Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#iDEA24
#ASMIRT2024
#EACH24
#CHFtalks
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
Croakey Professional Services
Sponsored content
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#ChurchillDeepEnd
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Croakey Funding Drive June 2024
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010
Support non-profit public interest journalism
Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28
#HealthyCOP27
#HealthyCOP26
#CoveringClimateNow
COVID collection
COVID-19
Long COVID
COVIDwrap
COVID SNAPS
#JusticeCOVID
Caring for the Frontline
COVIDglobalMHseries
Croakey Conference News Service
#iDEA24
#ASMIRT2024
#EACH24
#CHFtalks
#WICC2024
#HealthierSocieties
#DigitalDeterminants24
Croakey Professional Services
Sponsored content
NHLF series
#KidneyCareTogether
ACSQHC series
ACSQHC series 2022
ACSQHC series 2021
ACSQHC series 2020
ACSQHC series 2019
CATSINaM 25 Years
Croakey projects
#ChurchillDeepEnd
@WePublicHealth 2024
Summer reading 2023-2024
The Zap
#CroakeyLIVE #DigitalNationBuilding
#CroakeyLIVE #VoiceForHealth
#PHAAThinkTank2023
The Health Wrap
ICYMI
@WePublicHealth
@WePublicHealth2023
#CroakeyVOICES
#SpeakingOurMinds
Croakey longreads
#CroakeyREAD
CroakeyEXPLORE
CroakeyGO
#CroakeyGO #NavigatingHealth
#GamblingHarms
#HeatwaveHealth
Mapping CroakeyGo
Determinants of health
Environmental determinants of health
Social determinants of health
Education
Discrimination
Housing
Internet access
Justice and policing
Justice Reinvestment
Newstart/JobSeeker
Poverty
Racism
Social policy
Commercial determinants of health
Alcohol
Arms industry
Digital platforms
Food and beverages
Fossil fuels
Gambling
Pharmaceutical industry
Plain packaging
Sugar tax
Tobacco
Vaping
Disasters and extreme weather events
Disasters
Extreme weather events
Bushfires
Bushfire-emergency 2019-2020
Floods 2023
Floods 2022
Floods 2021
Floods 2011
Donor-funded journalism
Donor-funded journalism – 2024
Donor-funded journalism – 2023
Donor-funded journalism – 2022
Donor-funded journalism – 2021
Donor-funded journalism – 2020
Elections
lutruwita/Tasmania 2024 election
#NSWvotesHealth2023
Victorian election 2022
Federal Election 2022
The Election Wrap 2022
#QldVotesHealth
SA election 2022
WA election 2021
Tasmanian election 2021
First Nations
Indigenous health
Community controlled sector
Cultural determinants of health
Cultural safety
Indigenous education
Social and emotional wellbeing
Uluru Statement
The Voice
Lowitja Institute
NT Intervention
WA community closures
Acknowledgement
#CTG10
#NTRC
#RCIADIC30Years
General health matters
Abortion
Cancer
Cardiovascular disease
Child health
Chronic conditions
Consumer health matters
Death and dying
Diabetes
Disabilities
Euthanasia
Fetal Alcohol Spectrum Disorders (FASD)
Genetics
HIV/AIDS
HRT
Infectious diseases
Influenza
LGBTQIA+
Medical marijuana
Men's health
Mental health
Mpox
Non communicable diseases
Oral health
Organ transplants
Pain
Pregnancy and childbirth
Sexual health
Suicide
Swine flu
Trauma
Women's health
Youth health
Global health matters
Asylum seeker and refugee health
Conflict and war
Global health
WHO
Ebola
NHS
#WorldInTurmoil
Health policy and systems
Co-design
Health financing and costs
Health reform
Health regulation
Medicare 40 Years
MyMedicare
National Health Performance Authority
Pharmaceutical Benefits Scheme
Private health insurance
Royal Commissions
TGA
Workforce matters
Strengthening Medicare Taskforce 2022
National Commission of Audit 2014
Healthcare
Adverse events
Allied healthcare
Australian Medical Association
Choosing Wisely
cohealth
Complementary medicines
Conflicts of interest
Co-payments
Digital technology
E-health
Emergency departments and care
Equally Well
General practice
Health Care Homes
Health ethics
Hospitals
International medical graduates
Medicare Locals
MyHospitals website
Naturopathy
NDIS
Nursing and midwifery
Out of pocket costs
Palliative care
Paramedics
Pathology
Pharmacy
Primary healthcare
Primary Health Networks
Rural and remote health
Safety and quality of healthcare and aged care
Screening
Social prescribing
Surgery
Telehealth
Tests
Media and health
Media-related issues
Health & medical marketing
Misinformation and disinformation
Public interest journalism
Social media and healthcare
The Conversation
Media Doctor Australia
News about Croakey
Croakey Funding Drive June 2024
Public health and population health
Air pollution
Artificial intelligence
Australian Centre for Disease Control
Government 2.0
Gun control
Health communications
Health impact assessment
Health in All Policies
Health inequalities
Health literacy
Human rights
Illicit drugs
Injuries
Legal issues
Marriage equality
Nanny state
National Preventive Health Agency
Obesity
Occupational health
Physical activity
Prevention
Public health
Road safety
Sport
Transport
Vaccination
VicHealth
Violence
Web 2.0
Weight loss products
#PreventiveHealthStrategy
#UnmetNeedsinPublicHealth
Research matters
Cochrane Collaboration
Evidence-based issues
Health and medical education
Health and medical research
NHMRC
#MRFFtransparency
The Croakey Archives
#cripcroakey
#HealthEquity16
#HealthMatters
#IHMayDay (all years)
#IHMayDay 2014
#IHMayDay15
#IHMayday16
#IHMayDay17
#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2023
2023 Conferences
#GreenHealthForum23
#hpsymposium2023
#NMS23
#HEAL2023
#ASMIRT2023
#NSPC23
Our Democracy Forum
#AskMSF
#Lowitja2023
2022 Conferences
#16nrhc
#GreenHealthForum22
#Heal2022
#ICEM22
#NAISA22
#NNF2022
#RANZCP2022
#RethinkAddiction
#RTP22
GiantSteps22
Equally Well 2022 Symposium
Choosing Wisely National Meeting 2022
2021 conferences
#21OPCC
#BackToTheFire
#FoodGovernance2021
#GiantSteps21
#GreenHealthForum21
#HealthClimateSolutions21
#HearMe21
#IndigenousClimateJustice21
#NNF2021
#RANZCP2021
#ShiftingGearsSummit
#ValueBasedCare
#WCepi2021
#YHFSummit
2020 conferences
#2020ResearchExcellence
#Govern4Health
#HealthReImagined
#SAHeapsUnfair
2019 Conferences
#ACEM19
#CPHCE19
#EquallyWellAust
#GiantSteps19
#HealthAdvocacyWIM
#KTthatWorks
#LowitjaConf2019
#MHAgeing
#NNF2019
#OKtoAsk2019
#RANZCOG19
#RANZCP2019
#ruralhealthconf
#VMIAC2019
#WHOcollabAHPRA
2018 conferences
#6rrhss
#ACEM18
#AHPA2018
#ATSISPC18
#CPHCE
#MHED18
#NDISMentalHealth
#Nurseforce
#OKToAsk2018
#RANZCOG18
#ResearchIntoPolicy
#VHAawards
#VMIACAwards18
#WISPC18
2017 conferences
#17APCC
#ACEM17
#AIDAconf2017
#BTH20
#CATSINaM17
#ClimateHealthStrategy
#IAHAConf17
#IDS17
#LBQWHC17
#LivingOurWay
#OKtoAskAu
#OTCC2017
#ResearchTranslation17
#TheMHS2017
#VMIACConf17
#WCPH2017
Australian Palliative Care Conference
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
#LowitjaConf2016
#PreventObesity16
#TowardsRecovery
#VMIAC16
#WearablesCEH
#WICC2016
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
Croakey Professional Services archive
#CommunityControl
#CommunityControl Twitter Festival
#COVIDthinktank21
Lowitja Indigenous knowledge translation series
Croakey projects archive
#PHAAThinkTank 2022
Summer reading 2022-2023
#CommunityMatters
#CroakeyFundingDrive 2022
#CroakeyLIVE #Budget2021Health
#CroakeyLIVE #USvotesHealth
#CroakeyLIVE Federal election 2022
#CroakeyYOUTH
#HousingJusticeAus
#IndigenousHealthSummit
#IndigenousNCDs
#JustClimate
#JustJustice
#LookingLocal
#OutOfPocket
#OutOfTheBox
#RuralHealthJustice
#TalkingTeeth
@WePublicHealth2022
@WePublicHealth2021
@WePublicHealth2020
AroundTheTraps
Croakey register of influence
Croakey Register of Influencers in Public Health
Croakey Register of Unreleased Documents
Gavin Mooney
Inside Story
Journal Watch
Naked Doctor
Poems of Public Health
Summer reading 2021-2022
Summer reading 2020-2021
Summer Reading 2019-2020
Summer Reading 2017-2018
Summer Reading 2016-2017
The Koori Woman
TOO MUCH of a Good Thing
Wonky Health
CroakeyGO archive 2017 – 2018
CroakeyGo 2018
#CroakeyGO #QuantumWords 2018
#CroakeyGO #VicVotes 2018
#CroakeyGO Albury 2018
#CroakeyGO Callan Park 2018
#CroakeyGO Carnarvon 2018
#CroakeyGO Marrickville 2018
#CroakeyGO Palm Island 2018
CroakeyGo 2017
#CroakeyGO Adelaide 2017
#CroakeyGO Melbourne 2017
#CroakeyGO Newcastle 2017
#CroakeyGO Sydney 2017
Elections and Budgets 2013 – 2021
Budget2020Health
Federal Budget 2020-21
Federal Budget 2019-20
#AusVotesHealth Twitter Festival 2019
#Health4NSW
Federal Election 2019
NSW Election 2019
Federal Budget 2018-19
Federal Budget 2017/18
NZ Election 2017
Federal Budget 2016-17
Federal Election 2016
#HealthElection16
NT Election 2016
Federal Budget 2015-16
Qld Election 2015
NSW Election 2015
Federal Budget 2014-15
Victorian Election 2014
Federal Budget 2013-14
Federal Election 2013
Federal Budget 2012-2013
Federal Budget 2011
Federal Budget 2010
Federal Election 2010
Federal Budget 2009-2010

The health system is under stress, and here are some of the ways that is affecting patient care

Introduction by Croakey: An instructive, entertaining and overall quite depressing summary of the history of Australian health reform is presented by Dr Bill Coote this week in Medical Republic, with a focus on general practice.

It’s well worth a read, if you haven’t already. Coote has many strings to his long bow – a former rural generalist and practice owner, Australian Medical Association Secretary-General, director of the Professional Services Review, and policy advisor to federal health ministers.

Overall, his analysis, titled ‘From universal care to a two-speed system’, highlights the persistent inertia confronting health reform efforts, and how little real progress has been made over decades despite the “alphabet stew of acronyms”, including “GPPAC, GPCG, MBCC, EPC, ADGP, AGPAL, FMP, RACGPTP, GPET, RTPs (re-birthed as RTOs), the PIP (originally BPP), RCS, RAMUS, PDSA, NPS and BEACH”.

His analysis – described by one reader as “an unlovely trip down memory lane” – would have been even more depressing if it had delved into the history of public health and prevention. Let’s not forget ANPHA (the Australian National Preventive Health Agency) and other public health initiatives slashed over the years, including many Aboriginal and Torres Strait Islander health initiatives.

What this lack of progress means for peoples’ health and lives can be seen in some of the data presented below by health policy analyst Charles Maskell-Knight, who has been wading through data recently released by the Productivity Commission, and identifies many worrying trends.

“Taken as a whole, the report shows a health system under stress and struggling to deal with increased demand by extending waiting times,” Maskell-Knight reports.

His analysis underscores the importance of reform that is effective in tackling inequities – in access, outcomes and within systems. If the Albanese Government hasn’t got meaningful dental reform on its policy agenda, then it must have a bad case of another acronym, FJiE (Fingers Jammed in Ears).


Charles Maskell-Knight writes:

On 31 January the Productivity Commission released the health part of its 2024 Report on Government Services. It includes four sections: primary and community health (with 16 performance indicators), ambulance services (7 performance indicators); public hospitals (16 performance indicators), and services for mental health (19 performance indicators). The data behind the indicators is presented in 248 tables.

The 2024 Report is the 30th in the series, which began in 1995.

The introduction to the 1995 report states that it was intended to “present information relating to the effectiveness and efficiency of a number of government-funded (and largely government-provided) social services… [and] inform parliaments, governments, government service agencies, and the clients of these agencies – the wider community – about their overall performance, based primarily on results rather than inputs”.

The only health service included in 1995 was public hospitals, and the report presented a potpourri of data, often collected and reported inconsistently by jurisdictions, with lengthy footnotes explaining the inconsistencies. (The footnotes for a table presenting the capital value of public hospitals (in five jurisdictions) amounted to 500 words.)

In addition, each jurisdiction was allowed to contribute a page of comments on the results, which they usually used to explain why the results weren’t really comparable and weren’t as bad as they appeared.

The report has come a long way in the past three decades. In this article I will report on the most significant results across the 58 performance indicators now used.

A note on data

The Productivity Commission does not collect any data itself to construct the report, and all the data comes from separate established data collections. The sections below identify the data source for each indicator.

Primary and community health

The report uses ABS Patient Experience Survey data to state that in 2022-23, seven percent of respondents people who needed to see a GP delayed or avoided a visit due to cost, double the rate in 2021-22. This was most common in NSW (9.5 percent) Tasmania (8.7 per cent), and ACT (8.1 per cent).

The same data source shows that 7.6 percent of people delayed or did not fill a prescription due to cost in 2022-23, an increase from 5.6 percent the previous year.

The Government’s recent decisions to increase the incentive for GPs to bulkbill from 1 November last year, and to cut the general co-payment under the PBS from 1 January 2023, are intended to address these affordability concerns.

The ABS survey also showed that 45.6 percent of respondents waited more than a day for an urgent appointment with a GP in 2022-23, up over six percentage points on the previous year, and almost 20 percentage points on 2013-14. In Queensland and South Australia, the proportion waiting more than a day is over half.

It remains to be seen if Urgent Care Clinics will attract patients waiting for a GP, who might well be attending an Emergency Department because they cannot find a GP appointment.

The report presents data from the AIHW on so-called ‘Potentially avoidable presentations to emergency departments’ showing an overall decrease between 2021-22 and 2022-23 of 7.2 percent. (SA and NT bucked the trend, with small increases.)

The report notes that the definition of a potentially avoidable presentation is an interim measure. As I have written before, it is likely that many patients captured by the existing definition attend EDs because they are aware that their condition could not actually be managed in a general practice. Indeed, one study found that just a quarter of patients captured by the current definition were in fact referred to the ED by a GP.

Leaving the definitional issue to one side, the establishment of Urgent Care Centres represents the Government’s policy response to the problem.

Sustainability of the GP workforce is an emerging problem. The report cites departmental data showing that the proportion of full-time equivalent GPs aged over 60 has been steadily increasing (from 23.1 percent in 2015 to 26.6 percent in 2022). While the Government acknowledges there is an issue with GP supply, its response so far has been to commission a review of distribution mechanisms.

The report uses a combination of MBS and ABS data to calculate the rate of First Nations people receiving an Aboriginal and Torres Strait Islander-specific health check or assessment. After reaching a peak of 288 checks per 1,000 people in 2018-19, the rate declined to 235 in 2021-22. It has now climbed back to 270. A welcome improvement, but there is clearly a lot more to do.

The final primary and community health indicator worth mentioning is the median waiting time for a first visit to a public dental service.

While it is reported idiosyncratically by each jurisdiction, in only SA and WA is it less than a year, and in NSW it is 13 months. In every other state or territory it is over 18 months, and as long as 47 months in Tasmania.

The Government is due to respond to the Senate Select Committee report on dental services by the end of the month.

Ambulance services

The report presents Council of Ambulance Authorities data on ambulance response times, comparable across all jurisdictions except SA. The state-wide median response time in 2022-23 was between 10 and 15 minutes (excluding SA), but in every case was higher than 2013-14.

Public hospitals

The report presents data on emergency department waiting times drawn from the National non-admitted Patient Emergency Department Care Database.

This shows a gradual decline in the overall proportion of patients seen on time from 75 percent in 2013-14 to 71 percent in 2018-19. Following an uptick to 74 percent in 2019-20 (associated with a decline in the number of presentations), the proportion has now declined to 65 percent.

While NSW is still managing to attend to 74 percent of patients on time, the performance in WA, SA, Tasmania and ACT hovers around 50 percent.

The report also presents data from the AIHW National Elective Surgery Waiting Times Data Collection showing that the median elective surgery patient waited 49 days for surgery in 2022-23, up from 40 days the previous year, and 37 days in 2013-14.

The NSW experience is again an outlier, but this time in a bad way, with a median waiting time of 69 days, far higher than the second worst performer, Tasmania, at 53 days.

The report includes three indicators of adverse events in public hospitals – the rates of: Staphylococcus aureus bacteraemia infection; adverse events treated in hospitals; and falls resulting in patient harm in hospitals.

While the first two indicators are largely stable, the rate of harmful falls has increased nationally from 4.0 per 1000 separations in 2013-14 to 6.1 per 100 separations in 2021-22. The rate in NSW, WA, SA and Tasmania is now over 7 per 1000: an alarming prospect for anyone with an older family member admitted to hospital.

It also includes data on unplanned readmissions following seven common procedures. It is difficult to discern any clear trend by jurisdiction or over time, other than a 70 percent increase in the rate for tonsillectomy and adenoidectomy over the ten years to 2021-22 to 48 per 1000 separations.

Services for mental health

The report presents data on use of mental health services by patients classified by the SEIFA (socio-economic index for areas) of their postcode of residence.

State data on public mental health services shows a decline in service use from 2.2 percent of the population in the lowest SEIFA quintile to 1.2 percent in the highest. (Use of private hospitals for mental health services, likely to increase with SEIFA, is not reported.)

MBS data on service use showed the opposite gradient: 7.6 percent of the population in the lowest SEIFA quintile using services, rising to 14.4 percent in the highest. Almost 60 years ago Professor Lou Opit* found that use of private psychiatrists across Adelaide was positively associated with average income in the patient’s postcode. It appears nothing much has changed. Either wealth is a mental health risk factor, or access to private psychiatry is grossly inequitable.

The report presents data from the ABS Patient Experience Survey showing that 27.8 percent of respondents reported delaying or avoiding visiting a psychiatrist due to cost in 2022-23 – up from 18.4 percent in 2020-21.

There is some good news: State data shows that the rate of community follow-up within seven days for people discharged from an acute psychiatric inpatient unit was 75.2 percent in 2021-22, up from 60.0 percent in 2012-13.

But despite this improved follow-up, the rate of readmission within 28 days has remained fairly constant: 14.7 percent in 2021-22, up from 13.9 percent in 2012-13.

The report and accompanying tables also show that the age standardised suicide rates for the period 2018-22 of 12.4 per 100,000 population is the same as the average rate over the period 2012-22. Well over 3,000 people are taking their own life each year, despite the efforts of the health system.

Specific population groups

Many of the performance indicators reported by the Commission are also reported by SEIFA, remoteness, and First Nations status. In some instances (for example, MBS-funded psychiatric services) these results show exactly what one would expect: better resourced, non-Indigenous people living in metropolitan areas have better, more timely, and more affordable access to services with better outcomes.

But there are exceptions, and I will aim to report on some of these differences in a subsequent article.

Indicators of what, exactly?

The health section of the report includes a number of what the Commission regards as technical efficiency indicators, which “measure how well services use their resources (inputs) to produce outputs for the purpose of achieving desired outcomes. Government funding per unit of output delivered is a typical indicator of technical efficiency”.

The Commission goes on to observe that “some efficiency indicators included in the report are incomplete or proxy measures for technical efficiency. For example, as only the cost to government is reported on, some efficiency measures do not include the full cost of providing services and, are therefore, incomplete measures of technical efficiency”.

The health sections include a number of indicators defined as cost to government per some measure of output volume.

The cost to government per casemix-adjusted separation in the public hospital section does mean something – government funding makes up the whole cost, and the unit of output is standardised to remove any impact from changes in service mix. Even so, the measure is expressed in nominal not inflation adjusted dollars, reducing its utility.

However, the “cost to government of general practice per person” measure used in the primary and community health section doesn’t mean a great deal.

For a start, the cost to government in recent years has reflected a diminishing share of the total cost, as patient co-payments have increased. In addition, the denominator does not reflect changes in service mix or volume – particularly relevant given the changes in services due to COVID-19.

The indicator for 2023-24 and 2024-25 will show a substantial increase as the impact of the increased bulk-billing incentives flow through – but this won’t imply a reduction in efficiency.

What is the picture overall?

Taken as a whole, the report shows a health system under stress and struggling to deal with increased demand by extending waiting times.

Reduced affordability is also an issue, and while the Government’s recent measures will help address pharmaceutical costs and GP co-payments, they will not address the cost of community psychiatry or other specialist services.

* The Opit reference is not available online, but is cited in C.A. Maskell, Does Medicare Matter, 1988, ANU Graduate Program in Public Policy Discussion Paper No. 9.


Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021.  He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media. Follow on X/Twitter at @CharlesAndrewMK.


A note from Croakey Health Media

We are seeking sponsorship for the #Medicare40Years series of webinars, and welcome approaches from organisations interested in supporting informed public debate about health reform. Contact us.


Bookmark this link for more stories on #Medicare40Years

Image by Mitchell Ward

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments 1

  1. Ailsa Rayner says:

    Have been waiting over four years for removal of implants put in 2010 that are textured and risk BIAL. The hospital has used a change in a list, I.e. waiting for an appointment with the plastics dept 2019 and then another waiting for surgery 2022 as a category 3.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Search by: Categories or tags

Filter by Categories
Aged care
Budgets
Federal Budget 2024-25
Federal Budget 2023-2024
Federal Budget October 2022
Federal Budget 2022-23
Federal Budget 2021-22
Climate and health
Climate emergency
Healthcare sustainability
Heatwaves
National Health and Climate Strategy
#HealthyCOP28