Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands

Outlines efforts to enhance primary care quality and access, including postgraduate training for family physicians, general practitioner accreditation, greater use of nurse practitioners, and after-hours care; their outcomes; and insights for U.S. reform

Buying best value health care: Evolution of purchasing among Australian private health insurers

Since 1995 Australian health insurers have been able to purchase health services pro-actively through negotiating contracts with hospitals, but little is known about their experience of purchasing. This paper examines the current status of purchasing through interviews with senior managers representing all Australian private health insurers. Many of the traditional tools used to generate competition and enhance efficiency (such as selective contracting and co-payments) have had limited use due to public and political opposition. Adoption of bundled case payment models using diagnosis related groups (DRGs) has been slow. Insurers cite multiple reasons including poor understanding of private hospital costs, unfamiliarity with DRGs, resistance from the medical profession and concerns about premature discharge. Innovation in payment models has been limited, although some insurers are considering introduction of volume-outcome purchasing and pay for performance incentives. Private health insurers also face a complex web of regulation, some of which appears to impede moves towards more efficient purchasing

Chronic diseases in Australia: blueprint for preventive action

This paper identifies strategic priorities for taking action to prevent chronic diseases. It is the second report by the Mitchell Institute on this issue. The first report, Chronic diseases in Australia: the case for changing course, mapped out the social, economic and health costs of chronic diseases to the Australian community, as well as identifying the evidence on the effectiveness and cost-effectiveness of preventing chronic diseases. Chronic diseases in Australia: Blueprint for preventive action moves beyond the evidence to provide a framework for action. The vision of this Blueprint is to reduce the impact and incidence of chronic diseases through preventive interventions. The desired outcomes, against which progress should be measured, comprise: Healthy lives: improved health status for all populations. Healthy children: a healthy future for our children. Healthy communities: more liveable and socially connected communities. Healthy economies: increased economic participation and productivity. To achieve this vision, action will be required on many fronts. This recognises that chronic diseases have many shared risk factors and determinants, including health behaviours (such as smoking and physical inactivity), biomedical factors (such as high blood pressure and depression), and social and environmental determinants (such as early life conditions and socio-economic status). Taking preventive action early includes tackling the underlying social determinants of poor health (primordial prevention) and implementing strategies to reduce specific risk factors for chronic diseases (primary prevention). Preventive actions to reduce the disease burden for high-risk populations, including people with risk factors or in the early stages of chronic diseases, are also vitally important. Seven core principles have been identified that shape the actions we propose to reduce the impact and incidence of chronic diseases: 1. Systemic approach: focus on common risk factors and determinants, not individual diseases. 2. Evidence-based action: act now using best available evidence and continue to build evidence. 3. Tackling health inequity: work to improve and redress inequities in outcomes. 4. National agenda with local action: build commitment and innovation with local action. 5. A life course approach: intervene early and exploit prevention opportunities at all ages and across generations. 6. Shared responsibility: encourage complementary actions by all groups. 7. Responsible partnerships: avoid ceding policy influence to vested interests. This Blueprint identifies three strategic priorities, each of which includes specified actions. The first strategic priority is to drive healthy behaviours and healthy environments focussing on tackling the risk factors and social determinants that contribute to the burden of chronic diseases. It involves setting measurable objectives and assessing preventive interventions in order to determine priority actions for implementation. The second strategic priority is to create accountability for action and monitoring progress. Areas for action include Australian implementation of the World Health Organization targets and indicators to prevent chronic diseases, as well as independent reporting. The third strategic priority is to generate community support and action on prevention. Many factors that are important in preventing chronic diseases require action by groups outside government. Community support is also essential to achieving success, including the development of solutions that meet local circumstances and priorities. Responsibility for taking action on preventing chronic diseases must be shared. Sustainable change requires partnerships and action by individuals and families, communities, the non-government sector and governments. The Mitchell Institute will work with partner organisations to implement the strategic priorities included in this Blueprint. Work is already underway to auspice the development of an Australian set of indicators and targets that are consistent with the international target of a 25 per cent reduction in premature mortality from chronic diseases by 2025. Following the release of this Blueprint, the Mitchell Institute will continue to build a coalition of partner organisations committed to taking action on preventing chronic diseases

PenQuest Volume 3, Number 1

The Table of Contents for this Volume: Untitled by R. Bruce Warner Seeing the Unseen by Sharon Gresham Untitled by Helen Hagadorn Untitled by Steve Balunan Happy Holidays by Donna Kaluzniak River-walking, Night-talking by William Slaughter Ribbon of Light by Judith Mizrahi Love in Parentheses by Sharon Gresham Untitled by Steve Balunan Protohistory by Patricia Kraft Untitled by Bruce Abbey Untitled by Rick Wagner Thanatopsis by Pat Kraft Untitled by Sue Hightower Untitled by Rick Wagner Conversations of a Woman by Sharon Gresham Thur, Fri, Sat, at Mr. B\u27s by Patricia Kraft Untitled by Rick Wagner Untitled by Cindy Carlisle Untitled by Win Lyons Untitled by Cindy Carlisle Untitled by Modesta Matthews Untitled by James Tutten A Light at Mill Pond Crossing by Joe Palmer Untitled by Rick Wagner Two People by Kathleen Gay Untitled by Rick Wagner American Dream (Russian Version) by William Slaughter Untitled by Judith Mizrahi Untitled by Linda Willco

Chronic diseases in Australia: the case for changing course

The burden of chronic disease in Australia threatens to overwhelm the health budget, the capacity of health services and the health workforce. Much of that burden is preventable through effective, evidence‐based changes to policy. This is a background paper for the Mitchell Institute November 2014 policy forum Chronic diseases in Australia: The case for changing course. The paper, written by Dr Sharon Willcox with the Mitchell Institute and a national expert advisory group, provides the case for changing course in Australian policies. It addresses the health and non‐health factors contributing to the prevalence of chronic diseases and puts forward four major directions for change. We anticipate this paper will promote debate in the policy community and encourage new action on chronic disease

Revitalising health reform - time to act: discussion paper

Please note: This publisher no longer exists and the link to this paper is not available.  If you have a copy of this discussion paper please contact [email protected] and we will add it to our repository. Revitalising health reform - time to act: discussion paper was originally at http:// ww w.aihps.org/component/option,com_docman/task,doc_view/gid,155/Itemid,145/ __________________ The Australian Institute of Health Policy Studies has commissioned this discussion paper to encourage broad community debate and, importantly, action on reform of Australia’s health care system. This report demonstrates that, all too often, existing processes for health system reform are ineffective. It documents the \u27unfinished business\u27 on health system reform since 2000.   &nbsp