Is this the transparency we need?
* AMA Vice President Professor Geoffrey Dobb contributed to this column
One of the key policies developed by the Economics and Workforce Committee in the lead-up to national health reform was the need for transparency in health system performance and public hospital funding.
On 20 June 2013 the National Health Performance Authority (NHPA) released its report: Healthy Communities: Australians’ experience with access to health care in 2011-12.
This report specifically focuses on the health status of populations living in Medicare Local catchments, and the relationship between the health status, service use and experiences with care across those populations in the context of GP, dental and specialist services, waiting times, and cost barriers.
It uses the percentage of adults who self-reported having a long-term health condition (in the Government’s patient experience survey for 2011-12) as a measure of health status. While this may be useful data, it is not the same as a standardized, objective measure of health status.
Despite the sophisticated analysis and reporting by peer groups of Medicare Locals, the report doesn’t tell us very much about the relationship between ‘health status’ and use of services.
However, the survey data showed that, in 2011-12, patients were generally fairly happy with their doctors, whether GP or specialist, in terms of usage of health care services and waiting time for services.
They also showed that reported cost barriers were highest for seeing a dental professional (ranging from 11 to 34 per cent), with barriers for getting a script filled, or for seeing a GP or a specialist, being two to three times less (for example, patients who reported waiting time to see a GP as a barrier to treatment ranged from 1 to 13 per cent).
The report doesn’t tell us about the achievements of Medicare Locals.
Not only do the data it reports pre-date many Medicare Locals, but also, as NHPA states, its findings “do not reflect on the performance of Medicare locals as organizations”.
NHPA states it will publish future reports on the comparable performance of health care organisations to stimulate improvements in the health system, increase transparency and accountability and inform consumers.
Medicare Locals do not have a monopoly on these issues. Nor does this report assist with their accountability for performance against these issues.
Clearly, there is a place for this sort of detailed analysis and reporting of performance.
But does it tell us how well the system is performing, what Medicare Locals have achieved or plan to achieve, and whether national health reform has delivered a better health system?
Is this the sort of transparency we need?
Since December last year, NHPA has released three Healthy Community updates and two hospital performance reports. In addition, there is steady stream of health and hospital statistical reports from the Australian Institute of Health and Welfare, hospital pricing reports, frameworks and work programs from the Independent Hospital Pricing Authority, and performance reports from the COAG Reform Council. These reports are recycling the same data.
For all this reporting, we appear to be none the wiser about:
the actual funding provided to hospitals (even under Activity Based Funding, only the Commonwealth’s share of hospital funding must be reported); or
the service plans of all 136 local hospital networks (there is no central repository for these, with only some available on individual LHN websites); or
the local needs analyses made by Medicare Locals.
The information we now have, courtesy of the National Health Reform Agreement, covers many aspects of performance, some in great detail.
What it doesn’t tell us is whether the system as a whole is performing, how well it is or isn’t performing, and the performance benchmarks that we can hold organisations clearly accountable against.
It’s time to focus on clearly defined measures of system capacity, quantity and timeliness of service delivery, and the efficiency and quality of patient care.
We seem to be measuring many aspects of the system in more and more sophisticated ways, but missing out on the big picture: have we got sufficient capacity across our primary and acute sectors to deliver the care we need now and into the future?
The Committee will review the usefulness of these performance reports and analyse the degree to which they indicate progress or otherwise in our ‘post health reform’ system.