A presentation by Australia's Chief Medical Officer, Professor Jim Bishop AO, for the Australiasian college for Emergency Medicine 27th Annual Scientific Meeting - Canberra

1. CLINICAL GOVERNANCE and
HEALTH REFORM
AUSTRALIASIAN COLLEGE FOR EMERGENCY
MEDICINE 27th ANNUAL SCIENTIFIC MEETING
CANBERRA – 23 November 2010
Professor Jim Bishop AO
Chief Medical Officer
Australian Government Department of Health and Ageing

2. OECD HEALTH DATA 2010
How Does AUSTRALIA Compare
Health Expenditure per capita, public and private expenditure, OECD countries, 2008 ($US PPP)
8,000
7538
7,000
6,000
5004
5,000 4627
4210
4079 4063
3970
4,000 3793 3737
3696 3677
3540 3470
3359 3353
3129 3060
3008
2902 2870
3,000 2729 2687 2683
2151
2,000 1801 1781 1737
1437
1213
999
852
1,000 767
0
1 Refers to insured po pulatio n rather than resident po pulatio n. 2. Current expenditure. 3. 2006. 4. 2007. So urce: OECD, OECD Health Data, June 201
. 0
Public expenditure on health Private expenditure on health

3. AUSTRALIA’S RANKING AMONG
OECD COUNTRIES 1987-2006
Source: AIHW Australia’s Health 2010

4. Projected Burden of
Major Disease Groups, 2010
Source: AIHW Australia’s Health 2010

5. BROAD CAUSE MORTALITY
TRENDS IN AUSTRALIA
Source: AIHW

6. CANCERS WITH REDUCING DEATH
RATES 1997 to 2006 – ALL AGES
0
-5
-10
-15cancers, -13.8
All Breast, -13.8
-7.9
-20 Lung, -18.5 Bladder, -18.5
Colon, -19.6Rectum Prostate, -19.7
Bowel
-19.0 , -19.9
, -19.7
-25 -19.0 Leukaemia, -23.7Head and Neck, -23.7
, -18.9
Unknown, -24.8 , -15.2 , -24.3 Kidney
, -21.1 , -24.1
-30 Stomach, -29.4
-18.5
NHL, -25.1
-35 -31.9
-40 Cervix, -38.3
Testicular, -42.2
-45
Male Female
Source: Tracey et al, Cancer Institute NSW

7. AGED ADJUSTED DEATH RATES
From CVD, 1907 - 2006
Source: AIHW Australia’s Health 2010

8. CHRONIC PULMONARY DISEASE
MORTALITY 1980 to 2007
Source: AIHW Australia’s Health 2010

9. PREVALENCE OF CURRENT
ASTHMA 2007-08
Source: AIHW Australia’s Health 2010

10. DEATH RATES FROM
INFECTIOUS DISEASES, 1922-2007
Source: AIHW Australia’s Health 2010

11. NSW POPULATION AGE
DISTRIBUTIONS, MALE (1977 – 2036)
Source: Cancer Institute NSW

12. TOTAL CANCER CASES & DEATHS
per year (1972 to 2036)
Source: Cancer Institute NSW

13. TRENDS IN LEADING CAUSES
OF DISEASE BURDEN 2003-2023
Source: AIHW Australia’s Health 2010

14. Commonwealth Government Health
& Hospital expenditure under the NHHN
Source: Commonwealth Budget Papers, DOHA and PMC Analysis

15. HEALTH REFORM
 Increasing expenditure to $15 billion 2010/11
 Additional $7.3 billion over 4 years
 Local Hospital Networks (LHN) 60% Federal
Funds (60% of research and teaching)
 Medicare locals (100% Federal funds)
 GP Super-clinics – multi disciplinary teams
(100% Federal Funds)

16. MEDICARE LOCALS
OBJECTIVES
 Identification and response to local
health needs
 Integrated and coordinated care for the
patient
 Support clinicians to improve care
 Implement new primary care initiatives
 Accountable for efficiency and quality

17. BUDGET 2010-11
e-Health – connecting patients, providers and information
systems
The Government will establish a personally controlled electronic health
record system ($466.7m)
The system will:
 Enable people – and their chosen health provider - to
access online their key health information when and
where it is needed, for their care across the health
system.
 Allow people to register online to establish a personally
controlled electronic health record from 2012-13
 Rigorous governance
 Privacy maintained

18. HEALTH REFORM
KEY NEW STRUCTURES
 National Performance Authority
 Independent Hospital Pricing Authority
 Expanded Australian Commission of
Safety and Quality in Health Care
(ACSQHC)

19. CLINICAL GUIDELINES
SUPPORTS FOR CLINICAL
DECISION MAKING
 Evidence Base
 Highest Impact
 Range of best practice tools
 Successful implementation methods
 Monitor and report

20. CLINICAL GUIDELINES
Highest Impact
 Greatest Burden of disease
 Greatest harm from poor practice
 Greatest demonstrated need:
- New Standard of Care
- Proven variation in practice
 Greatest time spent/cost to health system

21. REVIEW OF CLINICAL GUIDELINES
N – 313
N %
CANCER 17 5%
CARDIOVASCULAR 18 6%
RENAL 22 7%
MENTAL ILLNESS 22 7%
NEUROLOGICAL 0 0%
INJURIES 13 14%
CHRONIC RESPIRATORY 0 0%
DIABETES 11 4%
OTHER 173 67%
TOTAL 313 100%
Buchan et al 2006

22. NON-COMMERCIAL CANCER
RESEARCH EXPENDITURE, 2004
(A$ per CAPITAL)
Source: Eckhouse et al (2007), ABS

23. NHMRC STRAGEGIC PLAN
2010 -12

24. NHMRC Support for National
Health Priorities Areas

25. Percentage of Expenditure by Broad
Research Area (2000 and 2010)

26. NHMRC SUPPORT FOR
TRANSLATIONAL RESEARCH
Translational funding mechanisms
 Partnership Projects for Better Health
 Partnership Centres for Better Health
 Centres of Clinical Research Excellence
 Centres of Research Excellence in Population Health
Research, & Health Services Research
 National Health Research Enabling Capabilities Scheme
 Industry Development awards

27. NHMRC PROJECT GRANTS
Clinical Trials Expenditure
$70 300
Millions
$60
250
$50
200
$40
150
$30
100
$20
50
$10
$0 0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Total Expenditure Number of Grants

28. Harmonization of Multi-centred
Ethical Review (HoMER)
 National Statement for Ethical Conduct of Human
Research (2007)
 Process supported by AHMAC conducted by
NHMRC
 Certification of ethical review processes – first
round
 Roles, responsibilities, templates published
 NHMRC working with States and Territories

29. HEALTH WORKFORCE
 Established Health Workforce Australia
 $1.2 billion in training more GPs and specialists,
nurses and allied health
 1375 more GPs by 2013, 5500 by 2020
 680 more specialists by 2020
 4600 practice nurses by 2013, 7500 rural nurses by
2020

30. GP Training Places per Year
2004 - 2014
Source: 2010 NHHN

31. CONCLUSIONS
 Increasing burden of chronic diseases especially cancer,
dementia and diabetes
 New reform structures offer opportunities to set new
clinical guidelines and standards
 Opportunities for more coordinated care through
medicare locals, local hospital networks and lead
clinician groups
 Increased health workforce provides opportunities for
greater depth in general practice and in specialist
training
 Increased need for greater evidence base as a framework
for improved guidelines and decision tools