|Implemented in this survey?|
The Australian Government has committed to the development of the country's first National Primary Health Care (PHC)Strategy. An External Reference Group has produced a Discussion Paper, intended to provide a broad framework and basic information on key issues for PHC. It proposes 10 elements which could underpin a future PHC Strategy. A snapshot of each element is used to ask what happens now, what this means for community, consumers, health professionals, where could changes be made?
The purpose of the Discussion Paper is to stimulate input and comment to assist in the development of the PHC Strategy. The Discussion Paper has been developed by an External Reference Group consisting of representatives of provider groups and including consumers. The development of the Strategy will require consideration of a wide range of issues including current planning, delivery, governance and financing of PHC services some of which cut across National, State and Territory responsibilities. It is recognised that some aspects of the current system work well and these will need to be built on in the future directions and reforms which will make up the new Strategy. A draft Strategy is expected to be available for consideration by the Minister by mid-2009.
The Discussion Paper is one of a number of inputs to the development of a national PHC Strategy. The Strategy is one of a number of reforms proposed by the Australian goverment which are intended to deal with challenges identified as
At the same time, the complexity and volume of care required and delivered in the community is likely to continue to increase.
At this stage, as the Strategy is not developed, no incentives have been identified. But, as the Strategy is explicitly intended to consider the financing and remuneration arrangements for the PHC workforce, such incentives can be expected to form part of the final Strategy.
PHC workforce, Patients, Government
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
The ratings above which indicate that this policy is rather innovative, controversial and may result in fundamental changes to the Australian health system are predicated on the strategy including the most radical and far-reaching changes outlined as potentially available in the Discussion Paper.
There is no indication from the Minister which direction the strategy is likely to take and so these ratings may turn out to be the opposite of what actually happens. Although there was some media coverage of the release of the Discussion Paper, it was not widespread and there has been no follow-up coverage indicating any progress in the development of the strategy. The actual strategy may borrow heavily from other health systems (eg if a system for enrolling patients with their GP is adopted) but any transferability from Australia to otther systems seems unlikely.
The National Labor government is committed to a raft of healthcare reforms. To this end, it has initiated a series of reform processes including a Health and Ageing Working Group, the National Health and Hospital Reform Commission (also see report Reforming the Australian Health System (13) 2009), a Preventive Taskforce and a review of Maternity Services. Thus, the development of a PHC Strategy is part of this reform process and is likely to inform and be informed by all of the other processes.
|Implemented in this survey?|
The Discussion Paper is one input to the development of the Strategy. A broad range of stakeholders is being encouraged to respond to the ideas developed in the Discussion Paper. Other inputs include research and expertise assembled from other sources.
Although the challenges have been recongnised previously, the responses have, so far, been incremental. The result is a PHC system that is characterised by an increasing proliferation of narrowly targeted programs and funding arrangements and growing inflexibility for healthcare organisations, professions and consumers.
There is increasing recognition of the need to improve integration between PHC services funded by the Commonwealth, State and Territory governments, aimed at reducing fragmentation of service delivery. The introduction of more flexible private health insurance (PHI) arrangements has also increased the scope for PHI providers to enagage with PHC to, for example, supplement the range of allied health services which are traditionally funded through PHI.
The approach of the idea is described as:
The Discussion Paper, developed by the External Reference Group, lists the following impacts on PHC which necessitate the proposed reforms:
In the Discussion Paper, the challenges and future directions are grouped around four key themes: quality of care and health outcomes for consumers; health care service delivery arrangements; health workforce capacity issues; and fiscal sustainability.
While the Discussion Paper is likely to reflect the position of a number of stakeholders, further consultations will be undertaken.
|Government||very supportive||strongly opposed|
|Providers||very supportive||strongly opposed|
|Patients, Consumers||very supportive||strongly opposed|
It is not known whether legislation will be required until the strategy is fully developed.
|Patients, Consumers||very strong||none|
The government (and, if legislation is required, the parliament) will be the main actors in the adoption of the strategy. However, much debate can be expected around the themes. The Discussion Paper has set out the challenges in terms of developing PHC services which
Once a draft strategy has been developed, there will be an opportunity to evaluate its potential impacts on the challenges identifed above. For example, proposals to develop multidisciplinary teams will need to be evaluated in terms of the options for funding and remuneration mechanisms, the availability of workforce and the need for additional education and training.
A draft PHC Strategy is expected to be delivered to the Minister for Health by the middle of 2009. At that time, further consultations would be expected to take place, including with the Extended Reference Group who developed the Discussion Paper. It is likely that some proposed inclusions in the Strategy will not be contentious, but any proposals to change funding and remuneration arrangements are likely to be debated by the professions; at the same time any proposals which cross organisational boundaries (ie between the Commonwealth and States/Territories) are also likely to be contentious.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
It is unlikely that a new high level strategy will have a major impact on the quality of care overall, although it may have an impact on the quality of care provided to sub-groups within the population eg those with complex needs or people living in rural and remote areas of the country.
However, if a radical strategy is adopted, including changes to the funding, remuneration, organisational and delivery arrangements for PHC services, it is likely that the system will be more equitable and more effiicient.
The Australian Government. Towards a National Primary Health Care Strategy. A Discussion Paper. Department of Health and Ageing. Commonwealth of Australia 2008.