New report calls for health system shake-up

The nation’s leading health policy experts have kept agreeing with each other that Australia’s health system is too complex and under stress.  

They have also agreed on what needs to be done to give Australians health care that is universal, fair and affordable and easier for people to use.

A new report, Australian Health Services: Too Complex to Navigate?, from the Australian Health Policy Collaboration, now part of Victoria University’s Mitchell Institute, has analysed 16 major reviews into Australia’s health system undertaken over the last 35 years.

Victoria University’s Professor Rosemary Calder says the roadmap for action to fix many of the well-known problems in Australian health care is clear.

“16 reviews over the last 35 years have consistently identified that the ways health services are led, funded and designed across Australia are the major contributors to Australia’s complex and often inefficient and sometimes ineffective health system. The recommendations by these reviews are strikingly consistent.  They provide a clear roadmap for reform.”

The report highlights that successive reviews, commissioned by governments or undertaken by national agencies, have identified the large equity gaps in health between wealthier and lower wealth Australians.  Chronic diseases affect one in two Australians and disproportionally affect people living in socioeconomically disadvantaged communities. The reviews have concurred that current health service arrangements are poorly equipped to address issues such as these with many Australians receiving suboptimal care as a result.

“Unless we make fundamental changes, the costs of chronic illness and resulting healthcare demand will continue to be a major issue for individuals and families and for governments” Professor Calder explained.

“Our health system is too complex. The health system is awkward and difficult to navigate for individuals who need care from general practitioners, one or more specialists and sometimes hospital care, often with geographical distance adding to the time and energy required to manage the health care they need.  For too many, the costs of the care they need become prohibitive.”

Australia spends over $180 billion annually on health care. Only 1.34% of that amount is spent on reducing health risks and preventing disease each year and yet it is well known that up to one third of chronic disease is preventable.

“Failing to reduce complexity and increase effective services will continue to contribute to increasing health care costs, and, at the same time, will lead to significant losses in workforce participation and productivity” Professor Calder says.

Professor Calder says the reviews, undertaken at significant cost over many years, agree that structural reforms, backed by collaborative leadership and action are essential.

The priorities for health policy and leadership that emerge from the AHPC review of reviews are:

• the need for Australia’s governments to agree to establish a national steward to oversee the implementation of a long-term plan for the health system and
• For restructuring of the financing of healthcare by governments to make access to healthcare based on health need simpler and more focussed on outcomes.

“Australians need a simpler, fairer and more affordable health system.  Medicare was established with this as the principal purpose– and 35 years of reviews have made it patently clear that Medicare is falling short of this aspiration.  

The Hon. Rob Knowles, a former Victorian health minister who has held a number of national health leadership positions, said in his foreword to the report that:

“A national discussion about how to re-engineer current arrangements to provide systemically, effectively and efficiently for chronic health conditions, their prevention, treatment and management, is now a pressing issue”

“These reviews have provided a solid roadmap for improvement. We need governments and health leaders to get on with building a health system that is simpler, fairer and more affordable for all Australians. The roadmap for reform is already there, it’s time to get on with it.”

Also read Prof Calder's opinion piece published in Croakey: "Get on with building a health system that is simpler, fairer and more affordable for all".