What Policy Reforms Would Address the Challenges Facing the Primary Health Care Sector in Australia - Literature review Example

Primary Health Care Name Institution Date Introduction Primary health care comprises of the first level with which persons, families as well as communities come into contact with the health care system (APNA, 2012). According to the Primary health care (PHC) involves the first level of care that is social appropriate, acceptable universally and scientifically sound. It is care that is provided by a trained workforce with the support of referral systems that are integrated. It gives priority to those in most need, while maximizing the self reliance of community and individuals together with the participation and collaboration with other sectors for the purpose of promoting public health (Australian Primary Health Care Research Institute, 2015). This essay aims at discussing the primary health care in Australia, its challenges and policy reforms that can be implemented in addressing the challenges that face the primary health care sector in Australia. Services offered in Primary Health Care The various services offered in primary health care include illness prevention, caring for the sick, health promotion, advocacy as well as community development. In Australia, primary health care also involves the intersecting principles of empowerment, equity, access, inter-social collaboration and community self determination. It incorporates having an understanding of the various determinants of health such as cultural, economical, social and cultural factors (Keleher, 2001). In primary health care, nurses work on various setting including community, domiciliary, educational, information and unstructured settings. The Australian Institute of Health and Welfare (2015) states that the primary healthcare in Australia includes various frontline health services that are delivered within the community like optometry services, dental services, physiotherapy and other community as well as public health initiatives. It also comprises of medical costs that are given through hospital funding. The Australian Government (2009) states that the primary health care nurse has the responsibilities of preventing illnesses, promoting health, midwifery, policy development and advocacy, education and research, rehabilitation and palliation, population and public health, treatment of sick people, antenatal and postnatal care and giving care for the sick people as well as community development Phillips, Pearve, Hall, et al., (2009) describes the roles of the PHC nurse as an organizer, problem solver, patient carer, quality controller, agent connectivity, improvement agent and educator. The importance of these roles to the nurse depends on the context of nursing that they are operating. Funding of the primary health care in Australia The Australian Institute of Health and Welfare (2015) describes that primary health care in Australia accounts for similar spending just like hospital services. In the year 2011-2012 budget, PHC accounted for 36.1% ($50.6 billion) spending of the total health expenses of the government while hospital services accounted for 38.2% ($53.5 billion) of the total government expenditure (ABS, 2013). Primary health care in Australia is funded by the Australian governments as well as state and territory governments. Challenges Facing Primary Health Care Sector in Australia The primary health care sector in Australia is faced with various challenges that hinder its effective administration of health services to the population. According to Britt, Miller, Henderson, Bayram, Valenti, Harrison et al., (2013), the health care system in Australia and specifically the PHC faces several challenges that hinders it provision of effective, well coordinated and timely care to the Australian people. These challenges if not addressed have a possibility of extending even in the future. As per the Australia’s Health Report 2014, the primary health care in Australia faces the challenge of an increased ageing population that has been changing the nature of health care services demands in primary health care (AIHW, 2014). There are increasing risk levels of factors like physical inactivity as well as obesity and increased prevalence of multiple chronic diseases. There has been an increase in the expectations of patients for health care services of high quality and their involvement in the provision of care. There are disparities in accessing primary health care together with varying outcomes for people from different groups of population in Australia. For example, the people who live in lower socio economic areas, those living in the most remote areas in Australia, as well as the Aboriginal and Torres Strait Islander Australians. Additionally, in Australia, there is no equal access of properly trained health care professionals all over the regions. There is also an economic climate that is uncertain that affect individual and government choices on spending on health (Armstrong, Gillespie, Leeder, Rubin & Russell, 2007). The challenges faced by the primary health care in Australia have caused the need for increased importance in the effectiveness of the health care system in delivering outcomes that are cost effective. A renewed focus has been initiated so as to ensure effectiveness of health care services in primary health care in Australia. However, the big question is that what initiatives need to be implemented so as to ensure efficiency of health care in primary health care in Australia? Various policy reforms need to be implemented to help in addressing the challenges facing the primary health care sector in Australia. Need for Policy Reforms The above challenges pose a great danger to the Australian population with the exposure of chronic diseases placing a huge demand on the health care system whereby over 50% of the patient consultations with general practitioners in Australian hospitals being conditions that are chronic like diabetes, cancer and heart disease (AIHW, 2014). Compounded with the many challenges, the primary health care sector in Australia has been operating desperately offering different health care services instead of having a service system that is integrated. This has made it difficult for the primary health care sector in Australia to effectively respond to pressures in health care demands that are changing including emerging technologies, change in clinical practice, demographic changes and changes due to the burden of disease. The PHC sector is also affected in terms of coordinating across and within the different elements of wider health care system in meeting the health care needs of every individual patient (Commonwealth of Australia, 2010). It is also evident that the accessibility of primary health care service for individuals and the quality of care that they receive depends on the areas that they live, the service providers available in the area, the specific condition as well as the circumstances and their clinical needs. Patients with needs that are complex are usually left to look for a health care system that can handle their complex health care needs on their own. Even when the patients are assisted by general practitioners, they tend to experience information gaps on health care accessibility for their complex needs. The flow of information from the GPs may be distorted or there is a limited influence of the patients to health care decisions in other services. Policy Reforms In developing the policy reforms, it is important to have an understanding of the challenges that face the primary health care sectors in Australia. This is a good way of having a background of the type of policies that are needed to the implemented so as to help in addressing the challenges. Duckett & Willcox (2011) denotes that the inputs made by the government on the Australian primary health care services like health care finances, the health care workforce and the responsibilities of the state as well as federal government need to be addressed. These are aspects that affect the outcomes of primary health care ranging from consumer confidence together with the need for policy change in the primary health care. Policy reforms should be developed based on these areas. Based on the challenges facing the sector and areas that can help in improving the sector, various policy reforms will help in addressing these challenges in the primary health care sector in Australia. These policy reforms include the need for a policy to establish a network for primary health care organizations (Medicare Locals), a policy to boost the primary health care workforce, a policy to implement eHealth records system and investing in primary health care infrastructure. These policy reforms will help in addressing the inequalities in primary health care sector together with the gaps and also meet the future challenges like the increasing rate of chronic diseases in Australia. The key priority areas for the policy reforms are advocating for initiatives such as management of the health care needs for people who have diabetes using an enrolment program that is voluntary, improvement of accessing services of health care for the elderly, being able to access primary health care after the working hours are over and increased focus on preventing diseases. Kringos, Boerma, Hutchinson, van der Zee, & Groenewegen (2010) state that the future primary health care in Australia depends on having a primary health care system that is responsive, strong and cost effective. The policy reforms will help equip the Australian health care system to ensure it meets future challenges in primary health care. Having funding as well as service delivery arrangements within the national framework can help in better responding to the primary health care needs and priorities of the Australian local communities (Fuller, Edwards, Martinez, Edwards & Reid, 2004). By taking an initiative of policy responsibility and fully financing the primary health care, the government of Australia can help in driving efficiencies within the primary health care system and also reduce the pressures on public hospitals. In such a case, the policy reforms advocate for a modern primary health care to be build based on five building blocks of regional integration, skilled workforce, infrastructure and eHealth (information and technology). Medicare Locals A policy reform for establishing primary health care organizations (Medicare locals) is necessary. All organizations and service providers operating within the primary health care system will be required to integrate and coordinate themselves in providing a model of care at the local level (Shortell, Casalino & Fisher, 2010). This policy reform will be essential in reducing congestion at public hospitals by people being able to receive primary health care services and advice at their local area. It is also a good policy reform that will help in achieving geographic distribution of skilled health care professionals even to the local areas instead of concentrating health specialists in the urban areas. Through the policy of establishing the primary health care organizations network, extra communities all over Australia will be able to receive health care services. These communities will also be able to make health care decisions at the local level in line with their primary health care needs. Pearce, Shearer, Gardner, Kelly & Xu (2012) describes that Medicare locals are essential institutions that help in building divisions of general practice networks that exist by assisting in the improvement of accessing and reduction of inequality, achieving an enhanced management of chronic conditions, increase in disease prevention focus and quality improvement, accountability, safety and performance. The Department of Health and Ageing (2012) denotes that Medicare locals help in monitoring and reporting performance of primary health care including the needs assessment of communities. This is essential for the organizations to plan and make decisions of health care. Boost the primary health care workforce A policy to boost the primary health care workforce is necessary in meeting the challenges faced in this sector. Harris, Jayasinghe, Christl, Proudfoot, Crookes, et al., (2011) says that having enough health care workforces at the primary health care is essential in meeting the challenges in the sector. The sector requires the provision of coordinated care especially in the management of chronic conditions. Hurst (2006) denotes that a multi disciplinary team in the primary care organizations will be suitable for effectively dealing with chronic diseases at the community levels. The policy reform needs to be set based on requiring a health care workforce that is well trained, flexible, with roles and responsibilities that are clear and built within core competencies. The workforce should be working together for the purpose of delivering quality and cost effective primary health care to patients. Continued training to build on their skills should be included in the policy to be enhanced through teamwork as well as training (Australian Government, 2010). This policy will provide an active management of patients who have chronic diseases and are not easily reached. It will also be a good strategy that will help achieve prevention activities that are well coordinated, available and integrated whereby health care professionals are keen in risk assessment, follow up and supporting patients. eHealth records system A policy requiring all primary care health care organizations needs to be implemented to help in managing patients’ information. This is a good policy initiative that will assist in developing a primary health care information system that is suitable for reporting performance and describing the achievement of the sector (Epstein, Fiscella, Lesser & Stange, 2010). Having a policy reform of eHealth records system in all primary health care organizations in Australia will play a big role in having an overarching framework of performance indicator in the sector of the level of population, the health care services available and administrative data extracted from the clinical care systems (McClellan, McKethan, Lewis, Roski & Fisher, 2010). In primary health care, this policy reform should involve a mandatory standard for electronic medical record content, a voluntary reporting systems and a health care indicator to be used by the health system managers and policy makers. The use of new technologies and targeted programs will help improving patient health outcomes in primary care, deliver capacity, integrated, quality as well as cost effective care (Australian Government, 2010). Patients will also be able to get involved in the provision of care through access of quality health care data. They will be able to choose a provider, facility and practice in primary health care. Investing in primary health care infrastructure According to McMurray & Clendon (2015), investing in primary health is one of the policy reforms that will work as a building block that underpins a responsive as well as an integrated primary health care system in Australia. A policy to improve on physical infrastructure in local areas will be an initiative that will work to support different models of care for the purpose of improving accessibility, support, integration as well as enabling teams in effectively training and working together (Australian Government, 2010). Financing arrangements by the government needs to be made at the local levels so as to build on the strength of primary health care system in Australia. This will help in identifying and filling local service gaps and also focusing on interventions that are cost effective. Evidence Based Policy Evaluation Evidence based policy evaluation involves determining whether the proposed or implemented policy is effective and meets the contents and specifications of an effective policy supported by evidence (Davies, 2014). Evidence based policy evaluation involves monitoring as well as assessing the policy intervention, process and its impact on the intended purpose. Young, Ashby, Boaz & Grayson (2002) state that a policy needs to be evaluated to determine its effectives and provide a basis for making decisions in the future. The evidence of the policy should be objective, relevant and also thorough. Shaxson (2005) describes that a policy should be developed by first understanding the issue and deciding what type of evidence is needed, carrying out research that will provide new evidence, interpret and apply the new and existing evidence to come up with policy that is suitable for the defined problem. The policy reform proposed for meeting the challenges facing the primary health care sector in Australia is evidence based. Based on the description on an evidence based policy, the decided policy reforms in the primary health care sector in Australia followed the defined process of coming up with these policy reforms. The problems or challenges facing the sector were first identified and corresponding policies were developed as per the identified areas that needed to be improved. The policy reforms were also supported evidence from literature that describes why such policy interventions are needed to be implemented in primary health care in Australia. Conclusion The policy reforms required in addressing the challenges facing the primary sector in Australia are based on the defined problems within the sector. This assignment aimed at identifying the areas that hinder the effective delivery of primary health care and coming up with corresponding policy reform that will help in addressing these challenges. The major areas that were identified in this paper included the need for better technology, increased skilled personnel in the sector, funding and infrastructure as well as need for integrated primary health care organizations (Medicare locals). Corresponding policy reforms were discussed based on these areas that need to be improved in the primary health care to achieve effective care for patients in this sector in Australia. To ensure that the policy is applicable in practice, an explanation of it being an evidence based policy confirms its suitability to solve the current challenges in the PHC when implemented. References ABS. (2013). Australian Health Survey: health service usage and health related actions. 2011–12. ABS cat. no. 4364.0.55.00. Canberra: ABS. APNA. (2012). Definition of primary health care nursing. Supporting Nurses in Primary Health care. Retrieved from http://www.apna.asn.au/lib/pdf/DefinitionofPrimaryHealthCareNursing.pdf Armstrong, B., Gillespie, J., Leeder, S., Rubin, G., & Russell, L. (2007). Challenges in health and health care for Australia. Medical Journal of Australia, 187(9), 485. Australian Government. (2009). Primary Health Care Reform in Australia. Report to Support Australia’s First National Primary Care Strategy. Australian Government. (2010). Building a 21st Century Primary Health Care System Australia's First National Primary Health Care Strategy. Department of Health and Ageing. AIHW. (2014). Australia's health 2014. Australia's health series no. 14. Cat. no. AUS 178. Canberra: AIHW. The Australian Institute of Health and Welfare. (2015). Primary Health Care in Australia: Preventing and treating ill health. Australia’s Health 2014. Australian Primary Health Care Research Institute. (2015). What is primary health care? Australian National University. Retrieved from http://aphcri.anu.edu.au/about-us/what-primary-health-care Britt, H., Miller, G., Henderson, J., Bayram, C., Valenti, L., Harrison, C., et al. (2013). General practice activity in Australia 2012–13. General practice series, no. 33. Sydney: Sydney University Press. Commonwealth of Australia. (2010). Building a 21st Century Primary Health Care System: Australia’s First National Primary Health Care Strategy. Australian Government, Department of Health and Ageing. Davies, P. (2014). The State of Evidence-Based Policy Evaluation and its Role in Policy Formation. Journal of the National Institute of Economic and Social Research,  219(1):41-52. DoHA. (2012). Background paper: Medicare Locals health needs assessment and planning. Canberra: DoHA. Duckett, S., & Willcox, S. (2011). The Australian Health Care System, 4th Edition. Oxford University Press. Epstein, R., Fiscella, K., Lesser, C., & Stange, K. (2010). Why the nation needs a policy push on patient-centered health care. Health Affairs, 29(8), 1489-1495. Fuller, J., Edwards, J., Martinez, L., Edwards, B., & Reid, K. (2004). Collaboration and local networks for rural and remote primary mental healthcare in South Australia. Health & social care in the community, 12(1), 75-84. Harris, M., Jayasinghe, U., Christl, B., Proudfoot, J., Crookes, P., et al., (2011). Multidisciplinary Team Care Arrangements in the management of patients with chronic disease in Australian general practice. Medical Journal of Australia, 194(5):236–9. Hurst, K. (2006). Primary and community care workforce planning and development. Journal of advanced nursing, 55(6), 757-769. Keleher H. (2001). Why Primary Health Care Offers a more Comprehensive Approach to Tackling Health Inequalities than Primary Care. Australian Journal of Primary Health, 7(2), 57-61. Kringos, D., Boerma, W., Hutchinson, A., van der Zee, J., & Groenewegen, P. (2010). The breadth of primary care: a systematic literature review of its core dimensions. BMC health services research, 10(1), 65. McClellan, M., McKethan, A., Lewis, J., Roski, J., & Fisher, E. (2010). A national strategy to put accountable care into practice. Health Affairs, 29(5), 982-990. McMurray, A., & Clendon, J. (2015). Community health and wellness: Primary health care in practice. Elsevier Health Sciences. Pearce, C., Shearer, M., Gardner, K., Kelly, J., & Xu, T. (2012). GP Network as enablers of quality of care: implementing a practice engagement framework in a General Practice Network. Australian Journal of Primary Health. 18(2):101–4. Phillips, C., Pearve, C., Hall, S., et al., (2009). Enhance Care, Improving Quality: The Six Role of the General Practice Nurse. MJA, 191(2):92-97. Shaxson, L. (2005). Is your evidence robust enough? Questions for policy makers and practitioners Evidence and Policy. A Journal of Research, Debate and Practice, 1(1):101-111. Shortell, S., Casalino, L., & Fisher, E. (2010). How the Center for Medicare and Medicaid Innovation should test accountable care organizations. Health Affairs, 29(7), 1293-1298. Young, K., Ashby, D., Boaz, A., & Grayson, L. (2002) Social science and the Evidence-based Policy Movement. Social Policy and Society, 1:215-224. Read More