Healthcare delivery for our ageing population: What does Australia need to do?

In the last few decades the proportion of GDP devoted to health care has increased in most OECD countries.This trend is expected to continue in coming decades. In Australia it is predicted that outlays on health and aged care will increase from 9.3 per cent of GDP in 2003 to 12.4 per cent of GDP by 2033. The underlying drivers of this growth include the rising cost of medical innovation, the ageing of the world population and, specifically, changes in the burden of disease, especially of chronic disease. In Australia, over 70 per cent of the burden of disease is attributable to chronic conditions, and 87.5 per cent of total recurrent health expenditure can be attributed to the 12 major chronic disease groups. On the other hand Australia's health care system, similarly to other OECD countries, is mainly organised around an acute, reactive and episodic model of care, inadequate to meet the needs and preferences of those who have, or are at risk of developing, chronic conditions and multiple pathologies. Therefore, a redesign of health care systems towards integrated care models with a focus on chronic-disease management seems to be a promising direction to increase responsiveness to consumers' needs and preferences and thereby increase efficiency. This chapter is organised as follows. Section 2 describes the main features of the Australian National Healthcare System. Section 3 discusses the challenges of chronicity and multi-morbidity focusing on Australia, and also presents the main chronic care models reported in the literature. Section 4 presents a framework proposed by Ham (2010) that identifies and analyses 10 key pre-conditions for a population-based model healthcare system. In section 5 Ham's framework is applied to the current decentralised Australian healthcare system, to assess its stage of development, and pathways towards the implementation of chronic care-focused healthcare are proposed. Finally, conclusions are drawn in section 6