Walk in centres: lessons from Canada

The current reforms of the United Kingdom's primary healthcare sector intend to improve accessibility to health care. One of the proposals is to introduce "walk-in" primary care centres. The intention is to pilot "a series of nurse led centres which can be used on a `drop in' basis, providing minor treatment, health information and self help advice." The Canadian medical system has many similarities to the British system. Canada's health system is funded through general taxation (and Medicare premiums), and its general practitioners (family physicians) have a gatekeeper role to secondary care in most provinces. Canada has had walk-in centres for over 20 years. However, these centres are a doctor led service. The lessons learnt in Canada about walk-in centres may be relevant to the NHS. In this article I review the available literature about Canadian walk-in centres

A global review of the expansion of multinational healthcare companies

There are some common patterns of expansion among healthcare multinational companies throughout the world. Many are diversifying away from just delivering healthcare to providing health insurance and other financial infrastructure

The tyranny of distance – mapping accessibility to polysomnography services across Australia

This paper finds that remote and very remote communities continue to experience inequity in health care in accessibility to specialist services such as diagnostic sleep studies. Abstract Objectives: To identify service gaps by mapping accessibility to diagnostic sleep studies across Australia using a Geographic Information System (GIS). Methods: Census-level data stratified by statistical areas were mapped to measure accessibility to polysomnography (PSG) based on geographical location of patients. All adult publicly funded home and laboratory-based PSG performed in Australia in 2012 were mapped to statistical areas based on patient address at the time of the sleep study. Results: Sleep health care is extremely under-resourced in central and northern Australia. For those living in areas classified as remote and very remote, geographical distance appears to be a barrier to the accessibility of specialist sleep services. Conclusions: Remote and very remote communities continue to experience inequity in health care in general and in accessibility to specialist services in particular. Attention needs to be given to barriers which may limit equitable accessibility. Implications: Residing in remote communities with limited or no public transport options is likely to have a particularly significantly impact on Aboriginal and Torres Strait Islander peoples’ ability to access PSG. Authored by Woods C, Usher K, Edwards A, Jersmann H, and Maguire G

Tackling out-of-pocket health care costs: a discussion paper

Growing out-of-pocket health care costs are creating barriers to essential care for many Australians and arguably leading to increased hospital costs. Over time they will undermine the universality of Medicare and widen health disparities in our community. Despite this, the Abbott Government is intent on increasing Australians\u27 individual health care costs, claiming variously that the health care budget is unsustainable, price signals are needed to reduce GP visits, budget deficits must be addressed and increased funding is needed for medical research. Regardless of the validity of the Government\u27s claims, it is clear that we need to improve the way in which we manage out-of-pocket costs within our health care system. The current financing mechansims and safety-net arrangements are inadequate to ensure that growing numbers of Australians with long-term medical conditions can manage their health care costs and afford the services they need. Given the compexity of Australia\u27s health care system, with funding and service delivery responsibilities split between different levels of government and the public and private sectors, this is a wicked problem to solve. There is no silver bullet and effective solutions are unlikely to be found through simple \u27add-ons\u27 to the currentfunding system. Effective solutions are likely to be multi-faceted and will require a potent mix of evidence, ideology, consultation and leadership to be successful. To kick-start the necesary analyses, debates and policy formulations, we have developed a discussion paper on out-of-pocket costs, focusing on Medicare-funded services. The paper sets out the parameters of the problem and canvasses some promising areas where solutions may be found. Our purpose is not to dictate future policy directions but to present the current evidence and to galvanise thought, expertise and engagement to address this issue of faireness and equity

Healthy communities: immunisation rates for children in 2011-12

Immunisation helps protect individuals and the community generally against potentially serious diseases such as measles, polio, tetanus and whooping cough (pertussis). Although the great majority of children in Australia are immunised, it is important to maintain high immunisation rates to reduce the risk of outbreaks of these and other diseases recurring. Australian governments and experts endorse achieving high immunisation rates to protect individuals and those not immunised or too young to be immunised. States and territories are expected to maintain or improve their existing respective immunisation rates under the terms of the National Partnership Agreement on Essential Vaccines agreed in 2009. This report allows the public, clinicians and health managers to see for all children, and for Aboriginal and Torres Strait Islander children, the percentages fully immunised and how those percentages differ across the country. It reports these immunisation rates for each of the 61 geographic areas covered by the new network of Medicare Locals, which have been established to improve the responsiveness, coordination and integration of local health services. These data were sourced from the Australian Childhood Immunisation Register (ACIR). It is important to note that these data cover the period from July 2011 to June 2012. As Medicare Locals were still being set up during this time, this report establishes a baseline for comparisons that in future will help clinicians, health managers and others to assess whether improvements are occurring. Where possible, the results are broken down into geographic areas that are smaller than Medicare Local catchments – more than 300 statistical areas and more than 1500 postcodes. The report shows the percentages of children who were fully immunised at 1 year, 2 years and 5 years in each Medicare Local catchment, and in the smaller units of geography where applicable. Also reported are the numbers of children in each area who are not fully immunised. Key findings: The report’s findings can be considered in the context of three broad themes: The percentages of children fully immunised and variation between Medicare Local catchments, and between age groups The numbers of children who are not fully immunised in each Medicare Local catchment Lower immunisation rates among Aboriginal and Torres Strait Islander children

Beyond resettlement: long-term care for people who have had refugee-like experiences

Describes the health needs of survivors of war and conflict in the immediate and long-term resettlement periods. Background Since 1945, more than 700 000 refugees and displaced persons, survivors of conflicts in over 60 countries, have resettled in Australia. Every general practitioner (GP) will have patients who have had refugee-like experiences. Objective To describe the health needs of survivors of war and conflict in the immediate and long-term resettlement periods Discussion In the immediate post-settlement period, refugees and asylum seekers will need assessment, catch-up primary healthcare and, in some cases, psychological support. Although refugees are generally a resilient group, enhanced support may be needed over key life periods: childbirth, rearing of young children and entering frail age. Asylum seekers (who do not have permanent visas) often face structural impediments to healthcare access and may be unable to meet basic health needs; GPs need to be aware of the enhanced need for psychological safety in addition to catch-up healthcare in this population. &nbsp

Expanding Health-Care Access in the United States: Gender and the Patchwork 'Universalism' of the Affordable Care Act

This paper focuses on the ways in which women in the United States are impacted by the 2010 passage of the Patient Protection and Affordable Care Act (usually referred to as ACA or 'Obamacare'). The ACA's three main goals of expanding access, increasing consumer protections and reducing costs while increasing quality of services will improve coverage, access to services and types of services that benefit women (and men). However, universal coverage remains illusive due to employer-based insurance coverage that allows firms to make decisions about coverage type. This patchwork universalism is the result of political decisions to extend rather than transform the current health-care system and as such reproduces many of the previously existing problems of uneven costs and coverage. The paper argues the ACA is consistent with other sets of US social welfare and labour market regimes that stratify access to social protections by income, race/ethnicity and gender as well as provide individual states with administrative and policy authority. The paper concludes that the passage of ACA will vastly improve health-care coverage in the United States, however, will continue to leave millions of people uninsured. This paper was produced for UN Women's flagship report Progress of the World's Women 2015-2016 and is released as part of the UN Women discussion paper series

Cost effectiveness after a pancreaticoduodenectomy: bolstering the volume argument

AbstractBackgroundThe cost implication of variability in pancreatic surgery is not well described. It was hypothesized that for a pancreaticoduodenectomy (PD), lower volume centres demonstrate worse peri-operative outcomes at higher costs.MethodsFrom 2009–2011, 9883 patients undergoing a PD were identified from the University HealthSystems Consortium (UHC) database and stratified into quintiles by annual hospital case volume. A decision analytic model was constructed to assess cost effectiveness. Total direct cost data were based on Medicare cost/charge ratios and included readmission costs when applicable.ResultsThe lowest volume centres demonstrated a higher peri-operative mortality rate (3.5% versus 1.3%, P < 0.001) compared with the highest volume centres. When both index and readmission costs were considered, the per-patient total direct cost at the lowest volume centres was $23 005, or 10.9$2263 per case) more than at the highest volume centres. One-way sensitivity analyses adjusting for peri-operative mortality (1.3% at all centres) did not materially change the cost effectiveness analysis. Differences in cost were largely recognized in the index admission; readmission costs were similar across quintiles.ConclusionsFor PD, low volume centres have higher peri-operative mortality rates and 10.9% higher cost per patient. Performance of PD at higher volume centres can lead to both better outcomes and substantial cost savings

Healthy school-age kids (HSAK) program

The Healthy School-Age Kids (HSAK) program is a joint initiative of the Department of Health and Community Services and the Department of Employment, Education and Training and it works within the health promoting school model. It recognises the need for schools, health services, families and communities to work in partnership. &nbsp; Its aim is to improve the health, well-being and learning outcomes of school-age children living in remote communities of the Northern Territory. This can be achieved by health and education staff working together with children, families and community for health promotion, education and provision of health services. The program components: health promotion in the school and community setting integration of other services and programs for school-age children health checks (screening). This manual is for: nurses, aboriginal health workers and doctors in remote communities school teachers and support staff in remote communities visiting health and education staff to remote communities community members of remote areas. A video Healthy School-Age Kids “Working Together” accompanies this manual and demonstrates how to carry out health checks