queensland has the highest infant mortality in Australia

  8. Health in Australia – whose responsibility? • Australian Government – Medicare/GPs, PBS, Aged Care, Veterans, AHCA payments, population health strategies • Queensland Government – inpatient services, outpatient services, rehabilitation and sub acute care, community health, mental health, oral health, population health, aged care services • Local Government • Non government charitable/welfare sector • Private for profit sector • Inherent complexity means that responsibility is contested – “blame game”; shared accountability = no accountability; inherent inefficiencies and inflexibility reduce capacity for innovation

  9. Key priorities – Australian government 12 critical challenges (NHHRC) – require action by all players • Close the gap -Indigenous health status • Invest in prevention • Ensure a healthy start • Redesign care for chronic and complex conditions • Recognise the health needs of the whole person • Ensure timely hospital access • Care for and respect needs at the end of life • Promote improved safety and quality • Improve distribution and access to health services • Ensure access on the basis of need • Improve and connect information • Ensure enough well trained Health Professionals and promote research To be linked to benchmarks applicable to both public and private sector, health system not just hospitals and AG and state performance. Indicators, indicators plus targets, benchmarks with consequences

  10. National Reform Agenda • Short term • more $ for public hospitals and elective surgery • GP super clinics • dental health; • additional nursing and vocational education places; • National Binge Drinking Strategy; • lifting threshold for the Medicare levy (debate ongoing) • Reform of AHCA payment schedule • Medium to longer term • National Health and Hospitals Reform Commission; National Preventative Health Taskforce; • review of rural health programs; • National Primary Care Strategy; • review of the Medicare schedule

  11. Key priorities – Queensland government Advanced Health Action Plan Addresses 5 key challenges • Demand generated by population growth • Preventable disease • Giving mothers and babies the best start • Improving mental health care • Reducing the gap for rural communities and all Indigenous Queenslanders

  12. Key priorities – Queensland government Strengthening consumer engagement – Health Consumers Queensland Strengthening community involvement in local health services – Health Community Councils Strengthening partnerships with other health service providers Improving Indigenous Health outcomes -DG and District CEO accountabilities Strengthening the quality of health services and independent review and management of complaints – Health Quality and Complaints Commission (HQCC) Improving performance and public access to QH performance information – publishing of quarterly hospital activity and waiting list information

  13. New models • Technology • telehealth, teleradiology • e- health - remote monitoring, HER • gene technology and nanotechnology • new drugs, vaccines and therapeutic devices • robotics, new diagnostics

  14. New models • Workforce - job design/redesign • Nurse Practitioners • Physician Assistants • Advanced Practitioners • Support Personnel • GP specialists • Rural Medical Generalists • New roles e.g. care coordination

  15. New models • Care setting • Community • Home, • GP super clinics, • RACF, • Public/private partnerships, • Private sector (OP services, elective surgery, chronic disease management, renal dialysis), • Care centres - cancer care

  16. New models • Sustainable services • MPHS • Primary Care Centres • Networked services • Outreach services • Self management

  17. Principles for new models • Safe, high quality • Ethical • Providers adequately trained/competent • Address burden of disease • Equivalent or better than existing model – value for $, sustainability, outcomes • Address consumer/community expectations • Address equity

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