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Meaningful health system performance information

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A major ongoing focus for the Economics and Workforce Committee’s (EWC) work is monitoring and developing policies in relation to the financing and delivery of health care, including public hospital funding and organisational issues.

This includes monitoring how the performance of health care is measured and reported by the range of Government bodies involved.

The Committee has reviewed recent Government reports and the AMA Public Hospital Report Card, and believes there is scope for more meaningful performance information that better reflects the perspectives of clinicians, and can be used for AMA commentary.

The current field for reporting health performance information is crowded.

Government organisations with a direct or indirect stake in performance reporting include the National Health Performance Authority (NHPA), the Independent Hospital Pricing Authority, the National Health Funding Pool Administrator, the Australian Institute of Health and Welfare, the Australian Bureau of Statistics, the Council of Australian Government (COAG) Reform Council and various Commonwealth and State Government departments.

It’s hardly surprising that performance reporting increasingly tends to recycle information already published by one or more of these bodies, though different presentations and schemas are used for analysis.

For example, the NHPA has released two series of performance reports (for hospitals and healthy communities) using a small number of specific indicators from the National Performance and Accountability Framework (48 indicators agreed to by COAG under National Health Reform).

NHPA’s Healthy Communities reports present data in ways that enable comparisons between peer groups of Medicare Local catchments. The most recent report used Medicare claims data and self-reported patient experience and health status to assess performance against criteria including access, urgency, waiting times and cost barriers.

The EWC has noted legitimate concerns that self-reported experience may not be a robust basis on which to objectively measure health care need, or GP waiting times.

Further, because the NHPA Healthy Communities website reports performance data against Medicare Local geographical areas, there is scope to wrongly assume the data reflects the performance of Medicare Locals.

But, in fact, the most recent NHPA Healthy Communities report provided comparable information on the performance of GPs and specialists – not Medicare Locals.

Nonetheless, it seems likely current approaches to performance reporting will continue for the foreseeable future. This includes defining and reporting primary care system performance by patient surveys on access and affordability, reported by Medicare Local boundaries.

The EWC has identified potential additional measures that the AMA could comment on to bring a new dimension to public hospital performance, such as:

  • hospital occupancy rates, rather than bed occupancy;
  • unplanned readmission rates;
  • mortality rates;
  • percentage of staff who rate their hospital as a great place to work;
  • simple doctor-to-patient ratios, for example staffing numbers in hospitals; and
  • transfers of care (including discharge summaries and discharge planning).

The AMA Council on General Practice is also considering how the performance of Medicare Locals in assisting general practice primary care can be reported by the AMA.

I welcome your views and suggestions on any additional health system performance measures that would be useful for AMA commentary.