The Australian health care system: reform, repair or replace?

Duckett, Stephen

doi:10.1071/ah080322

Cited by 29 publications

(23 citation statements)

References 19 publications

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“…Duckett 3 considers that it is extraordinary that Australia still does not have a comprehensive platform on which to build community-based health services, as the brief flirtation with a nationally mandated community health program initiated in the early 70s was undone by subsequent governments. Most organisational differences between jurisdictions are not evidence based, and having blurred the boundaries between policy direction and service delivery, most are devoting significant resources to 'crisis managing' their service systems.…”

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confidence: 99%

The future of community-centred health services in Australia: lessons from the mental health sector

Rosen

Gurr

Fanning

2010

Aust. Health Review

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Abstract* It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. * Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospitalcentred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospitalcentred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. * The reasons for these trends are explored. * The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. * Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services.What is known about the topic? Community-centred health care has been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions, e.g. in mental health service systems. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What does this paper add? Despite this global consensus, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends and possible solutions are explored. What are the implications for practitioners? Unless this trend is reversed, the loss of convenient public access to community health services at shopping and transport hubs and the consequent compromising of intensive home-based clinical care, will lead to a deterioration of preventative interventions and the health care of long-term conditions, contrary to international studies and reviews.

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confidence: 99%

The future of community-centred health services in Australia: lessons from the mental health sector

Rosen

Gurr

Fanning

2010

Aust. Health Review

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“…Schlenker T found that the traditional medical providers were included in the Medicaid Waivers to help achieving the "Triple Aim" goals in the United States Texas [31]. It's suggested that the government should carry out sustainable strategic design when designing and arranging hospital investment, and allocate sufficient resources which will help to effectively address patient needs, technological changes and increased acumen [32,33]. The growth of fixed assets also has a positive impact on PTHs' revenue growth [16].…”

Section: Discussionmentioning

confidence: 99%

The effect of government financial investment on the development of traditional medicine: Evidence from public Traditional Chinese Medicine hospitals (PTHs) of Henan Province, China

Ren

Fu²,

Tarimo

et al. 2020

Preprint

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Background Traditional medicine has long been used to address relatively common illness, and Chinese government has been continually increasing its investments on Public Traditional Chinese Medicine hospitals (PTHs) in recent years. Objectives This study aimed to assess the scales and structure of investments on PTHs in Henan Province, China, in order to analyze the contribution of Government Financial Investment (GFI) to the revenue growth of PTHs, as well as raising practical investment strategies for decision-makers. Methods This study was a panel data research, conducted in Henan Province, China. By collecting 143 PTHs’ operational data from 2005 to 2017, the authors computed data with Barrow Economic Growth Model (BEG), Stochastic Frontier Analysis (SFA) and Vector Autoregressive Model (VAR), respectively.Results The study observed that the contribution of GFI to PTHs’ revenue growth was positive (average MPG=2.84), which means the scale of GFI hadn’t reached an optimal level. The scales of GFI on Grade III, Grade II A, Grade II B PTHs need to be increased by -5.96%, 4.88% and 11.51% respectively in order to maximize the input-output efficiency. The third year after the investment year may be a more effective period for conducting an effect evaluation of GFI in Henan Province.Conclusions GFI on PTHs usually has a long-term impact on PTHs. Government needs to adjust its GFI policy to maximize the input-output efficiency.

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“…[141][142][143][144] Three aspects of economic efficiency were examined: (1) productive efficiency, analysed from econometric reports on efficiency; 10,12,13,15,22,52,145 (2) allocative efficiency measures, which, in the present study, are based on systems for priority setting for public hospital capital allocation and patient access; and (3) dynamic efficiency, assessed by examining systems for environmental sustainability, responsiveness to innovation and patient-centred care. 17 Productive efficiency was scored from three studies ranking WHO member countries for health service allocative and productive efficiency. 15,22,52 These three studies ranked 191 countries using frontier production function model and data envelope analysis, and were reviewed by an international scientific committee [146][147][148] and by the European Commission study of health system efficiency.…”

Section: Methodsmentioning

confidence: 99%

“…12 Dynamic efficiency examines how effectively capital distribution systems respond to emerging risks for public hospitals, including sustainability, patient demand, technological change and increased acuity. [17][18][19] An effective system of capital allocation for public hospitals would provide equity of access for patients, be appropriate, efficient and would fund quality services. 20 So the aim of the present study was to ask the question, is the system of capital funding for Australian hospitals effectively funding patient access to efficient public hospital care?…”

Section: Introductionmentioning

confidence: 99%

Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care?

Kerr

Hendrie

2018

Aust. Health Review

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This study asks 'Is capital investment in Australian public hospitals effectively funding patient access to efficient hospital care?' The study drew information from semistructured interviews with senior health infrastructure officials, literature reviews and World Health Organization (WHO) reports. To identify which systems most effectively fund patient access to efficient hospitals, capital allocation systems for 17 Organisation for Economic Cooperation and Development (OECD) countries were assessed. Australian government objectives (equitable access to clinically appropriate, efficient, sustainable, innovative, patient-based) for acute health services are not directly addressed within Australian capital allocation systems for hospitals. Instead, Australia retains a prioritised hospital investment system for institutionally based asset replacement and capital planning, aligned with budgetary and political priorities. Australian systems of capital allocation for public hospitals were found not to match health system objectives for allocative, productive and dynamic efficiency. Australia scored below average in funding patient access to efficient hospitals. The OECD countries most effectively funding patient access to efficient hospital care have transitioned to diagnosis-related group (DRG) aligned capital funding. Measures of effective capital allocation for hospitals, patient access and efficiency found mixed government-private-public partnerships performed poorly with inferior access to capital than DRG-aligned systems, with the worst performing systems based on private finance. Australian capital allocation systems for hospitals do not meet Australian government standards for the health system. Transition to a diagnosis-based system of capital allocation would align capital allocation with government standards and has been found to improve patient access to efficient hospital care. Very little is known about the effectiveness of Australian capital allocation for public hospitals. In Australia, capital is rarely discussed in the context of efficiency, although poor built capital and inappropriate technologies are acknowledged as limitations to improving efficiency. Capital allocated for public hospitals by state and territory is no longer reported by Australian Institute of Health and Welfare due to problems with data reliability. International comparative reviews of capital funding for hospitals have not included Australia. Most comparative efficiency reviews for health avoid considering capital allocation. The national review of hospitals found capital allocation information makes it difficult to determine 'if we have it right' in terms of investment for health services. Problems with capital allocation systems for public hospitals have been identified within state-based reviews of health service delivery. The Productivity Commission was unable to identify the cost of capital used in treating patients in Australian public hospitals. Instead, building and equipment depreciation plus the user cost of capital ...

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The Australian health care system: reform, repair or replace?

Cited by 29 publications

References 19 publications

The future of community-centred health services in Australia: lessons from the mental health sector

The future of community-centred health services in Australia: lessons from the mental health sector

The effect of government financial investment on the development of traditional medicine: Evidence from public Traditional Chinese Medicine hospitals (PTHs) of Henan Province, China

Is capital investment in Australian hospitals effectively funding patient access to efficient public hospital care?

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