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Health Reform in Australia and the Place of E-Health

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Health Reform in Australia and the Place of E-Health International Medical Community Health Reform in Australia and the Place of E-Health JMAJ 53(3): 193–198, 2010 Mukesh C. HAIKERWAL*1 Introduction: Health needs reform activity to be measured, clinical information to be electronically transferred and shared (with Health is of great importance for Australians. strict security, privacy, confidentiality and stan- Politically, health, the health system and funding dards—technical and ethical—applying). The use for it are major issues. Elections can be influenced of e-Health enables the reform process but also by health policy1: the 2010 Australian Federal supports the processes of health care improving election, not to mention the 3 State elections the patient journey, patient outcomes and health in Tasmania, South Australia and Victoria this professional effectiveness, efficiency and argu- year will see Health as a key policy area being ably satisfaction. considered by voters. The reasons for the need for health reform are The system of health care in Australia con- widely recognised across the globe. tinues to evolve. People in Australia see health as They relate to: an investment and as economic status improves, • growing demands for health care and services they pay for more health services. The election • greater expectations of consumers from these of a new Government in November 2007 in Aus- services tralia signaled reform to the Health Care system. • a need for consumer centred health care, self- The new Labor government has declared its care and health literacy intention to be a reforming administration which • research and medical advances that drive best intends to plan the health system of the future. It practice and innovation will make systemic changes with a view to the • greater ability to prevent, diagnose, treat illness long term sustainability of the health system. This and maintain health requires fundamental changes to the governance • technological advances including e-Health3 and funding arrangements across Australia. Work • improved, safer and more targeted pharmaceu- practices, including how health professionals ticals are deployed, must be addressed. Supporting • growth of non-communicable diseases (chronic and enhancing the high quality, but diminishing disease) numbers, of Health professionals including medi- • an ageing population with chronic and complex cal practitioners and the work they do is vital care needs to success. • increased complexity of care, management sys- The geography of the nation and the disjointed tems and organisation of services health system2 with its many components and • the vital role of safety and quality in healthcare large numbers of different health professionals • the need for an accessible and sustainable system engaged in health care mean that national stan- • accountability and responsiveness of health dards of care need to be set. These will require professions and the health system *1 Professor, School of Medicine, Flinders University, Adelaide, Australia ([email protected]). Chair, Finance and Planning Committee, World Medical Association. 2005–2007 President, Australian Medical Association. Visiting Fellow, Australian National University, Canberra. Head of Clinical Unit, Clinical Lead, National e-Health Transition Authority (NEHTA). JMAJ, May/June 2010 — Vol. 53, No. 3 193 Haikerwal MC Context of Australia & Japan was 127.69 million.6 Australia has a land area of 7,692,000 sq km Population & geography and Japan 377,944 sq km.6 Japan’s population On 7 March 2010 at 08:15:10 PM (Canberra time), density measured 338 persons per sq km in 2008, the resident population of Australia was pro- compared to Australia where there are fewer jected to be: 22,178,199.4 The official figure for than 3 people per sq km. This reflects the terrain 2008 is 21,644,000.5 Japan’s 2008 total population of the country. Consequently there are highly Healthy Australia 2020 Reform goals • Tackle the major access and equity issues that affect people now • Redesign our health system to meet emerging challenges A sustainable, high quality, responsive health system Vision • Create an agile and self-improving health system for future for all Australians, now and for future generations generations Taking responsibility Connecting care Facing inequities Driving quality performance Individual and collective action to Comprehensive care for people Recognise and tackle the causes Leadership and systems to achieve build good health and wellbeing— over their lifetime and impacts of health inequities best use of people, resources, by people, families, communities, and evolving knowledge health professionals, employers, health funders and governments Strengthen and integrate primary health care: ‘Healthy Australia Accord’— • Commonwealth responsible for creating ‘One health system’ all public funding and policy for through transformed government primary health care responsibilities • Form Comprehensive Primary Health Care Centres and Explore a more responsive and Services sustainable system for the future • Voluntary enrolment for young —‘Medicare Select’—introducing families, indigenous people and greater consumer choice, complex and chronic patients competition and innovation with a primary health care service Make real the universal entitlement as their ‘health care home’ to health services with targeting on Activity based funding with Healthy Australia 2020 Goals • Create regional Primary Health the basis of health need payments for performance and Care Organisations by quality and reshape the MBS National Health Promotion and transforming Divisions of GP National ATSI Health Authority— Prevention Agency—education, expert commissioning and Capital investment to support evidence and research to make Invest in a healthy start to life brokering of services to achieve reforms prevention a top priority from before conception through better health outcomes the early years—universal and Better workforce planning, Greater personal responsibility targeted services Healthy start to life—nutrition training and use of capabilities— for improving health supported support for remade indigenous National Clinical and education by policies that make healthy Reshape hospital roles for communities and Agency; clinical training choices easier emergency and planned care activity funding and infrastructure and fund accordingly; strengthen ‘Denticare Australia’—restorative Health literacy—in National outpatient and ambulatory specialist and preventive oral health care Embed focus on quality and Curriculum for all schools; services in community settings for all Australians safety—Permanent national body accessible high quality health to promote, monitor, and report information through out life Complete the ‘missing link’ of Remote and rural health— on quality and safety, and local sub-acute services and facilities equitable and flexible funding, systems of clinical governance Better information about creating innovative workforce models healthy local communities— Expand choices for care and and enhanced support for rural Smart use of data, information ‘wellness footprints’ accommodation in aged care practitioners, telehealth, patient and knowledge—by clinicians, travel support, research and health services, health funders Workplace and health fundees Improved palliative care and training infrastructure and researchers health promotion and wellness advanced care planning programs Mental health—early intervention Public reporting on access, National Access Targets across for young people rapid response efficiency and quality for public Person-controlled electronic health all public health and hospital teams, sub-acute care, linked and private hospitals record services health and social services Build and support research National action on broader System connections—e-health National reporting on progress and innovation capability determinants of health and communications in tackling health inequities at all levels People and family centred | Equity | Shared responsibility | Promoting wellness and strengthening prevention | Comprehensiveness Value for money | Providing for future generations | Recognise broader social and environmental influences shape our health Taking the long term view | Quality and safety | Transparency and accountability | Public voice and community engagement A respectful, ethical system | Responsible spending | A culture of reflective improvement and innovation Principles Priorities ad Actions Strategies Fig. 1 NHHRC final report: 4 pillars 194 JMAJ, May/June 2010 — Vol. 53, No. 3 HEALTH REFORM IN AUSTRALIA AND THE PLACE OF E-HEALTH concentrated population centres with over 70% hospitals currently owned, organised and run by of Australians living in urban areas mainly near each of the State and Territory governments the coastline. The proportion of the population (States) with some support from the Federal gov- identified as Indigenous (Aboriginal and Torres ernment. The health system is complex, discon- Strait Islander peoples) is 2.5%, the larger pro- nected, under-funded and indeed struggling under portion of who also live in urban areas. financial pressures, inadequate infra-structure, workforce shortages and inappropriate deploy- Ageing ment of staff and poorly planned services.15 Australia’s population, like that of most devel- Despite this it does perform well but cannot oped countries, is ageing7 as a result of sustained continue to do so without reform. low fertility and increasing life expectancy. The Upon taking office, the government through
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