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.

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.

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.

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.

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.

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.

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.

Commentary: The Consequences of Private Involvement in Healthcare - The Australian Experience.

The Cambie proposition is the American individualistic one: If I can afford to pay for quick access to care, then that should be my right. It denies any concept of universalism, of the common good or that your rights might adversely impact my rights and my healthcare experience. Some private care proponents offer the magical prospect that this quicker access for the wealthy few has no impact on access for the many. It is even sometimes perversely argued that if the wealthy pay for access outside the public health system, that reduces demand for public care, freeing up space for others and, hey presto, magically everyone benefits from the increase in inequality. The Australian experience is that this magic does not work.

What should primary care look like after the COVID-19 pandemic?

The response to COVID-19 transformed primary care: new telehealth items were added to the Medicare Benefits Schedule, and their use quickly escalated, general practices and community health centres developed new ways of working and patients embraced the changes. As new coronavirus infections plummet and governments contemplate lifting spatial distancing restrictions, attention should turn to the transition out of pandemic mode. Some good things happened during the pandemic, including the rapid introduction of the new telehealth items. The post-pandemic health system should learn from the COVID-19 changes and create a new normal.

Value-Based Healthcare: Fad or Fabulous?

Value-based healthcare has entered the lexicon of health service managers and policy makers over the past decade. But translating the idea from a rhetorical device or concept for use in the United States into a policy or action elsewhere is difficult. It has obvious appeal - who can argue against value? In this paper, I discuss the utility of value-based care as a rhetorical device and the complexity of operationalizing it and identifying patient perspectives on value.

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.

Degenerative meniscal tears of the knee: evaluation and management.

Meniscal injuries are among the most common orthopaedic injuries seen in knee clinics. Meniscal tears can occur as a result of acute injuries or chronic degeneration. However, the exact incidence of meniscal tears is difficult to ascertain because of the high number of asymptomatic tears and the high rate of degenerative tears in patients with advanced degenerative joint disease. The management of patients with knee pain is non-operative both for degenerative meniscal tears and degenerative joint disease in its initial stages. Magnetic resonance imaging has little added value in the management of middle-aged and elderly patients with degenerative disease. Failure to respond to non-operative measures warrants orthopaedic assessment with radiographic studies and counselling on managing degenerative joint disease both non-operatively and operatively. This article focuses on assessment and management of degenerative meniscal tears.

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.

Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand.

Countries in Asia are working towards achieving universal health coverage while ensuring improved quality of care. One element is controlling hospital costs through payment reforms. In this paper we review experiences in using Diagnosis Related Groups (DRG) based hospital payments in three Asian countries and ask if there is an "Asian way to DRGs". We focus first on technical issues and follow with a discussion of implementation challenges and policy questions. We reviewed the literature and worked as an expert team to investigate existing documentation from Japan, Republic of Korea, and Thailand. We reviewed the design of case-based payment systems, their experience with implementation, evidence about impact on service delivery, and lessons drawn for the Asian region. We found that countries must first establish adequate infrastructure, human resource capacity and information management systems. Capping of volumes and prices is sometimes essential along with a high degree of hospital autonomy. Rather than introduce a complete classification system in one stroke, these countries have phased in DRGs, in some cases with hospitals volunteering to participate as a first step (Korea), and in others using a blend of different units for hospital payment, including length of stay, and fee-for-service (Japan). Case-based payment systems are not a panacea. Their value is dependent on their design and implementation and the capacity of the health system.

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.