Clinical Governance and Health Reform

CLINICAL GOVERNANCE andHEALTH REFORM

AUSTRALIASIAN COLLEGE FOR EMERGENCY MEDICINE 27th

ANNUAL SCIENTIFIC MEETING

CANBERRA –

23 November 2010

Professor Jim Bishop AOChief Medical Officer

Australian Government Department of Health and Ageing

Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)

7538

5004

4627

42104079 4063 3970

3793 3737 3696 36773540 3470

3359 33533129 3060 3008 2902 2870

2729 2687 2683

2151

1801 1781 1737

14371213

999852 767

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

1. Refers to insured population rather than resident population. 2. Current expenditure. 3. 2006. 4. 2007. Source: OECD, OECD Health Data, June 2010

Public expenditure on health Private expenditure on health

OECD HEALTH DATA 2010How Does AUSTRALIA Compare

AUSTRALIA’S RANKING AMONGOECD COUNTRIES 1987-2006

Source: AIHW Australia’s Health 2010

Projected Burden of Major Disease Groups, 2010

Source: AIHW Australia’s Health 2010

BROAD CAUSE MORTALITY TRENDS IN AUSTRALIA

Source: AIHW

CANCERS WITH REDUCING DEATH RATES 1997 to 2006 –

ALL AGES

Lung, -18.5Colon, -19.6 Prostate, -19.7

Leukaemia, -23.7

Stomach, -29.4

Head and Neck, -23.7

Bladder, -18.5

Testicular, -42.2

Breast, -13.8

Cervix, -38.3

NHL, -25.1

Unknown, -24.8

Rectum, -19.9

Bowel, -19.7

All cancers, -13.8

, -24.3

-18.5

Kidney, -24.1

, -15.2

-31.9

, -21.1

-19.0-19.0

, -18.9

-7.9

-45

-40

-35

-30

-25

-20

-15

-10

-5

0

Male FemaleSource: Tracey et al, Cancer Institute NSW

Source: AIHW Australia’s Health 2010

AGED ADJUSTED DEATH RATESFrom CVD, 1907 -

2006

Source: AIHW Australia’s Health 2010

CHRONIC PULMONARY DISEASEMORTALITY 1980 to 2007

Source: AIHW Australia’s Health 2010

PREVALENCE OF CURRENT ASTHMA 2007-08

Source: AIHW Australia’s Health 2010

DEATH RATES FROMINFECTIOUS DISEASES, 1922-2007

NSW POPULATION AGE

DISTRIBUTIONS, MALE (1977 –

2036)

Source: Cancer Institute NSW

TOTAL CANCER CASES & DEATHS per year (1972 to 2036)

Source: Cancer Institute NSW

TRENDS IN LEADING CAUSESOF DISEASE BURDEN 2003-2023

Source: AIHW Australia’s Health 2010

Commonwealth Government Health& Hospital expenditure under the NHHN

Source: Commonwealth Budget Papers, DOHA and PMC Analysis

HEALTH REFORM

Increasing expenditure to $15 billion 2010/11

Additional $7.3 billion over 4 years

Local Hospital Networks (LHN) 60% Federal Funds (60% of research and teaching)

Medicare locals (100% Federal funds)

GP Super-clinics –

multi disciplinary teams (100% Federal Funds)

MEDICARE LOCALS

Identification and response to local health needs

Integrated and coordinated care for the patient

Support clinicians to improve care

Implement new primary care initiatives

Accountable for efficiency and quality

OBJECTIVES

BUDGET 2010-11

e-Health –

connecting patients, providers and information systems

The Government will establish a personally controlled electronic

health record system ($466.7m)

The system will:

Enable people –

and their chosen health provider -

to

access online their key health information when and where it is needed, for their care across the health system.

Allow people to register online to establish a personally controlled electronic health record from 2012-13

Rigorous governance

Privacy maintained

HEALTH REFORM

KEY NEW STRUCTURES

National Performance Authority

Independent Hospital Pricing Authority

Expanded Australian Commission of Safety and Quality in Health Care (ACSQHC)

SUPPORTS FOR CLINICAL DECISION MAKING

Evidence Base

Highest Impact

Range of best practice tools

Successful implementation methods

Monitor and report

CLINICAL GUIDELINES

CLINICAL GUIDELINESHighest Impact

Greatest Burden of disease

Greatest harm from poor practice

Greatest demonstrated need:-

New Standard of Care

-

Proven variation in practice

Greatest time spent/cost to health system

REVIEW OF CLINICAL GUIDELINES

N –

313N

%

CANCER 17 5%

CARDIOVASCULAR 18 6%

RENAL 22 7%

MENTAL ILLNESS 22 7%

NEUROLOGICAL 0 0%

INJURIES 13 14%

CHRONIC RESPIRATORY 0 0%

DIABETES 11 4%

OTHER 173 67%

TOTAL 313 100%

Buchan et al 2006

NON-COMMERCIAL CANCER RESEARCH EXPENDITURE, 2004

(A$ per CAPITAL)

Source: Eckhouse et al (2007), ABS

NHMRC STRAGEGIC PLAN

2010 -12

NHMRC Support for National Health Priorities Areas

Percentage of Expenditure by Broad Research Area (2000 and 2010)

NHMRC SUPPORT FOR TRANSLATIONAL RESEARCH

Translational funding mechanisms

Partnership Projects for Better Health

Partnership Centres for Better Health

Centres of Clinical Research Excellence

Centres of Research Excellence in Population Health

Research, & Health Services Research

National Health Research Enabling Capabilities Scheme

Industry Development awards

$0

$10

$20

$30

$40

$50

$60

$70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Mill

ions

0

50

100

150

200

250

300

Total Expenditure Number of Grants

NHMRC PROJECT GRANTS

Clinical Trials Expenditure

Harmonization of Multi-centredEthical Review (HoMER)

National Statement for Ethical Conduct of Human Research (2007)

Process supported by AHMAC conducted by NHMRC

Certification of ethical review processes –

first round

Roles, responsibilities, templates published

NHMRC working with States and Territories

HEALTH WORKFORCE

Established Health Workforce Australia

$1.2 billion in training more GPs and specialists, nurses and allied health

1375 more GPs by 2013, 5500 by 2020

680 more specialists by 2020

4600 practice nurses by 2013, 7500 rural nurses by 2020

GP Training Places per Year2004 -

2014

Source: 2010 NHHN

Increasing burden of chronic diseases especially cancer, dementia and diabetes

New reform structures offer opportunities to set new clinical guidelines and standards

Opportunities for more coordinated care through medicare locals, local hospital networks and lead clinician groups

Increased health workforce provides opportunities for greater depth in general practice and in specialist training

Increased need for greater evidence base as a framework for improved guidelines and decision tools

CONCLUSIONS