The Australian government spends approximately A$1Billion annually on planning hospital, coordination, and reviewing chronic disease care in general practice. There are over a quarter of a million hospital admissions for medical problems that could have avoid if primary care was better for chronic diseases.
Chronic Failure in Primary Care our report that publish today. It argues primary care services aren’t working as well as they should due to the way Medicare pays for them and organizes them.
The health system of Australia built to handle infectious diseases, wars, and accidents. Chronic disease is the greatest burden on our health system.
Chronic Diseases Hospital Are Expensive
Over three quarters of Australians 65 years and older have at least one chronic condition. This puts them at high risk for serious complications or premature death. A chronic condition is responsible for around 90% of deaths.
Six chronic diseases heart disease and oral health problems, diabetes, mental disorders, musculoskeletal issues (including arthritis), asthma, respiratory disease (including asthma), and heart disease – make up about half the total cost of all disease.
These conditions are most commonly treat by primary care physicians. We are not able to manage and prevent chronic diseases in primary care.
About a million Australians affect by diabetes. This group is at a twice higher risk for dying from peripheral, heart and kidney disease than the general population.
They require help with managing their diet, exercise, smoking, and alcohol consumption. They need regular monitoring and medication. The best place to seek help is primary care from general physicians.
Analysis Hospital Revealed
Our analysis revealed that only about a fifth (or less) of diabetes patients who visit a GP each year have their blood pressure, body mass, and blood sugar recorded. About 20% of these patients achieve the recommended clinical targets. They often receive little advice or support for their self-management.
Similar stories can be found for major chronic diseases such as heart disease and chronic respiratory illness. Many times, less than half the people suffering from chronic diseases receive the recommended care. It leads to poorer outcomes for patients than is possible.
Ineffective primary care management leads to poor health outcomes and higher healthcare costs.
Hospital admissions that could be prevented are estimated at 7% of all hospital admissions, 9% hospital bed days, and cost as high as A$2Billion each year. Even using the more realistic estimates in our report, we estimate that the annual costs will be A$322 millions.
Support For Chronic Diseases Is Already Well-Funded
The Commonwealth attempted to solve the problem by introducing team management, assessment, planning and coordination payments to GPs in order to improve chronic disease management, including mental health.
In 2013-14, more than A$1.7 billion was invested in systems management, care planning, and coordination of primary care. These included A$904 millions for health assessment, management and treatment of chronic diseases and mental health and incentives payments for diabetes and asthma.
A$210 million paid to practices in incentive payments. These payments made to improve practice and infrastructure development. A further A$661 million was use to support GPs through Medicare Locals, which are now Primary Health Networks.
It is difficult to prevent and manage chronic diseases in primary care. This requires a partnership between people living with chronic conditions and a team of healthcare professionals. It is crucial that GPs play a vital role. The role of GPs is vital.
The Australian split between state and Commonwealth responsibilities makes it more difficult to provide high-quality care for chronic diseases and prevention. The public hospitals are manage by the states, while primary and GP care is provide by the Commonwealth. The result is that the system to prevent and manage chronic diseases is fragment.
There are few performance targets. It is difficult to agree on local care pathways that will guide patients’ treatment. Poorly designed funding incentives mean that there is little support for service innovation or improvement.