Diane Watson, CEO of the National Health Performance Authority, outlines the key findings from the NHPA’s report into primary care and explains why independent and accurate collection and analysis of health data can empower consumers to drive changes within our health system….
Everybody is interested in health care. Individuals seek it when they need it because it contributes to healthier, more satisfying lives. Likewise, policy makers recognise health care has become a social good that consistently ranks at or near the top of people’s priorities for services.
But providing health care does not come cheap. Australia is a relatively frugal performer by international standards, with total health spending accounting for 9.1% of GDP in 2009-10, slightly lower than the OECD average of 9.5%, and only just above the average in terms of health spending per capita. The sums at stake are still huge. In a single year, 2010-11, the federal government in Canberra provided $55.6 billion for health, and state and territory governments spent a further $34.4 billion. Individuals, private insurers and other sources provided the remaining $40.2 billion. When the pursuit of health is considered alongside these financial figures, many people are very motivated to improve care in local communities for the benefit of their neighbours, their families and themselves.
What is at stake is people’s lives and their quality of life. This week the National Health Performance Authority has released its second report, Healthy Communities: Australians’ experiences with primary health care in 2010-11. It paints a picture of differences across local communities in Australia in perceptions of availability, accessibility and affordability of GP services. The results are broken down into the 61 geographic areas that are covered by the new network of Medicare Locals, which were set up in 2011 to improve responsiveness, co-ordination and integration of health services.
Most data in the report were collected before any of the Medicare Locals were set up. As such, the data is intended to stimulate and focus local action to improve care and provide a baseline to track progress. The report tells us things we did not know before. People in some Medicare Locals can be up to five times more likely to report delaying seeing a GP due to cost than people in other Medicare Locals (15% compared to 3%). The percentage of Australians who felt they waited longer than acceptable to get a GP appointment was three times higher in some areas compared to others (28% compared to 8%). And there are big differences in other measures, such as the number of GP after-hours visits per person, which was five times higher in some areas than others, even when limiting the comparison to within metropolitan Medicare Locals.
There are already state and national figures describing these and other indicators, but while that’s important for transparency and accountability of the system, what it doesn’t do is show the variation in experience between local communities, which evidence shows is the most efficient driver of service improvement. The Authority’s reports are different. They show how local populations and health organisations fare on specific measures — and crucially, how these local results compare to peers, whether they be in the same state or on the other side of the continent. Local information provided to inform local decisions and local action.
What we are harnessing with these statistics is the power of local communities to drive both improvements in care and increased efficiency. That can mean lives spared and money saved. Australia is coming late to this movement, but the evidence that this approach works is already there, thanks to several other nations that have already realised the benefits of putting information in the hands of clinicians and health managers. In the UK, an analysis by the Society for Cardiothoracic Surgery in Great Britain and Ireland found collecting data on cardiac surgery in England cost £1.5m per year – but that this was just 0.6 per cent of the total spending on cardiac surgery, and that the quality improvements triggered by the reporting saved £5m in bed days for coronary artery bypass operations alone. There are plenty of other examples – from Canada, where there have been significant declines in unexpected death in 40% of hospitals since hospital data were publicly reported in 2005 ; and in Sweden, where the biggest improvements in care for heart attack patients were seen in the hospitals identified as below average (see the following graph from a study reported in Health Affairsin 2012) .
Australia has a chance to benefit from similar improvements. The evidence is clear on what styles of reporting are most likely to work. While national and state-level reporting is important for transparency, it doesn’t unleash the power of local communities to take local action. Instead, what is required is locally relevant information that is nationally consistent and allows comparisons to be drawn fairly. Although these comparisons might empower consumers to modify their choice of provider, they also directly motivate providers themselves to learn from the top performers. The anonymity afforded by national and state-level reporting ensures this will not happen unless accompanied by locally relevant data.
The final and perhaps most important requirement is this: independence from the system and health managers they report on. Only then can the data be trusted to be impartial, and only then will clinicians and health managers engage with it to deliver the improvements that they, as much as patients and politicians, all seek.