The OECD has this week released a report of their evaluation of the quality of Australian health care.
The good news is that Australia has the 6th highest life expectancy of OECD countries with its residents living to an average age of 82.2 years. It also has the fourth lowest smoking rate (12.8%), and deaths from heart disease are well below the OECD average. This is all in spite of the fact that Australia is the fifth most obese country with 28.3% of Australians aged 15 and over being obese.
The bad news is that compared to other countries with a similar federal system, the Australian health care system is particularly complex. Responsibilities are split between federal and state governments and according to the OECD, this has led to a system that is fragmented and difficult for patients to navigate. Care coordination is complicated even more by a division of care between “primary care” and “community health” resulting in the possibility of duplication of services as well as a lack of coordination.
It is perhaps not surprising that the OECD should highlight the complexity of the Australian health care system. This complexity has developed historically and been driven more by politics than considerations of efficiency or quality. Unfortunately, there has been little to offset the complexity. The use of technology by the Australian health care system outside of GP surgeries has been, as the OECD report, “slow and disappointing”. This lack of uptake of information technology has been responsible for another aspect of the system that received a poor rating by the report authors, namely the lack of data on quality of care and patient outcomes, particularly in primary care.
Fixing the deficiencies
Some of the problems highlighted in the report could be fixed “relatively” easily. The introduction of healthcare identifiers in Australia will slowly allow health care data to be properly identified and linked across the entire system. Adoption could even be accelerated by making its use mandatory through changes in legislation.
The argument for health identifiers is a compelling one. The current system relies on patient identification by name, address and date of birth and in a complex system like Australia’s, is particularly prone to error. Use of an identifier for laboratory and radiology reports is plain common sense.
Updating information technology throughout the health care system is another matter and one with no easy solutions. The main barriers for this are the extremely high cost of these systems and the relatively low organisational abilities of our current health services to be able to implement them successfully.