REPORTS published recently by the New York-based Commonwealth Fund show that despite having the most costly health system in the world, the United States consistently underperforms on crucial dimensions such as the promotion of healthy living, and the provision of health care that is safe, coordinated, accessible, efficient and equitable when compared with Australia, Canada, Germany, New Zealand and Britain.
Primary care doctors in the US are least likely to have clinical IT systems, to receive incentives targeted at quality, or to use nurses to improve care coordination for the chronically ill.
The reports attribute the poor American report card to the absence of universal health insurance cover and increasingly high deductibles for those who are insured, and the failure to use general practitioners to deliver a range of services and serve as the gatekeepers to more specialised care.
These findings surely provide all the evidence necessary to overturn the statements made earlier this month in a policy paper from the Centre for Independent Studies, where Jeremy Sammut proposed we opt out of Medicare before Medicare opts out on us, and Australians explore new ideas on how to self-fund their health care. What is proposed is a more costly road to poorer health outcomes.
The findings specific to Australia provide no grounds for complacency, however, and should give the next health minister cause for concerted action.
The current Minister for Health, Tony Abbott, regularly claims Australia has one of the best health systems in the world. But, in fact, Australia sits right in the middle of the pack, behind Britain and Germany, but ahead of Canada and the US.
Australia ranks poorly in the provision of quality care and efficiency, with plenty of room for improvement. Interestingly, given that less than 2 per cent of the health budget is spent on health promotion and prevention, Australia scores top marks in that area.
Primary care services provide most people with their first contact with the health-care system, and their main source of preventive and treatment services. The increasing recognition that prevention and early intervention can ameliorate the growing burden of chronic illness and keep people active and participating in the community, highlights the need to improve primary care practice.
The Commonwealth Fund found a high proportion of Australian general practitioners did not feel well prepared to care for patients with multiple chronic conditions, and the use of multi-disciplinary teams and the involvement of nurses and other health professionals lagged well behind Britain, Germany and NZ.
It seems the effectiveness of Australian programs and incentives to drive better care for people with chronic illness is sub-optimal, and should be addressed in consultation with the doctors who use them. At the same time, there may be lessons to be drawn from Britain , Germany and NZ, where doctors also routinely receive feedback on their clinical performance as well as financial incentives aimed at quality improvement.
The increasing inability of Australians to afford needed health-care services should give policymakers most cause for concern. Thirteen per cent of people surveyed said they did not visit a doctor when sick, 17 per cent did not get a recommended medical test, treatment or follow-up, and 13 per cent did not fill a prescription or skipped doses because of cost. Overall, 26 per cent of people went without needed care or treatment. Only the US reported a higher figure, at 37 per cent, and only the US had a higher proportion of people who reported out-of-pocket costs of more than $1000 for medical bills in the past year.
It is not surprising 55 per cent of Australians surveyed thought the health-care system needed fundamental changes, and 19 per cent thought the system should be rebuilt completely. Less than a quarter thought the system worked well.
The lessons from the Commonwealth Fund's scorecard are these: to turn away from a health-care system of universal coverage to a user-pays system is folly; Australia's health-care system has done well, but needs substantial reforms to address inefficiencies and improve the management of chronic illness in primary care; and a major barrier to better health outcomes is the increasing cost of care to the patient.
These issues must all be on the agenda of the next health minister.
Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.