The OECD has this week released a report of their evaluation of the quality of Australian health care.
The good news is that Australia has the 6th highest life expectancy of OECD countries with its residents living to an average age of 82.2 years. It also has the fourth lowest smoking rate (12.8%), and deaths from heart disease are well below the OECD average. This is all in spite of the fact that Australia is the fifth most obese country with 28.3% of Australians aged 15 and over being obese.
The bad news is that compared to other countries with a similar federal system, the Australian health care system is particularly complex. Responsibilities are split between federal and state governments and according to the OECD, this has led to a system that is fragmented and difficult for patients to navigate. Care coordination is complicated even more by a division of care between “primary care” and “community health” resulting in the possibility of duplication of services as well as a lack of coordination.
It is perhaps not surprising that the OECD should highlight the complexity of the Australian health care system. This complexity has developed historically and been driven more by politics than considerations of efficiency or quality. Unfortunately, there has been little to offset the complexity. The use of technology by the Australian health care system outside of GP surgeries has been, as the OECD report, “slow and disappointing”. This lack of uptake of information technology has been responsible for another aspect of the system that received a poor rating by the report authors, namely the lack of data on quality of care and patient outcomes, particularly in primary care.
Fixing the deficiencies
Some of the problems highlighted in the report could be fixed “relatively” easily. The introduction of healthcare identifiers in Australia will slowly allow health care data to be properly identified and linked across the entire system. Adoption could even be accelerated by making its use mandatory through changes in legislation.
The argument for health identifiers is a compelling one. The current system relies on patient identification by name, address and date of birth and in a complex system like Australia’s, is particularly prone to error. Use of an identifier for laboratory and radiology reports is plain common sense.
Updating information technology throughout the health care system is another matter and one with no easy solutions. The main barriers for this are the extremely high cost of these systems and the relatively low organisational abilities of our current health services to be able to implement them successfully.
Lack of data is the biggest challenge
Ironically however, the lack of data that is holding back the quality and performance of the Australian health care system may also be making it difficult to assess it meaningfully. This is as true for the Australian Government as it is for the OECD. Much of the data that is being used by the OECD is from 2013 and is already dated. In its analysis, the report also details the possibilities of beneficial outcomes from initiatives that have in fact completed. For example, a trial called the Diabetes Care Project is cited in the report as laying the possible foundations for coordination of health services when in fact the results of the project already demonstrate that this approach did not lead to any improvements in outcomes.
Australia draws particular criticism in the report for its hospital admission rates for chronic obstructive pulmonary disease which is substantially above the OECD average. However, hospital admissions due to diabetes are below the OECD average and so it is really hard to draw any particular conclusion from the respiratory disease data. Interestingly, the respiratory disease patterns seem unrelated to smoking data with Japan, a nation with a large number of male smokers having the lowest hospital admission rates for chronic obstructive pulmonary disease. This data perhaps simply reflects differences in clinical practice between countries rather than an actual objective measure of a specific problem.
Is there really a problem?
The overall conclusions that come from the report are that Australia has a complex health system, doesn’t collect and use health data effectively, and lags other countries in its use of technology. Despite this, Australia enjoys a high life expectancy with a high quality of health care generally and with few objective measures for concern, at least in terms of the data presented in the report.
There is however, a general lack of real data that can give us the full picture of what is really happening at the individual level. The report draws attention to this deficiency but unfortunately also suffers in its overall analysis because of that same lack of data.
The lack of quality data also has another important consequence. Without it, there is little chance that anyone will be able to predict whether the health picture in Australia is going to improve, stay the same, or get worse in the near future. There is also little chance of being able to create an effective strategy to change that outcome.
David Glance has participated in committees organised by the OECD