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This is where the health system fails

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The effect of where you live on your health is nowhere more apparent than on Palm Island.

Inhabitants of the small island just north of Townsville are being hospitalised for chronic obstructive pulmonary disease at almost 21 times the rate of other Queenslanders, are being admitted for epilepsy and the bacterial skin infection cellulitis at 12 times the state-wide rate, are in hospital for diabetes complications at almost nine times the state-wide rate, and are six times more likely to be admitted for a urinary tract infection.

Leading health economist Professor Stephen Duckett says these figures show a community that is being failed by the health system.

“When people end up in hospital for diabetes, tooth decay or other conditions that should be treatable or manageable out of hospital, it’s a warning sign of system failure. Australia’s health system is consistently failing some communities,” he says.

Palm Island is among 63 locations in two states – Queensland and Victoria – identified by Professor Duckett and his colleagues at the Grattan Institute in their report Perils of place: identifying hotspots of health inequalitywhere rates of preventable hospitalisation are at least 50 per cent above the state-wide average for a decade or more. These include conditions such as asthma, diabetes, high blood pressure and malnutrition.

“Persistently high rates of potentially preventable hospitalisations are not normal,” the health economist says. “They are a signal that the existing health policies are not working or are insufficient.”

What causes these areas to have such high rates of health disadvantage are as individual as the places themselves, and influences include air and water quality, housing standards, employment, services like schools, clinics, roads and public transport, crime and community cohesion.

Professor Duckett says that while these areas tend to be more disadvantaged, “we found that potentially preventable hospitalisations are actually generally widely spread, and the places where hospitalisations are most concentrated are quite different for different diseases”.

The complex picture means that policy prescriptions have to be tailored to the individual characteristics of each location: “There is no single solution. The driving forces will be different in each place”.

But just because they defy generalisation and a one-size-fits-all solution, that is no reason not to address the issue, and the rewards in improved health and lower expenditure are considerable – Professor Duckett calculates that reducing preventable hospitalisation rates in the 63 areas identified in the Grattan Institute report to the state-wide average would, conservatively, save between $10 and $15 million a year in direct health costs alone, without taking into account indirect savings from fewer sick days and improved workforce participation.

Professor Duckett says the Commonwealth should fund trials, led by local Primary Health Networks, to test solutions and, crucially, commission rigorous and independent evaluations to identify what works and what does not.

PHNs should also develop tools to more precisely identify and target preventable hospitalisation hotspots. As data from trials is accumulated and lessons drawn, PHNs should use this information and experience to strengthen and expand their efforts.

Professor Duckett admits the priority areas identified in his report represent only a fraction of the problem, and “prevention efforts in these areas alone will not substantially reduce the overall burden of potentially preventable hospitalisations”.

“But,” he added, “they will help to efficiently reduce the worst health inequalities and will build the evidence base for how to address health inequalities more broadly.”

The bottom 10

The nation’s worst preventable hospitalisation hotspots

Palm Island

Yarrabah

Mount Isa

Mount Morgan

Northern Peninsula

Donald

Langwarrin South and Baxter

Broadmeadows

Frankston North

Kingaroy

Source: Grattan Institute

 

Adrian Rollins

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