Primary care a ‘chronic failure’: Report

Thursday, 17 Mar 2016

An outdated model of health service delivery in Australia is failing patients with chronic diseases like asthma and costing the country millions of unnecessary dollars.

The claim comes in a controversial new Grattan Institute report titled Chronic failure in primary care, and calls for sweeping reform to the current system.

“We use the wrong model,” the authors wrote. “The dominant model of health service delivery in use today evolved in another era. It was designed to deal with infectious disease, wars and accidents. It focuses on the diagnosis and immediate treatment of acute episodes of illness by medical practitioners.”

They said greater specialisation and treatment intensity, often delivered in hospital settings, evolved over time and required patients to “present their problem, let professionals sort out what needed to be done and then follow treatment directions”.

“This model works well in the right circumstances, particularly for self-limiting episodic illnesses and injuries, but not for chronic disease,” the authors wrote.

They found “ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million each year in avoidable hospital admissions”.

“Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented,” said co-author and Grattan Health Program Fellow Professor Hal Swerissen.

“Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.

“Our primary care system is not working anywhere near as well as it should because the way we pay for and organise services goes against what we know works.”

He said care must be planned rather than reactive and focus on the patient and outcomes rather than on health professionals.

“We need more effective regional management of primary care services by Primary Health Networks,” they wrote.

“We need clear targets and financial incentives for the prevention and management of chronic disease in regional areas. The focus of chronic disease funding needs to move away from a patient-related payment to a general practice and towards a broader payment for integrated care.

“The evidence shows that a consistent approach to clinical care pathways for specific chronic diseases can make a real difference to outcomes. And for that, we need much greater investment in supporting service development and innovation in primary care.”


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