National Health Reform

Primary Health Care Reform in Australia - Report to Support Australia’s First National Primary Health Care Strategy

Summary and conclusions

Primary health care is an integral part of the Australian health care system. At a broad level, the outcomes look good and compare well internationally:

• long life expectancy;
• affordability of GPs.

Primary health care in Australia is delivered by a mix of public and private, Commonwealth and state/territory services. It is best described as a sector, rather than a system. Hence, as other parts of the health system such as acute care have changed and evolved, the primary health care sector has not been able to respond effectively in a coordinated manner to this change. This is most obvious at the points of intersection, for example people who are treated both in the hospital sector and primary health care, and in the management of conditions that were once undertaken in hospital, but can now effectively be managed
out-of-hospital.

There are many points of failure in the primary health care sector, for both patients and health care professionals:

• Access to the full range of primary health care professionals can be a major issue, either because the health professional required is not located in the region, or because an individual has physical, cultural or affordability barriers in getting to the health professional.
• Even where services are on the ground, both patients and providers can find it difficult to navigate the range of services and providers to obtain the best care possible.
• Funding models are relatively inflexible, and sometimes mitigate against the right care being provided by the right person appropriate to their health care needs at the time.

These problems apply across the board for patients and providers. For those patients with higher care needs, and who need to see a variety of health care providers, there are additional issues in relation to:

• quality and safety, especially at the point of information transfer;
• affordability of services; and
• referral pathways.

The options for the Australian Government, as the major funder in this sector, in responding to the changing needs of both patients and providers has been a choice between whole of system responses, such as through the MBS, or specific targeted programs. In some cases, the MBS has been used to try and address specific, targeted problems, but with limited success and some unwanted outcomes. The MBS works well as a public health insurance system for episodic care or ill-health for whole-of-population, and has been effective in underwriting the costs of running small business for GPs.

Top of pageThere are several key enablers for change identified throughout the Report. These are:

• regional integration;
• information and technology, including eHealth;
• skilled workforce;
• infrastructure; and
• financing and system performance.

These are whole-of-system issues that, in the absence of change, will continue to cause problems for both patients and providers. Addressing these issues is integral to implementing targeted change to increase the focus on prevention or better manage chronic and complex conditions.

From the 10 Elements identified in the Discussion Paper and analysed in this Report, four Key Priority Areas for change have been distilled:

• improving access and reducing inequity;
• better management of chronic conditions;
• increasing the focus on prevention; and
• improving quality, safety, performance and accountability.

To implement many of these changes requires some sort of regional governance structure to drive integration, facilitate change management and ensure that the reforms deliver real outcomes for patients at the local level, in particular to manage the program funding around chronic disease management and prevention activities.

Changes to primary health care arrangements would also benefit from acknowledging the changing interface between the acute and primary health care sectors, by promoting a more integrated role for specialists in the management of patients out-of-hospital.Top of page