Presentation by Professor John Horvath to the 1st Alumni Health Policy Conference
Presentation by Professor John Horvath, Chief Medical Officer, to the 1st Alumni Health Policy Conference - The Commonwealth Fund Harkness Fellowships in Health Care Policy, England, 17 July 2005.
Topic: scene setting: what are the issues that will be driving policy in the next 20 years?New challenges in delivering health care constantly emerge, as societies continue to develop and evolve.
For any country, ensuring that a system contains the right mix of services, as well as the right financial incentives to produce the best possible patient outcomes, is no easy task.
The key challenges that Australia faces in health care are common to developed countries worldwide. These include meeting rising consumer expectations, the ageing of the population and the introduction of new medical technologies.
Currently in Australia, addressing the changing patterns of disease and continuity of care while managing the divided responsibilities between the Australian Government and the state and territory governments are of particular focus.
Each country has its own unique approach to tackling heath care issues and responding to these sorts of pressures.
More and more, the Australian government is basing policy and funding decisions on hard evidence, placing great importance on both clinical effectiveness and efficiency. For this reason, research is becoming even more essential to inform and assist policy makers.
Engaging with other countries in our region is also becoming increasingly important to Australia, both for moral and strategic reasons.
Changing patterns of diseaseIn Australia, chronic diseases are estimated to be responsible for 80 per cent of the total burden of disease. It is particularly regrettable that most of this is preventable.
Whilst many important gains have been made in the prevention and control of chronic disease (for example through a significant reduction in smoking) rates of diseases such as diabetes, depression and asthma continue to rise.
Strategies for reducing the burden of chronic disease should work across the continuum of care, from prevention through to treatment and management and should be supported by a strong evidence base.
A strong and detailed evidence base is being developed in Australia in relation to highly targeted chronic disease prevention strategies. Initial findings show that prevention yields both patient benefit and government return on investment.
It has been recognised that risk factors such as obesity, high blood pressure and high cholesterol are common to many chronic diseases, including diabetes and heart problems.
Addressing key risk factors and adopting an increased focus on prevention will help improve the health and wellbeing of our entire population, ranging from young children, workers and retirees to the frail elderly.
It will also be important to consider and address non-health issues in research, such as the contribution of housing, employment, education etc to health outcomes. This will facilitate a whole-of-government approach to health policy.
Education and training - preparing the future health workforceWith the rise in chronic disease, most of the illnesses burdening today’s society are too complex to be addressed by one single health discipline. Chronic disease prevention and management requires an inter-disciplinary team approach yet our medical education is still delivered in a silo approach.
It is essential that all stakeholders view education and training as the foundation upon which doctors can develop as they proceed through their career. In this sense, medical education is an on-going process which must adapt to the profession’s constantly changing dynamics with respect to technology, patient needs, and service delivery.
It is crucial that education and training continues to adapt, and also prepares those in it to adapt, to the needs of doctors, patients, the health system and society if it is to remain relevant.
Continuity of careIt is important to ensure that patients are able to access all the services they need in a timely manner, and that their conditions are managed effectively.
With increasingly complex conditions, such as multiple disabilities and chronic disease, come difficulties at the interface between different types of health care services.
In Australia, these difficulties are exemplified by a division of responsibility for health care between the Commonwealth government and state and territory governments.
The challenges of a system whereby the commonwealth and the states have shared responsibility for health apply not only to individual patients, but also at the level of overall financing and management.
Since different levels of government are responsible for the availability and quality of health services, there is no clear accountability for overall health system performance. There is potential scope in our system for various forms of cost shifting and/or blame shifting to occur from one level of government to another.
These sorts of scenarios are not only frustrating for and detrimental to patients; they can also represent an inefficient use of health resources.
Australia is mindful of these issues, and is working to address them via a number of processes, including a newly announced health reform agenda of the Council of Australian Governments (CoAG).
At a recent meeting of the Council of Australian Governments (CoAG) members agreed that although Australia has one of the best health systems in the world there is room for improvement, particularly in areas where governments’ responsibilities intersect.
Suggested improvements included improving the supply, flexibility and responsiveness of the health workforce and increasing the health system’s focus on prevention and health promotion.
Rural/remoteAustralia faces an ongoing challenge in maintaining access to health services in rural and remote areas.
Workforce shortages, for example, increase waiting times for GP appointments, particularly in rural and remote areas, and place greater pressure on hospital emergency departments.
Increasing the medical workforce in areas of shortage is seen as crucial to meeting both the current and projected requirements of Australia’s health care system.
The Commonwealth government has introduced a wide range of initiatives, including increasing the number of appropriately qualified overseas trained doctors operating in Australia and training and funding more practice nurses.
International - Moral ObligationsAustralia also has ongoing obligations in the international community. As a member of WHO and with a health system that is recognised as among the best in both our region and the world, there are expectations that Australia will continue to support the strengthening of health systems in the Asia Pacific region.
As such, Australia has longstanding relationships with other countries and agencies to develop regional approaches to issues and to building on regional and individual country strengths to respond to ongoing challenges.
Australia has recently taken on a greater leadership role in the Asia Pacific region, in response to significant events such as state failure, declining governance, instability, conflict, terrorism, the spread of HIV/AIDS and the emergence of new pandemic threats.
It is recognised that the quality of governance has a decisive influence on growth and social development, particularly in small states with limited economies of scale and few opportunities for diversification. Additionally, it is acknowledged internationally that improved delivery of social services such as health, contributes to improved stability.
For these reasons, Australia is seeking to enhance the capacity of regional states to pursue sustainable governance reform and the Department has a role to play in ensuring that our neighbours’ health systems are effectively managed and delivered.
The importance of regional collaborationAustralia has acknowledged for a long time that it is important that we collaborate with our regional neighbours as health systems have become more complex and the international health arena more interdependent. No country can operate successfully in isolation.
Never has this shown to be more essential than with the outbreak of diseases such as SARS and avian influenza and recent disasters such as the tsunami. Time and time again it is the Asia Pacific region that seems to be the hardest hit. Therefore countries are recognising that they need to work closely with each other in the wake of these challenges.
Disasters such as the tsunami and disease outbreaks have shown that they do not affect the health sector in isolation. There has been a proliferation of actors with increasing influence in the health sector, including key players from agriculture, foreign policy, economic and trade sectors. For example, WHO, FAO, OIE, ASEAN, APEC and agricultural ministries of individual countries are all playing important roles in combating the spread of zoonotic diseases. Only through strong collaboration will we successfully avoid duplication and wasted effort.
Benefits to AustraliaWe are also recognising that the health of the region has the potential to impact on the health of Australians. Strategic international engagement positions the Department of Health and Ageing to react quickly, effectively and appropriately to new health challenges as they arise.
Interaction with international experts and counterparts also makes our own health system stronger. It increases our knowledge and understanding of best practice methods in health service delivery and our ability to deliver a world class health system.
ChallengesFor all these reasons, there is a need to continually reinforce to the Australian community that international engagement is an essential component of strengthening our own health system.
However, the major challenge will be to ensure that our international engagement is well targeted so that our domestic priorities are enhanced, rather than overburdened.
ConclusionsAs we move into the 21st Century the key issues driving policy internationally include cost containment and efficiency, technological advances and changing patterns of disease. Challenges to the health system will continue to emerge, from ageing of the population to unforeseen threats such as the emergence of Severe Acute Respiratory Syndrome (SARS).
A strong evidence base for policy-making will become increasingly important to achieving sustainability of our health systems.
The kinds of research that will be needed to underpin evidence-based policy making in the coming years, will address key issues that drive policy internationally and be characterised by:
Australia is working hard to ensure that the health system continues to operate as one of the best in the world, and that it remains responsive to the needs of all Australians.
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