National Primary Health Care Strategic Framework

Systemic National Challenges in Health Care

Page last updated: April 2013

One of the best ways to ensure a strong, effective health system is to have a strong, integrated primary health care system at its centre.

Re-orienting the health system towards primary health care will need solutions that help to overcome some of the inherent challenges in the Australian health care system, particularly:

  • fragmentation arising from the divide between Commonwealth and state funded services;
  • complexities in funding, governance and reporting arrangements;
  • poor coordination of service planning and delivery within the sector and with other health care, social and welfare sectors; and
  • system inadequacies, including workforce shortages and maldistribution.
In addition, the primary health care sector needs to look towards:
  • supporting continuous improvement in performance, safety and quality;
  • making the best use of the workforce, infrastructure and technologies;
  • using the best available evidence-base; and
  • providing appropriate services that meet the needs of the local community.

The Case for Change

Australians generally enjoy some of the best health outcomes in the world. In 2008-10, Australians’ average life expectancy at birth was 79.5 years for males and 84.0 years for females4 – with the fifth highest life expectancy in OECD countries in 2009.5 The most recent National Health Survey (2007-08) indicates that 85 per cent of Australian citizens aged 15 years and over perceive their health status as good or better.6 We achieve these outcomes at a comparatively low cost, spending 9.4 per cent of gross domestic product on health in 2009-10.7 This expenditure is slightly under the OECD median of 9.6 per cent, less than similar OECD countries such as the United Kingdom (9.8 %), Canada (11.4 %) and New Zealand (10.3%), and significantly less than the United States (17.4%). 8 Top of page

At the same time, Australia faces some significant challenges to improving health outcomes and ensuring health system sustainability.

The National Primary Health Care Strategy identified that Australia’s health system faces significant challenges due to the growing burden of chronic disease, an ageing population, workforce pressures, and unacceptable inequities in health outcomes and access to services. It noted that, for many individuals, the primary health care services they access and the quality of care that results, has depended on where they live, their specific condition, and the service providers involved, as much as their clinical needs and circumstances.

From a patient perspective there is evidence that people prefer to be cared for within their own homes and communities and this requires an emphasis upon high quality integrated care that will allow primary health care practitioners and hospital based specialists to more easily collaborate in the treatment of patients in the community.

It has been well documented that specific Australian population groups such as Aboriginal and Torres Strait Islander people, people living in rural and remote areas, people who are less well off, and those with additional or specialised health needs, experience significantly poorer health outcomes. Recent statistics clearly illustrate this:
  • The life expectancy of Aboriginal and Torres Strait Islander peoples is 11.5 years lower for males and 9.7 years lower for females than non-Indigenous Australians. 9
  • People living in outer regional and remote areas are 4.5 times more likely to travel more than an hour to see a GP than those living in major cities. 10
  • The average person with disability has 3.1 long-term health conditions that may not be directly associated with their disability. 11
  • Among older Australians living in the community, almost half aged 65-74 years have five or more long-term conditions, increasing to 80 per cent of those aged 85 years or over. 12 Top of page
In addition to these poorer health outcomes for some specific groups, there is a growing burden of chronic disease in Australia. Our obesity rates are among the highest in the world, with about 1 in 4 Australian adults classified as obese, which contributes to the increase in chronic conditions such as heart disease and diabetes. The changes in the burden of disease across Australia, when combined with the demographics of a rapidly ageing population, are increasing the overall pressure on Australia’s health care system. This pressure is evident in demands for increased funding for resources including workforce and infrastructure. One of the key ways to address the financial sustainability of the health sector is to ensure that we use current resources in the most effective manner possible.

For many individuals, the primary health care services they access and the quality of care they receive is influenced as much by where they live, their cultural background, and social and economic circumstances, as their specific health needs. People also need to feel engaged in their own care, and have the option to be cared for within their own homes and communities whenever possible.

This requires some major changes in how we plan and deliver primary health care in Australia. Our health care professionals also need to look at new ways of working with consumers and with other providers so they can better meet the needs of the people in their care. Governments also need to find ways to bridge the system divides and better support a strong and effective primary health care sector.

To do so will achieve better health outcomes for all Australians.

Footnotes

4 Australian Institute of Health and Welfare (2012), Australia’s Health 2012, p120
5 OECD (2012), Health at a Glance, p7
6 Australian Institute of Health and Welfare (2012), Australia’s Health 2012, p107
7 Australian Institute of Health and Welfare (2012), Australia’s Health 2012, p468
8 OECD (2012), Health at a Glance, p197
9 ABS (2009) Experimental Life tables for Aboriginal and Torres Strait Islander Australians 3302.55.003
10 Commonwealth of Australia (2012), National Strategic Framework for Rural and Remote Health, p9
11 Australian Institute of Health and Welfare (2012), Australia’s Health 2012, p6
12 Australian Institute of Health and Welfare (2012), Australia’s Health 2012, p6