Health reform report welcomed but calls for focus on primary care

The Australian Healthcare and Hospitals Association (AHHA) welcomed the recommendations in the recently released National Health Reform Agreement (NHRA) Mid-term Review Final Report.

“Expanding the focus of the National Health Reform Agreement beyond hospital funding to include health care more broadly has long been the missing piece in Australia’s health reform agenda,” said Acting AHHA Chief Executive Rebecca Haddock.

“The fact that this has been acknowledged in the Review’s Final Report is a step in the right direction towards a more sustainable and holistic healthcare system that can achieve better health outcomes for the Australian people and their communities,” Haddock said.

Need for a holistic system

The Royal Australian College of GPs (RACGP) President Dr Nicole Higgins welcomed the report’s acknowledgement of flaws in the current NHRA around health system fragmentation, bureaucratic barriers to care and a lack of focus on preventative care.

“Australia needs a holistic health system that recognises the interdependency between general practice, hospitals and allied health services,” Higgins said.

“While the NHRA aspired to that, it hasn’t occurred in practice. We need an approach that has the flexibility to adapt to local needs, but there must be a shared vision, clear roles for different parts of the system and easy exchange of information between them, and clear accountabilities. Current funding models do not encourage continuity of care between settings; they, as the report acknowledges, ‘discourage’ them.

“As we have been saying, by focusing on activity — hospital procedures — the health system has missed opportunities to support effective, efficient health care delivered by GPs. This has resulted in a health system that fails to apply the value of preventative health, where the federal government spends $3166 per person per year on public hospitals, versus $437 on general practice. The result? Growing gap fees for patients and missed opportunities to reduce hospital presentations.

“When it costs the government $611 per person for a non-admitted hospital presentation, versus around $90 for a patient to see a GP, it’s clear where the value lies. As the report says, we need a health system that rightly values the work of GPs in preventative health and in the community after a hospital discharge.

Conservative estimates suggest a 12% reduction in hospital readmissions could save the Australian health system a minimum of $69 million per year, said Higgings noting that this conservative estimate “isn’t even accounting for better quality of life”.

“The fact is, you need to invest in the efficient parts of systems to get their benefit,” she said.

“The report discusses bundled funding to link health care delivered before, during and after a planned hospital admission, for example, but we need to see real and significant investment in general practice after years of funding freezes and effective decline.

Digital health

AHHA’s Rebecca Haddock said references to the health workforce in the current NHRA have largely been limited to isolated capability requirements rather than taking a more strategic approach. “We are pleased to now see the importance of the health workforce being recognised in the Review Final Report.

“But real reform success will require health workforce planning that extends beyond the numbers and distribution of professions and starts to consider the skills mix innovation and health funding planning required to accommodate jurisdictional difference and regional needs.

“Greater accountability is needed within the Agreement itself to systematise collaboration, and this must be supported by adequate resourcing and collective focus on reducing low value care.”

Recommendation for the National Health Reform Agreement to focus on innovation and reforming at scale would enable grassroots innovation to be structured through a collaborative, data-driven approach.

“The report also acknowledges there are lessons to be learned from the pandemic about how the system can be more efficient with a greater focus on value and equity,” Haddock said.

AHHA commended the recommendations to include a focus on digital health, alternative funding models, care pathways that consider the patient journey and Closing the Gap through a dedicated Agreement Schedule.

RACGP’s Higgins also said there were further opportunities in data sharing that were supported in the report. “This is also an opportunity to better integrate primary health and hospitals’ data,” she said.

“We can achieve this with pilot data-sharing arrangements between hospitals and primary care with the ultimate goal of better identifying at-risk patients, tailoring individual care/reducing low-value care, developing services tailored to the health needs of communities and funding support for specialist GPs located within hospitals to improve care,” Higgins said.

Image credit: iStock.com/Olesya Boltenkova