A Healthier Future for all Australians - Final Report June 2009
3.3 Creating robust commitments to ongoing improvements in access – National Access Targets
To date, we have discussed some of the most significant access and equity issues that affect health outcomes for people now – either relating to particular services or impacting on specific population groups.
We believe that we need an ongoing way in which we can continuously measure and report on whether people are getting access to the health services they need. (Access is one important dimension of whether our health system is performing well.)
In our Interim Report, we proposed developing and using National Access Guarantees and Targets to measure the performance of hospitals. Based on further deliberation, we have refined this initial concept and we are now recommending the development of National Access Targets across the whole continuum of health services. Our rationale and development of this recommendation is as follows:
- current performance measures are weighted heavily, or almost exclusively, on public hospitals. This does not recognise that people have equally important needs to access other types of services such as general practitioners, mental health services or family and child health services. We want to ensure that access measures do not distort the allocation of resources. If we only set National Access Targets for one part of the health system, it is likely that funding (and media interest) will focus on that one issue to the detriment of other important health services;
- in thinking about access to health services, we need to recognise that health needs and use of health services form part of a continuous ‘episode of care’. Often, we only measure and value access at the ‘acute’ end of the episode of care, but access earlier in the episode of care can be equally important in improving health outcomes for people. For example, if we think about cancer, a balanced approach might include measuring access to:
- risk reduction interventions (such as smoking cessation programs);
- preventive interventions (such as the provision of the cervical cancer vaccine);
- cancer screening services (such as mammograms);
- diagnostic visits and tests (such as GP, private specialist and hospital outpatient consultations, magnetic resonance imaging);
- treatment interventions (such as cancer surgery, radiation oncology and chemotherapy); and
- palliative care (such as hospices, respite care, community nursing).
- we also must weigh the need to take a balanced approach to measuring access to a broad range of health services with an equally important objective of not creating excessive ‘red tape’ for health service providers. This means that we should identify a small number of high value National Access Targets, not create a multiplicity of measures that take health professionals away from patients; and
- we believe it is important to first develop and test the use of National Access Targets, before moving to implementation of National Access Guarantees. Some ‘targets’ may evolve into ‘guarantees’ as long as we can ensure that this does not distort how funds are allocated across the health system. Further work will be required about how to give effect to a guarantee in the health system. For example, a guarantee could be interpreted to mean that a person is given a voucher to access the same service elsewhere if the recommended access times are not met for that service. Implementing such an approach would involve significant changes to how health services are currently funded and implies that ‘substitute’ services are available, which may not always be the case. Our current proposal is that National Access Targets be given effect through the payment of ‘bonuses’ to health services that meet the targets. Achieving this will, in itself, require substantial work if we hold true to setting National Access Targets across a wide spectrum of health services, rather than just hospitals.
We want National Access Targets to be developed through broad consultation involving the community and incorporating clinical, managerial and financial perspectives. Different groups will have different values and priorities about the range of health services which should be measured against new National Access Targets.
To set the ball rolling and to demonstrate leadership on this issue, we are proposing a preliminary set of National Access Targets (see Table 3.1).
Table 3.1 illustrates both the breadth of health service domains that we believe should be included in National Access Targets and actual measures of access. Our views on progressing this preliminary set of National Access Targets are as follows:
- we would expect that these targets would be the subject of broad and extensive consultation and further refinement before their implementation. It is critical that we get real community engagement on what is valued and the priority we should give to measuring access to different types of health services;
- national Access Targets should not be cast in stone, but should evolve over time. This should occur in response to both changing community priorities and to improvements in performance in some health service domains (this means that we can move on to measuring and improving performance in other domains); and
- we know that the need for health care does not fall evenly across the whole population. This means that we should also measure access for specific groups in the population (Aboriginal and Torres Strait Islander people, residents of remote and rural Australia etc) who may have different needs than the ‘average’ person in the population.
| Table 3.1: Preliminary set of National Access Targets |
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| This set of National Access Targets identifies the maximum time119 in which patients should be able to receive access. Depending upon the urgency of their needs, some patients may require treatment much more rapidly. National Access Targets should be used in association with the development of robust triage and urgency classifications120 so that health professionals can make decisions based on the particular needs of individual patients. |
| Primary health care services: no more than 1 day to access a primary health care professional; no more than 2 days to access a medical practitioner |
| Health telephone support (National Health Call Centre Network): no more than 10 minutes to receive initial telephone advice |
| Postnatal care: home visit to a new mother within 2 weeks of giving birth |
| Crisis mental health services: response within 1 hour for emergency patients and within 12 hours for priority patients |
| Community mental health services: contact within 7 days of discharge from an acute mental health service for patients with psychosis, or within 1 month following referral for other patients |
| Drug and alcohol treatment program: within 1 month following referral |
| Aged care assessment: assessment within 48 hours for patients requiring immediate response, or 14 days for patients whose condition is deteriorating |
| Public hospital outpatient services: within 2 weeks for first appointment for urgent patients with a life-threatening condition and within 3 months for other patients |
| Radiotherapy: within 1 day for emergency care patients, 2 weeks for high priority patients and 1 month for other patients from referral to commencement of therapy |
| Planned surgery: 1 month for high priority (Category 1) patients and 3 months for priority (Category 2) patients |
| Ambulance services: 15 minutes for potentially life-threatening events in metropolitan areas |
| Emergency departments: immediately for resuscitation (Category 1) patients, within 10 minutes for emergency (Category 2) patients, within 30 minutes for urgent (Category 3) patients |
119 For simplicity, we have set these targets on the assumption that all people (100 per cent) of the population should get access within these times. However, some of these measures are now reported using the median (the time in which 50 per cent of the population can expect to receive access) or the 90th or 95th percentile. A percentile approach builds in an escalator to ‘ratchet-up’ performance over time. However, this performance improvement approach needs to be balanced with a system that is transparent and able to be readily understood by people using health services.
120 the development of this preliminary set of national Access targets has had regard to existing targets and measures in Australia and internationally. It builds upon our earlier work on the development of performance benchmarks in our first report, Beyond the Blame Game. it has also built upon existing triage and classification schemes (such as the Australasian College of emergency Medicine categorization of patients presenting to emergency departments and the Queensland Health urgency classification system for radiotherapy). We would expect that health officials would review and further develop the fine detail of these targets in consultation with relevant health professional groups.
