Primary Health Care Reforms - National Health and Hospitals Network - Essay Example

Primary health care reforms Name Course Institution Date Introduction Reforms in the health care systems have far-reaching effects primarily being the accessibility and affordability of health care that is of high quality. The council of Australian governments ushered in a new phase of reforms in the health care sector. The commonwealth, territories and states did intend to reform the delivery, funding and organization of aged and health care (Council of Australia Governments, 2008, p. 9). The aim of these reforms is to create a national health system that receives national funding but locally run. The reforms would ensure access to health care services, improved local accountability. It would also ensure that the systems meet the needs of the communities and founded on strong financial basis. These strategies by the National Health and Hospitals Network (NHHN) would ensure that all Australians can easily access and can afford health care. This paper will focus on the implementation strategies of primary health care a stream of the reforms. The paper will proceed by giving an overview of primary health care; it will also highlight the factors calling for the sector’s reforms and the factors that have exerted pressure onto the primary health care sector. Strategies for the realization of the reforms in accordance with the heads of agreement will be highlighted and thereafter an evaluation of strategies to determine the impact on primary health care. The reforms would improve the health and hospital conditions. A successful reformed health sector will have among others the following fundamental characteristics. 1. Patients would receive flawless care across the entire health system. 2. The quality of patient care would be improved through the high performance standards set, improved transparency and engagements by clinicians. 3. The funding of the hospitals would be secure in the future. The key elements of the reforms as stipulated in the heads of Agreement are, firstly, the commonwealth renewed commitment to provide the base funds for the hospitals and to increase its contribution for the efficient growth of the hospitals of not less than $16.4billion. The funds agreement showed the treasury’s commitment to ensure continued maintenance and development of public hospitals (Council of Australia Governments-Heads of Agreement, 2011, p. 6). Secondly, the agreement indicates of the setting up of the national pool of funds that would be independent of the commonwealth and states. The independence of the body would guarantee its transparency. This body would be responsible for the transparent provision of funding to the public hospital systems. Thirdly the parties agreed to the establish a national approach for providing funds to public hospital based on their activity and in respect to the price charged for services to its patients. The introduction of activity-based-funding would ensure transparency and consequently fair pricing of hospital services. In this element, parties agreed to the formulae used to fund the rural hospital (Council of Australia Governments-Heads of Agreement, 2011, p. 7). Fourthly, the implementation of national standards for public hospitals and quality and safety assurance by the Australian commission of quality and safety would see to it that the patients received better services. Fifthly, the parties agreed that transparency would drive for higher performance standards and that this would see patients make informed choices for their health care. Performance standards would be foreseen by the National Performance Authority, which among other roles would be involved in the provision of performance reports for the public hospitals. This performance would also be reinforced by the use of a MyHospital website. (Council of Australia Governments-Heads of Agreement, 2011, p. 10). The sixth element to the parties’ agreement was local governance. The establishment of LHN’s would ensure the local running of hospitals but with a national based funding. This is because the local hospitals would be operating as separate legal entities. Other elements to the agreement would be clarity on public hospital responsibility, primary health care reforms, and reforms on aged care, dental and mental health (Family Medicine Research Centre 2008). Primary health care refers to that initial contact a patient has with the health care system. It could therefore mean the care concerned with continued care giving, accessibility, collaboration of care giving with other sectors as well as community involvement of health care provision. Primary health care by the Australian consumer definition means the health care, provided at the community or hospital level. The WHO defines primary health care to be an essential health treatment that is founded on practical, scientific and socially sound methods of technology, which is made accessible to all individuals in communities at a cost that is both affordable and sustainable. According to the WHO, this care forms a fundamental part of the nation’s health system and to the social-economic progression of the community. It is therefore that first encounter an individual and communities has with the nation’s health sector. The national health care system’s aim is to take the services as close as possible to individuals and communities at their workstations and homes (Council of Australia Governments 7). In Australia, primary health treatment is defined as that generally acceptable first instance health care that is provided by health systems. It also comprises services by an appropriately trained workforce, workforce that is multi disciplinary and offered support by an incorporated referral system. It is a system that also gives priority to those in ardent need of care thus addresses the problem of health care inequality. In addition, this care maximizes self-reliance, control and participation by the community and individuals (Starfield et al 2005, p. 458). Based on this definition it may also involve health campaigns, illness prevention, community development, care, treatment, and rehabilitation. Reforms in the primary health care sector are essential for the strengthening and improving of the quality of the health system. Such reforms enable the health system to be responsive to current and future pressures in the system. Efficiency, fewer cases of hospitalization, fewer instances of health care inequalities and low mortality rates are some of the benefits that accrue from a health care system that is responsive to environmental changes that create pressures to the system (Catholic Health Australia and Newspoll Market Research, 2007). Factors necessitating the need for primary health care reforms 1. Increased burden of diseases, increased workforce pressures and to avert the increasing prevalence of chronic illnesses (Australian Institute of Health and Welfare, 2006). 2. To minimize the number of cases needing hospitalization and the time spent seeking health care by providing appropriate community health services. 3. To reduce the in equitability gap in receiving health care services that result from regional differences of health facilities and differences in income distribution. Health care reforms are aimed at making the health care institutions responsive to current and emergent pressure. Causal pressures are the basis for strategy formulation in the institution of sector reforms. The sources of the pressures in the primary health system are discussed in this section: 1. Changes in demographic trends The Australian population has been experiencing persistent growth with figure currently estimated at 22.9 million (Australian Bureau of Statistics, 2012, p. 1). This is attributed to the high fertility levels and the influx of migrants from other countries. This increase in population calls for focused health care services for children, aged, youths and young families (Australian Bureau of Statistics, 2008, p. 1). 2. Burden of disease Chronic diseases, such as cancers and health conditions such as diabetes increase with age (Australian Institute of Health and Welfare, 2006, p. 96). The increased prevalence of chronic diseases has exerted more pressure on the health system, it expenditures and the workforce. The prevalence of diabetes for example is expected to stand at 9 % in 2020 due to the increased levels of obesity in the country. Chronic diseases have economic impacts thus the need for greater focus for controlling the diseases. Multiple chronic diseases on a person are also an emergent trend for the health care system (Australian Institute of Health and Welfare, 2006, p. 149). 3. Changes in care delivery The application of technology in care giving reduces the time of diagnosis. This reduction in time increases pressure on post care treatment such as surgeries, therapy and dialysis. This may mean more sessions of dialysis, chemotherapy and surgery being performed on a daily basis. 4. Increased expectations The rise in consumer and caregiver expectations on the best practice of care giving is the result of advancements in technology. The country has experienced more cases of inequitable health care provision. Inversed care provision had been a challenge to primary health care systems (World Health Organization, 2008, p. 1). 5. Economic implication There are various pressures on the funding of health systems. The pressures call for increased or revised formula for fund allocation. These pressures originate from demographic changes as well as an increased prevalence of chronic diseases (Australian Government, 2008). 6. The ABS puts the health care workforce population at over 600000. It is also estimated that 52% of this number are employed in hospitals, 25% being employed in primary care, 4% are specialists and 4% are employed at the community-based clinics while the remainder work in other health jobs. This workforce is aging with up to 16% being 55 years and above (Australian Institute of Health and Welfare, 2009, p. 70) with an average age of 42 years. This old generation GP workforce attends twice as much to even older patients of the ages 65 in comparison to the young generations. Reforms in the primary health care The objective of this stream was to improve accessibility to general practice and primary health care by providing an integrated and interlinked care for all patients in the aged and health care systems. The objectives of the streams reforms were stated as follows • Taking responsibility of funding of services by GPs and primary health care in the country • Providing a broader scope of primary health treatment services in a convenient location. • Providing an integrated and intertwined health care by establishing numerous Medicare locals (Australian Government Department of Health and Ageing, 2008, p. 100). • Ensuring access to GP health advice after normal working hours • Transforming the way in which patients with chronic illnesses are treated. Improving accessibility to primary health treatment by expanding and enhancing the roles played by practicing nurses (Australian Institute of Health and Welfare, 2009, p. 22). The reform strategy as formulated by the commonwealth and in accordance with the Heads of Agreement are listed below Establishment of Medicare locals would improve on the coordination and community integration of primary health care. This was aimed at bridging health care gaps and easing patient navigation to the localized health care systems. The local organizations would reflect the community needs and be governed and run by the community. The care providers would however be funded by the government (Australian Government, 2009, p. 45). The reasoning behind the establishment of this strategy was that the centers would be better placed to identify community needs and as a result address their issue (Medicare Australia 2007, p. 32). The Medicare local would aid in the improvement of care accessibility by planning localized after-hour services and consequently reduce pressures on the emergency sections. This strategy would enhance the coordination of primary health care systems by working with the current care givers to enhance integration and information dissemination. The second strategy would be established of sixty-four community based general practice super clinics. There would be infrastructural grants of 400 existing practices. This strategy would see the recruitment of 1200 general practitioners, 4600 general practicing nurses and to utilize the workforce service provision matching with community needs. The objectives of the reforms in the Australian primary health care are firstly to ensure that all community members can access to basic health care, which is culturally and medically appropriate and focused to the requirements and circumstances of the community (Medicare, 2008). Such a service would also be apt and affordable. Secondly, the reforms would see to the establishment of patient-oriented health care system that is supportive of health literacy, personal preference and self-management. The third objective would be to ensure that the systems focus on preventive health care that entails support for lifestyle change. The fourth objective is the provision of a well-integrated, continued and coordinated health care with particular interests on complex and multiple conditions. The service delivery would be safe, of high quality and having room for continued improvement through appropriate research and innovations in the systems. It would also see better information management that would be underpinned on the use of eHealth. The service delivery would end up being, flexible and responsive to community needs through sustainable operations models. The reforms would also focus on making the working environment conducive to attract and retain an efficient health care. In this light, the reforms would also see to the provision of quality training for practicing and the new health care employees. The reforms would also ensure fiscal sustainability, efficiency and cost effectiveness (Australian Institute of Health and Welfare, 2009). This next segment will look at the milestones made in this system’s reforms. The accessibility to GPs has risen to 80% of Australia’s population visiting GPs once annually (Catholic Health Australia, 2007, p. 12) primary health care is comprised of GP together other specialists such as doctors and nurses. There is still a percentage of Australian residents who cannot still access primary health care services as at and when needed for various reasons (Australian General Practice Network, 2007, p. 45). The accessibility of health care is dependent on the availability of the workforce. Specialists are majorly located in the cities. This then means that a great proportion of the care centers are experiencing workforce shortages of up to 70%. This is because a great majority of these specialists prefers the urban centers to the remote areas (Australian Government Department of Health and Ageing, 2008b, p. 100). The issue of availability of the workforce may have the result of logistical difficulties of providing health care to a dispersed population (Australian Government Department of Health and Ageing, 2008b, p. 100). The accessibility of health care is to be made possible by providing after hour care. Despite the fact three quarters of general practitioners have signed in for after hour, it has remained difficult for Australians to access care during weekends, holidays or during the night (Australian General Practice Network, 2007, p.12). In view of the above challenges of rural accessibility to health care, infrastructural development in the rural areas could act as an incentive for the workforce to be willing to relocate to the rural and remote areas. National Rural and Remote Health Infrastructure (NRRHIP) provide opportunities for partnerships for accessing funds to deliver primary health care to the rural residents (Australian Government Department of Health and Ageing, 2009, p. 90). There have been government responses that have seen the establishment of super clinics for the GPs, which is a positive indicator of its commitment to improving primary health care provision through infrastructural development (Britt, 2008, p. 12). Accessibility of allied health practitioners has been difficult for the majority of Australian. Allied practitioners are psychologists, nutritionists and physiotherapists. The funding for these practitioners has been, made from the territorial or state fund. The commonwealth, in the spirit of making the services of allied workers accessible, have invested in programs that see to it that persons requiring their services get access to their services. Additionally MBS provides funding for patients that require allied services. However, the conditions placed for eligibility to such funding such as patient enrollment to a local GP or the need for the patient to be suffering from chronic illnesses. Other challenges to the accessibility of primary health care are in service delivery, which is relatively complicated and not coordinated with other health care systems (Australian Government Department of Health and Ageing, 2009, p. 34). A large proportion of Australians’ can easily access affordable health care though there is a percentage of who cannot get affordable health care because of location disparities. The cultural contexts of the health care should also be put under consideration. This is because people will not shy always for an institution that is considered culturally awkward. Thus before the establishment of a Medicare local, sufficient research into the culture of the residents needs to be done so as to avert this challenge. The second milestone made having implemented the reforms is the development of the Australian charter of health rights. Among the rights provided to the patients are accessibility, safety, communication, respect and participation. The rights are aimed at making the system person centered an attribute that improves the intensity of treatment and the quality of living. However, in general practitioners are not sensitive to the beliefs and understanding of the patients. A major shortcoming to this objective is that income and ethnicity are factors that have led to the variations in accessibility of health literacy self-management of diseases among the patients has been recorded as improving (Osbourne, 2004, p. 22). These are patients’ personal involvement in activities that mitigate the effects of their conditions and the prevention of getting chronic diseases. More literacy campaigns should be underway in order to encourage self-management and prevention of illnesses (Howell, 2006, p. 45). To bridge the gap of receipt of medical services, the health of indigenous people should be of priority as opposed to laying emphasis on the health of aboriginal. Appropriate health workers should be involved in encouraging self-management of illness especially for disadvantaged and marginalized people. Information should also be made available to patients so that their understanding of their rights. This would help improve on individual centeredness of health care provision (Australian General Practice Network, 2007, p. 89). As a part of the preventive care strategies, general practitioners have been involves in disease control programs such as immunization, risk factor identification and disease screening. A large portion of treatment by the GPs is in the form of health advice. However, the gap in health care services is because of involvement in risky behavior such as intake of alcohol and smoking. Absolute preventive care is only; possible if this duty is delegated to other practitioners as opposed to heavily relying on general practitioners (Australian Institute of Health and Welfare, 2006, p. 78). Conclusion The outcomes of the reforms have been longer life expectancy and General practice is much more affordable. The reforms have addressed major issues of accessibility, affordability and bridging the gap of health care accessibility. However, problems in the sector do exist touching the patients and the providers probably due to the changing needs of the patients and health institutions. Such trends needed to be analyzed in to ensure that the reforms established were fully implemented and successful. References Australian Bureau of Statistics, 2008. Population Projections, Australia, 2006-2101, ABS Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/ Australian General Practice Network, 2007. Real Health Solutions key election priorities launched today, retrieved from: http://www.agpn.com.au/client_images/120922.pdf Australian Government, 2009. 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