Hospital utilisation in Australia, 1993-2020, with a focus on use by people over 75 years of age: a review of AIHW data.

OBJECTIVES: To assess Australian hospital utilisation, 1993-2020, with a focus on use by people aged 75 years or more. DESIGN: Review of Australian Institute of Health and Welfare (AIHW) hospital utilisation data. SETTING, PARTICIPANTS: Tertiary data from all Australian public and private hospitals for the financial years 1993-94 to 2019-20. MAIN OUTCOME MEASURES: Numbers and population-based rates of hospital separations and bed utilisation (bed-days) (all and multiple day admissions) and mean hospital length of day (multiple day admissions), overall and by age group (under 65 years, 65-74 years, 75 years or more). RESULTS: Between 1993-94 and 2019-20, the Australian population grew by 44%; the number of people aged 75 years or more increased from 4.6% to 6.9% of the population. The annual number of hospital separations increased from 4.61 million to 11.33 million (146% increase); the annual hospital separation rate increased from 261 to 435 per 1000 people (66% increase), most markedly for people aged 75 years or more (from 745 to 1441 per 1000 people; 94% increase). Total bed utilisation increased from 21.0 million to 29.9 million bed-days (42% increase), but the bed utilisation rate did not change markedly (1993-94, 1192 bed-days per 1000 people; 2019-20, 1179 bed-days per 1000 people), primarily because the mean hospital length of stay for multiple day admissions declined from 6.6 days to 5.4 days; for people aged 75 years or more it declined from 12.2 to 7.1 days. However, declines in stay length have slowed markedly since 2017-18. Total bed utilisation was 16.8% lower than projected from 1993-94 rates, and was 37.3% lower for people aged 75 years or more. CONCLUSION: Hospital bed utilisation rates declined although admission rates increased during 1993-94 to 2019-20; the proportion of beds occupied by people aged 75 years or more increased slightly during this period. Containing hospital costs by limiting bed availability and reducing length of stay may no longer be a viable strategy.

The problematic place of private payment for healthcare in Australia.

Private funding and private hospital provision play a key role in Australian healthcare. However, this role is inherently inequitable, creating a two-speed health system. Canada should avoid expanding private involvement in paying for healthcare.

Australia's new digital health record created ethical dilemmas.

The last few months of 2018 saw a major battle over privacy, autonomy and use of health information in Australia as the basis for the national electronic health record changed from an opt-in system to one where every person had such a record unless they specifically requested to opt-out of the system. The debate was messy, involving both ethical and wider political concerns, with the ethical concerns partly heightened because of the political context. Canadian health leaders can learn from the mistakes and successes of this situation.

Aligning policy objectives and payment design in palliative care.

BACKGROUND: Payment models for palliative care vary across nations, with few adopting contemporary payments designs that apply to other parts of the health system. AIM: To propose optimal payment arrangements for palliative care. APPROACH: Review of relevant literature on funding mechanisms in health care generally and palliative care in particular. RESULTS: Payment models for palliative care should move toward activity-based funding using an agreed classification, be uncapped funding with performance monitoring, and make explicit use of performance metrics and reporting. CONCLUSIONS: If palliative care is to become a universally accessible service, new approaches to funding, based on the experience of funding reforms in other parts of the health system, need to be adopted.

The Canadian health system's "administrative efficiency" is a problem.

The Commonwealth Fund's "administrative efficiency" criterion ranks Canada poorly-sixth of the 11 countries compared. On two of the four patient-sourced measure used in this criterion, Canada was below the international average performance. For two of the three physician-sourced measures, Canada performs well but is significantly behind the best performing country. This suggests that Canada has room to improve, despite being better than average. Two opportunities for health leaders to make improvements are in relation to reducing the time physicians spend negotiating patient access to needed medications and reducing other administrative burdens related to claiming.

In search of professional consensus in defining and reducing low-value care.

Care that confers no benefit or benefit that is disproportionately low compared with its cost is of low value and potentially wastes limited resources. It has been claimed that low-value care consumes at least 20% of health care resources in the United States - the comparable figure in Australia is unknown but there is emerging evidence of overuse of diagnostic tests and therapeutic procedures. Very few clinical interventions are of no value in every clinical circumstance, and efforts to label interventions as being so will meet with professional resistance. In the context of complex and highly individualised clinical decisions, nuanced clinical judgements of experienced and well informed clinicians are likely to outperform any service-level measurement and incentive program aimed at recognising and reducing low-value care. Public policy interventions should focus on supporting clinician-led efforts to seek professional consensus on what constitutes low-value care and the best means for reducing it.

Identifying and acting on potentially inappropriate care.

OBJECTIVE: To develop a model to measure potentially inappropriate care in Australian hospitals. DESIGN: Secondary analysis of computerised hospital discharge data for all Australian hospitals for the 2010-11 financial year. MAIN OUTCOME MEASURE: Hospital-specific incidence of selected diagnosis-procedure pairs identified as inappropriate in other literature. RESULTS: Five hospital procedures that are not supported by clinical evidence happened more than 100 times a week, on average. The most frequent of these do-not-do treatments was hyperbaric oxygen therapy for a range of specific conditions (4659 admissions in 2010-11). The rate of do-not-do procedures varied greatly, even among comparator hospitals that provided the procedure and that treated the relevant patient group. Among comparator hospitals, an average of 3.3% of patients with osteoarthritis of the knee received arthroscopic lavage and debridement of the knee (a do-not-do treatment), but four hospitals had rates of over 20%. There was also great variation in hospital-specific rates of procedures that should not be done routinely. CONCLUSION: Hospital-specific rates of do-not-do treatments vary greatly. Hospitals should be informed about their relative performance. Hospitals that have sustained, high rates of do-not-do treatments should be subject to external clinical review by expert peers.

The creation of Grampians Health - a case study focusing on lessons learned from a health service merger.

This case study of the merger of four hospitals in western Victoria reports on the views of participants affected by the merger - as staff or from the communities - about 2 years after the merger. Respondents reported that many of the sought-after benefits of the merger were being delivered. However, the merger process itself attracted criticism, and it is here that this merger can provide lessons for others. Although there was a long lead time of consultation prior to the formal decision to merge, there was very little time to plan the next steps of implementation - there were only days between the decision and the merger taking effect. Future mergers should manage that differently. There is also a lot of literature on mergers which might provide a check list to enhance the likelihood of success in future mergers.

Can Alberta's primary care networks provide any lessons for Medicare Locals?

Australia's Medicare Locals are in a formative period, and any comparison so far has focused on the United Kingdom.

Development of an interactive model for planning the care workforce for Alberta: case study.

INTRODUCTION: In common with other jurisdictions, Alberta faces challenges in ensuring a balance in health worker supply and demand. As the provider organization with province-wide responsibility, Alberta Health Services needed to develop a forecasting tool to inform its position on key workforce parameters, in the first instance focused on modeling the situation for Registered Nurses, Licensed Practical Nurses and health care aides. This case study describes the development of the model, highlighting the choices involved in model development. CASE DESCRIPTION: A workforce planning model was developed to test the effect of different assumptions (for instance about vacancy rates or retirement) and different policy choices (for example about the size of intakes into universities and colleges, different composition of the workforce). This case study describes the choices involved in designing the model. The workforce planning model was used as part of a consultation process and to develop six scenarios (based on different policy choices). DISCUSSION AND EVALUATION: The model outputs highlighted the problems with continuation of current workforce strategies and the impact of key policy choices on workforce parameters. CONCLUSIONS: Models which allow for transparency of the underlying assumptions, and the ability to assess the sensitivity of assumptions and the impact of policy choices are required for effective workforce planning.

Planning to meet the care need challenge in Alberta, Canada.

The Canadian province of Alberta faces challenges in ensuring an adequate supply of nurses to meet care needs. This paper describes the approach adopted by Alberta Health Services (the public health care provider in Alberta) to address this challenge. Planning was undertaken on the basis of care needs rather than starting from a particular professional perspective and highlighted that the needs could be met by Registered Nurses, Licensed Practical Nurses or Healthcare Aides. Six scenarios, representing different potential mixes of Registered Nurses, Licensed Practical Nurses and Healthcare Aides were identified and used as the basis of stakeholder consultations. The paper identifies the workforce outcomes and needs for the different scenarios and the outcomes of the workforce planning process.

Frameworks and primary healthcare policy.

Healthcare reform in Canada needs to start with primary care reform, putting patients and their caregivers at the centre of the health system. Although the directions are well accepted, primary care reform requires changes to organizational structures (moving toward multidisciplinary practice) and to physician remuneration to be effective. Without action on these system-level enablers, little real action will be able to occur in repositioning the healthcare system.

Election 2022 should address unfinished business in health and aged care.

sion="1.0" encoding="UTF-8"?> AH Australian Health Review Aust. Health Rev. 0156-5788 1449-8944 CSIRO Publishing 36 Gardiner Road Clayton 3168 Melbourne Victoria Australia AH22054 10.1071/AH22054 Policy Reflection Election 2022 should address unfinished business in health and aged care S. Duckett Duckett Stephen PhD, DSc, FASSA, FAHMS, Director, Health and Aged Care Program, Honorary Enterprise Professor A * Grattan Institute, 8 Malvina Place, Carlton, Vic. 3083, Australia. * Correspondence to: Stephen Duckett Grattan Institute, 8 Malvina Place, Carlton, Vic. 3083, Australia Email: sduckett@unimelb.edu.au 7 April 2022 46 2 127 128 11 March 2022 Received 11 March 2022 15 March 2022 Accepted 15 March 2022 7 April 2022 Published © 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA. 2022 The Authors The 2022 federal election is critical for the health and aged care sectors. Both parties need to address the COVID care deficit, oral health care, and commit to fix the aged care mess. The ongoing tragedy of First Nations health should also remain a priority. And a bipartisan acceptance of the need to address climate change is also required.

Public Health Management of the COVID-19 Pandemic in Australia: The Role of the Morrison Government.

The Australian Commonwealth government has four health-related responsibilities during the SARS-CoV-2 pandemic: to provide national leadership; to manage external borders; to protect residents of residential aged care facilities; and to approve, procure and roll-out tests and vaccines. State governments are responsible for determining what public health measures are appropriate and implementing them-including managing the border quarantine arrangements and the testing, tracing, and isolation regime-and managing the hospital response. This paper analyses the national government's response to the pandemic and discusses why it has attracted a thesaurus of negative adjectives.

Australia's Response to COVID-19.

Australia suffered two waves of the coronavirus disease 2019 pandemic in 2020: the first lasting from February to July 2020 was mainly caused by transmission from international arrivals, the second lasting from July to November was caused by breaches of hotel quarantine which allowed spreading into the community. From a second wave peak in early August of over 700 new cases a day, by November 2020 Australia had effectively eliminated community transmission. Effective elimination was largely maintained in the first half of 2021 using snap lockdowns, while a slow vaccination programme left Australia lagging behind comparable countries. This paper describes the interventions which led to Australia's relative success up to July 2021, and also some of the failures along the way.

Remoteness, models of primary care and inequity: Medicare under-expenditure in the Northern Territory.

Objective To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age-sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model.