Andrew Southcott (Boothby, Liberal Party) Share this | Hansard source

I rise to talk about the health system in Australia and to draw on a couple of reports which came out in June 2014, which would allow us to have an overall view on how the health system in Australia is performing. The Commonwealth Fund released a survey in June this year. In this regular survey which comes out from the Commonwealth Fund they did an international comparison of 11 countries, and gave Australia an overall ranking of fourth among the 11 countries. Australia was ranked second on quality care, after the UK. As is generally the case in these surveys, the United States ranked 11th of 11 countries. But Australia ranked quite well—fourth—and second on quality care after the UK. The United Kingdom performed very strongly on that measure.

Also there was a report that came out from the Australian Institute of Health and Welfare on the state of our health. That looked at a number of things which we can celebrate as great successes over the last 20 or 30 years. When we look at life expectancies for men and women, they are some of the highest in the OECD. We have seen smoking rates fall dramatically. We have seen a 20 per cent fall in heart attack rates, just in four years, from 2007 to 2011. We have seen that, over the last three decades, death rates from coronary heart disease have fallen by 73 per cent. And over just a 12-year period we have seen that the rates of stroke events have fallen by 25 per cent, or a quarter. The rate of death from stroke has fallen by almost 70 per cent since 1979.

But there are still some areas where we can do better. Seventy per cent of all cardiovascular disease mortality is due to the combined effects of high blood pressure, high cholesterol and physical inactivity. There are estimated to be one million people in Australia with diabetes, and there are likely to be at least another quarter of a million with undiagnosed diabetes. On top of that, there would be at least as many again of Australians with prediabetes—and there is evidence, from Finland and other countries, that intensive physical activity, weight loss and changes to lifestyle can actually delay or even prevent the development of diabetes for people with prediabetes. But when we look at diabetes we see that rates of death due to diabetes have actually risen since 1990.

We do have an opportunity in this grievance debate to take a step back. At the moment, the debate in health policy is very much dominated by the co-payment and Medicare. But we should be able to look at the system and say, 'How can we improve the system? How can we use the existing infrastructure of Medicare, and the soon-to-be new infrastructure of the primary care networks, to improve our system on a system-wide basis?'

When you look at the debate that is occurring—including, think tanks and the Bennett review into the National Health and Hospitals Reform Commission—two of the areas that are most obvious are chronic disease management and potentially preventable hospital admission. What we need to do is look at a way of harnessing the capacity of our existing primary care system—the 25,000 GPs who are working in our system and who are using Medicare as a financing mechanism.

There was a recent article by Linda Cobiac and others in the BMC public health journal in 2012. They looked at an Australian population and cardiovascular disease prevention using an absolute risk model and found it to be more cost-effective than current guidelines. The model involves measuring absolute risk for cardiovascular disease; depending on the results, appropriate preventable medication—such as blood pressure lowering drugs, or statins, to improve the lipid profile—should be prescribed.

The National Vascular Disease Prevention Alliance—which consists of four groups: Diabetes Australia, Kidney Health Australia, the Heart Foundation and the Stroke Foundation—was established in 2000 with the goal or reducing cardiovascular disease. They have built on this work around the absolute risk model, and in 2012 they developed guidelines for the management of cardiovascular disease risk.

Where is the opportunity here? In May the excellent Health Minister announced at the AMA conference that five out of the 10 existing practice incentive payments will be streamlined into a single incentive, focusing on continuous quality improvement in general practice. I have previously spoken about this. The practice incentive payment—to explain for members of the House—is an add-on to Medicare. It is a payment to the practice to encourage various activities. It is not the fee for service that people are paid for the consultation; but it is to encourage other activities, prevention activities, which are not funded through a fee-for-service mechanism.

I have previously spoken about this in parliament—the need for a genuine quality measure. I believe there is a great opportunity to move towards a quality measure which is evidence based. We now have general practices that are widely computerised, with sophisticated practice management databases. This was initiated by Michael Wooldridge 14 or 15 years ago. General practice is now well set up to lead the adoption of an integrated health check.

This would involve having a new PIP, which could include an integrated health check for all eligible patients, including an absolute cardiovascular risk assessment diabetes check and kidney disease check. The practices would be required to manage the overall risk profile and to stratify risk within their practice. They would be required to maintain a patient register and to record and report the proportion of eligible patients who are checked and who have had their risk managed. Many of these activities are already done at a practice level but the evidence is very strong that focussing on an integrated health check is cost effective; it will help to improve the inroads we have already made into cardiovascular disease.

Seeing the adoption of an integrated health check could be a key role for the new primary health networks. When you look at New Zealand, their primary health organisations have information which is reportable and evidence based, and which leads to changes in people being admitted to hospital and having their chronic disease managed.

So I rise to support the call from the National Vascular Disease Prevention Alliance to have an integrated health check. I think it is something that is presently missing. There are elements of it there in the existing Medicare framework, but certainly it is a framework which can be improved on, so that we can see that our excellent primary care system is even better.

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