National Health Reform

Building a 21st Century Primary Health Care System: A Draft of Australia's First National Primary Health Care Strategy

The Case for Change

Changing nature of the health system

• Significant changes to the overall health system, including developments in the acute sector and in the provision of hospital care, have placed additional demands on primary health care.
• These changes suggest the health system overall would benefit if a more systematic response from primary health care, together with more effective integration of other health sectors with primary health care, could be achieved. Primary health care services have historically been delivered in a relatively unplanned environment.

Demand pressures

• Ageing, the growing burden of chronic disease and changes to the way in which care is delivered, particularly across acute and primary health care sectors, have placed increasing pressures on the health system.
• Traditional organisational and funding structures are focussed more towards treating episodes of ill-health, rather than prevention and ongoing management of disease. As the burden of disease has moved increasingly to chronic conditions, enormous pressure has been placed on the service system.

Variable access

• There are disparities in access and outcomes across different parts of Australia and between different population subgroups, often associated with disadvantage, perhaps most significantly for Indigenous Australians.
• Some Australians do not have the health literacy skills needed to navigate the health system and are often left unsupported in their patient journey. Primary health care services do not always provide adequate and culturally appropriate support and transitions across settings are not well managed.

Poor integration

• Service delivery is characterised by multiple and fragmented funding streams, and service delivery arrangements can be inflexible and poorly coordinated, both within primary health care but also across hospitals, aged care and specialist care.

Safety and quality

• There is a lack of good information and performance measures to support primary health care professionals, consumers, funders and policy makers.
• Technological change has added costs to parts of the health system and opened opportunities to treat patients in different care settings, often without accompanying care and follow-up.
• Use of technologies including eHealth is falling behind consumer expectations, other service industries and progress in other comparable health systems.

Workforce shortages and inflexibility

• Workforce shortages exist across most primary health care professions, and are exacerbated by mal-distribution.
• Funding arrangements, rather than clinical need, can determine which services individuals access and which health professionals are involved in their care.
• Current education and training arrangements do not support the future needs of primary health care.