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Preventable burden
Rethink needed on preventable
chronic disease, experts say.
By Conor Burke
I
n 2007–08, just over 42 per cent of
Australians had one or more chronic
conditions. Ten years later, this figure
had risen to over 47 per cent.
Chronic disease accounts for 37 per
cent of hospitalisations and is putting an
enormous strain on the health system. A
report from the Grattan Institute put the
cost of preventable hospital admissions
due to “ineffective management” of
chronic disease at $320 million a year.
The ABC’s 7.30 program recently
investigated the issue. It put the figure at
11.4 million Australians living with chronic
disease, or one in two.
Ben Harris, a health policy expert at
Victoria University’s Mitchell Institute, told
7.30 that this is too high.
“About a third of chronic disease is
preventable, yet we only spend 1.3 per cent
of our health budget on preventing disease.
“We need to do better with prevention
and managing chronic disease. We need to
start treating people, rather than treating
diseases,” he said.
The series, entitled The Health Divide,
found that although Australians have one
of the highest life expectancies in the
world, with good access to healthcare
compared to countries like the US, more
could be done to tackle chronic disease.
“Our health system is designed to cure,
and that means something has to go
wrong first,” Harris said.
WEALTHY IS HEALTHY
AMA chief medical officer Brendan Murphy
argued that the sustainability of the current
system is a pressing issue. He told 7.30 that
the cost of healthcare is growing faster
than the GDP, and that this is resulting in
higher out-of-pocket costs for patients.
Harris argued that the fee-for-service
medicine model is no longer helping
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Australians. He pointed to figures which
show that wealthy communities do a lot
better health-wise, and that people in
lower socioeconomic areas are more likely
to have chronic disease, and much more
likely to die early.
In fact, 49,000 more people die a
year in low socioeconomic areas than in
wealthy areas.
“The best thing you can do for your
health is be wealthy,” Harris said.
He added that steep fees charged by
specialists is another barrier to care, as are
long waiting lists at public hospitals.
There is also a stark health divide between
cities and rural/remote communities.
Although a third of the population resides
in rural areas, some communities do not
have full-time GPs, and if you live in a rural
area, you are statistically more likely to
have a shorter life than your counterparts
in the cities. Government stats show that
as of 2011, mortality rates in rural areas are
1.4 times higher than those in major cities.
You are also 2.5–4 times more likely
to die due to diabetes and, for suicide,
between 1.8 and 2.2 times.
Access to healthcare is an ongoing issue,
as is convincing healthcare professionals
to move to rural communities. Despite
having one of the highest rates of doctors
per person in the OECD, there are still
significant rural shortages.
BRIDGING THE DIVIDE
Alison Verhoeven, chief executive of
the Australian Healthcare and Hospitals
Association, said a recent announcement
by Health Minister Greg Hunt that he would
institute a national preventive strategy is a
positive step, but more effort and funding
are urgently needed.
“One way to address this would be to
better target health services at achieving
outcomes, rather than simply funding more
activity,” she told Aged Care Insite. “It will
require funding different approaches to
health service delivery, including using
team-based approaches to care where
every health professional works to the top
of their licence.”
Verhoeven argued for more reliance on
health coaches, allied health professionals
and other such services.
“Some services might be provided
to groups of people, or using digital
technologies such as remote monitoring
and feedback, or mHealth apps.
“While many of these ideas are already
being put into practice across the health
system, the funding has to be in place to
ensure equity of access to care.
“Co-designing services with consumers
is needed to ensure that they meet patient
needs and desired outcomes, and investment
in new technologies and treatments needs
to be undertaken in a way which ensures all
Australians can access the best care, not just
who can pay for it themselves.”
Dr Amy Nguyen, of the Australian Institute
of Health Innovation at Macquarie University,
said that embracing digital transformation
can ease the burden of chronic disease on
the nation, especially in the elderly.
Initiatives such as My Health Record give
treating clinicians the tools they need to
correctly treat disease.
“Mobile health apps that educate the
patient and support them in self-managing
their conditions are helpful, as well as
providing access to their health information
such as through My Health Record,” she said.
“Data is plentifully collected, but little of it
is being used to predict chronic conditions.
Use of big datasets from GPs, hospitals and
aged care facilities to examine vulnerable
groups, genetic causations and associations,
medication usage and so on could provide
more information about modifiable risk
factors to prevent chronic disease.”
The way we currently use data and treat
chronic disease is costly to the health
system and can cause misdiagnosis, poor
medication management and avoidable
presentations to emergency departments.
“Health information being kept in data
silos means that tests (pathology, imaging
and so on) are being repeated, and this
duplication is costly to the health system,
as well as the patient,” she said.
Overall, the experts suggest an overhaul
is needed to reduce the burden that
preventable chronic disease is placing on the
economy and the wellbeing of the nation.
“We need a mindset shift to recognise
health expenditure by governments is
an investment in a healthy country and a
healthy economy,” Verhoeven said. “But
that investment has to be well-targeted.” ■