RURAL AND REMOTE IMPLICATIONS OF A NEW STRUCTURE FOR AUSTRALIA’S HEALTH SYSTEM

1. 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

2. 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.

3. Changes in mortality rates 1907 to 2000

4. 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

5. 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

6. 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)

7. Model for Single Commonwealth Funder Health System

8. Potential Benefits for Rural and Remote Communities • Transparency over allocation of resources across regions - ability to highlight regions receiving less than their population needs • Greater flexibility to find local solutions to regional problems • Informed choice about services to be provided locally (and greater allocational efficiency)

9. 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

10. 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

11. 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