Forget typhoid and tuberculosis, these days the epidemics are heart disease and diabetes. But is our current health system, principally conceived in the 1970s and early 80s, equipped to deal with the challenge?
According to health experts, the answer is not really and not well; but the question remains as to how the health system should be changed to improve that.
That is the question at the heart of a community consultation process underway, led by the Department of Health’s Primary Healthcare Advisory Group. The group, chaired by former president of the Australian Medical Association and general practitioner, Dr Steve Hambleton, is still currently seeking comments and feedback, including from patients and ordinary people in the community, on a discussion paper called, Better outcomes for people living Chronic and Complex Health Conditions through Primary Health Care’.
It’s a really important topic. While Australia is fortunate to have a pretty good health system that performs well by international standards, it’s certainly not perfect. One of the challenges is that the types and nature of healthcare has changed since our Medicare system was established, largely because of demographic and lifestyle changes.
Health challenges have changed
In the first half of last century, the most common causes of death were infectious diseases – like tuberculosis, influenza, smallpox, whooping cough and tetanus – and accidents and injuries. Infant and child mortality was high. Population-wide vaccination programs and other medical advances have eradicated most of these while public health initiatives in road safety and occupational health and safety have dramatically improved the death rates from accidents.
…[chronic diseases]don’t cause a swift demise but are persistent and long lasting. Generally they have to be managed, rather than cured.
We are now living an average of 25 years longer than we were a century ago and that has increased the likelihood of our developing ‘chronic diseases’ – illnesses that don’t cause a swift demise but are persistent and long lasting. Generally they have to be managed, rather than cured. They include heart disease, diabetes, respiratory diseases like asthma and COPD, arthritis, many cancers, and some mental illnesses.
These conditions are now the leading causes of illness, disability and death in Australia. According to the discussion paper, 35 per cent of Australians, or around 7 million people, have a chronic condition and many people experience multiple chronic conditions. Moreover, the risk factors for chronic conditions, such as obesity, are at high levels and increasing.
Is our health system up for the challenge?
The discussion paper points out that the way our current health system is set up and organised doesn’t work well for managing chronic diseases. With chronic disease, the care needs are more complex, require more maintenance and many different interactions with different kinds of health professionals – for example, GPs and specialists, nurses, physiotherapists, dieticians and many others – across the health system.
“We are facing some significant system challenges that primarily relate to a shift […] from infectious diseases requiring episodic, or one-off care to chronic illnesses that require more ongoing care with input from multiple health care providers,” it says.
“Medicare was designed as a public insurance mechanism, to manage episodic, or one-off illnesses and its core features have not changed. As a result, there are some health system barriers to providing the ongoing, comprehensive and coordinated care that is required to manage chronic and complex health conditions.”
As Dr Hambleton says, we can do better. And everyone has a chance to provide input.
A source of frustration
As users of the health system, these barriers are probably very familiar to many of us and a regular source of frustration.
Why is it often so hard to find the information and services we need? Why do our different health care providers work in isolation from each other, rather than as a team, sharing information and keeping each other – and us – informed?
How often do we experience pointless duplication of questions, tests, procedures and services from different people at different points in the system? Why can’t someone coordinate it all efficiently?
The electronic health records system could help with many of these frustrations but its introduction has not been easy or well managed so far.
Meanwhile, things like transport, access to specialist services in non-metropolitan areas, communication in languages other than English, and sometimes prohibitive costs can leave even the most hardy of us feeling powerless and without hope.
As Dr Hambleton says, we can do better. And everyone has a chance to provide input.
Have your say
Unfortunately the nationwide public consultation process was only open for a short time – 6-21 August, finishing up today. But you can provide your feedback through an online survey, which will be open until Thursday 3 September.
You can read the discussion paper and some of the potential changes being discussed and take the survey by clicking on this link to the Department of Health’s website.
