People ending up in hospital for diabetes, tooth decay, or other conditions that should be treatable or manageable out of hospital is a warning sign of system failure. And Australia’s health system is consistently failing some communities.
A Grattan Institute report, Perils of place: identifying hotspots of health inequalities, released today, identifies a number of geographical areas where high rates of potentially preventable hospital admissions have persisted for a decade. This is unacceptable place‑based inequality.
Using data from Queensland and Victoria, the report identifies 38 places in Queensland and 25 in Victoria that have had potentially preventable hospitalisation rates at least 50% higher than the state average in every year for a decade. There is no evidence to suggest the pattern is any different in other states and territories.
Reducing potentially preventable hospitalisations in these places to average levels would save at least A$10 million a year for the Queensland and Victorian health systems. Indirect savings, such as improving the productivity of the people affected, should be significantly larger.
Different places, different problems
Some of the areas identified as having high rates of potentially preventable admissions were in remote areas such as Mt Isa in Queensland. Others were in suburban centres such as Broadmeadows in Melbourne.
In some places, the high rates of admissions were driven by high rates of re-admissions – a small number of people each having a large number of admissions each year. In these places, better targeting care to high-risk individuals may help to reduce rates.
Yet in other places, re-admissions did not contribute to the problem at all.
Areas that have a low socioeconomic status, are regional, and/or have a high proportion of Indigenous people are more likely to experience health inequalities.
But even in Australia’s most disadvantaged areas, persistently high rates of potentially preventable hospitalisations are rare. Because many such areas have low rates of potentially preventable hospitalisations, examining why some have a problem while others do not may help to understand what needs to improve.
What can governments do about it?
The Grattan Institute’s report has three clear messages for governments and local health agencies such as Primary Health Networks.
First, make sure prevention efforts are focused in places where high rates of potentially preventable hospitalisations have existed for a while. These are the places where health inequalities are already entrenched and, without intervention, are most likely to endure.
On average, about half of areas which had a high rate of potentially preventable hospitalisations in one year had dropped back to closer to the state average the next year (55% in Victoria, 45% in Queensland). This means that if governments or Primary Health Networks make their intervention decisions based on just one year of data, they will have a false sense of reassurance that their interventions are working when in fact their success might just be the result of random chance.