Since this year is no exception, here are a few of the top concerns that manufacturers are grappling with. Regulatory compliance and traceability Nearly every type of manufacturer faces increasing regulations aimed at everything from ensuring product safety to managing disposal and reclamation procedures.
The next Australian Government will confront major challenges in the funding and delivery of health care.
These challenges derive from: Changes in demography and disease patterns as the population ages, and the burden of chronic illness grows; Increasing costs of medical advances and the need to ensure that there are comprehensive, efficient and transparent processes for assessing health technologies; Problems with health workforce supply and distribution; Persistent concerns about the quality and safety of health services; Uncertainty about how best to balance public and private sectors in the provision and funding of health services; Recognition that we must invest more in the health of our children; The role of urban planning in creating healthy and sustainable communities; and Understanding that achieving equity in health, especially for Indigenous Australians, requires more than just providing health care services.
T he next Australian Government will confront major challenges in the funding and delivery of health care. Inequalities in health between our most and least advantaged citizens persist, and are the sentinels that remind us that there is no room for complacency, or for inertia in reforming our health care system.
There is almost universal agreement that the health care system must focus on prevention and better management of chronic illness. There is little flexibility to do this in a system hamstrung by a focus on fee-for-service and isolated episodes of acute care, growing out-of-pocket costs for patients, and workforce shortages.
Here, we present a number of pressing challenges that will require national leadership. We do not propose solutions here, but we are committed to being part of the search for effective responses to these challenges after the upcoming federal election.
While our list of health challenges confronting an incoming federal government may not be definitive, we believe these challenges must be addressed if Australians are to maintain or improve on present levels of health and wellbeing, have the health services they need when they need them, and be able to participate fully in the workforce and the community.
Changing demography and disease patterns Our ageing population challenges the ability of health services to maintain health and wellbeing, manage serious and continuing illness, and provide support for the frail and disabled.
The ageing of the population is not a major contributing factor to rising health costs. Chronic diseases also dominate the long list of health problems experienced by our Indigenous communities. Preventive initiatives do not reach out effectively to those most at risk, and services for the chronically ill are concentrated in the acute care sector, with suboptimal links to general practice and community care.
Coordinating services in the cause of better primary, secondary and tertiary prevention, and better care for patients with serious and continuing illness, some of whom may require support for decades, is hindered by the separate and competing contributions made by the federal and state governments and the private sector to the funding and supply of health services.
The costs of new technology Much of the rise in health care costs can be attributed to advances in medical technology Box 2. Listing these for subsidy through Medicare or the Pharmaceutical Benefits Scheme PBS greatly increases their availability and use, and therefore the cost to the community.
Failing to subsidise them inevitably raises questions about why new medical advances are not available to all Australians, and generates political pressure. Australia has an enviable record in the assessment of new pharmaceutical products, based on the principles of cost-effectiveness.
Different criteria are used in public and private hospitals to determine access to new technology and expensive cancer drugs not yet available on the PBS. These and other factors have led to problems in the supply and distribution of the health workforce Box 3.
Shortages are more significant in outer metropolitan, rural and remote regions, especially in Indigenous communities, and in particular areas of care, such as mental health, aged care, and disability care.
Rigid, fault-seeking, blame-allocating cultures are tolerated, even enshrined, in professional hierarchies.
There is a new agency for quality and safety, built on a succession of preceding committees and councils, but its effectiveness has yet to be demonstrated Box 4. This has been presented as a matter of choice. However, the private health insurance surcharge can be seen as unfair by those who live in rural areas where access to private health facilities is limited Box 5.
This creates an equity challenge where access to care is based on ability to pay rather than need. Specialist surgical training remains concentrated in the public sector, where the caseload is diminishing. The private health insurance sector is heavily regulated. Premiums for private health insurance are the same for the active and the indolent, the prudent and the profligate.
Should this be so? Health funds respond by shifting their bad risks back to the public sector — for example, they do not pay for home renal dialysis and limit payments to specific dialysis centres.
The reinsurance scheme, which evens out the risk to insurance companies irrespective of performance, obliterates incentives for funds to seek out and develop imaginative solutions to chronic disease management and prevention.
The responsible afflictions include: There is an increase in learning disabilities, aggressive behaviour and violence.
Children living in rural and remote areas and from the lowest socioeconomic groups are particularly at risk. Increasing urbanisation — especially when there has been little attention paid to the preservation of pedestrian amenities, public safety, access to cheap, fresh food, social cohesiveness and the potential for pollution — is associated with higher rates of obesity, asthma and depression Box 7.
Threats to the global environment and international concerns about the transmission of infectious diseases are perceived with growing clarity in Australia, but the impact of urban design has yet to be appreciated adequately. Health inequality and concerns with equity Despite the great improvements in average life expectancy achieved in recent decades, health gains have not been equally shared across the Australian population.
Women do better than men; well educated city dwellers in leafy neighbourhoods do better than people living in the bush or less affluent suburbs, the less well educated and the unemployed Box 8. Conclusion We have examined eight major health and health service challenges that Australia faces.
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