The health system is awash with data. Sometimes the data is transformed into useful information about health system performance, like comparing rates of health-care associated infection by named hospital, waiting times in emergency departments by hospital and ambulance response times by state.
There are currently three different publications that report these data: the Productivity Commission’s Report on Government Services, the Australian Institute of Health and Welfare’s series of reports on specific aspects of hospitals or primary care and the Australian Institute of Health and Welfare’s separate biennial report on Australia’s Health.
The heads of Australia’s health departments recognise the way we measure the system at the moment is not good enough. They recently released a consultation paper in which they called for a single performance report instead of the three we have currently.
The proposed single report is logical enough. Under the proposal, the report would recognise the determinants of health; outline six key elements of the system’s performance (effectiveness, safety, responsiveness and consumer satisfaction, continuity of care, accessibility, and efficiency and sustainability); and highlight the importance of results in terms of individual and community health and well-being.
But unfortunately this is too weak and narrow.
How we need to be assessing our health system
The big problem is in the way the entire health system - including hospitals, primary medical care (GPs), community health centres and other aspects of primary care such as physiotherapy - is conceptualised. Our health policymakers seem to think the system is static. The proposed report contains little about measuring how well the health system positions itself for change.
It mentions the importance of the health system’s capacity to sustain its workforce, but does that mean ensuring the workforce is healthy and satisfied, or does it mean ensuring the workforce is appropriately prepared for the future? The goal needs to be that we have a health workforce with the right skills in the right places.
The section on consumer satisfaction is full of tired and outdated thinking. It refers to the collection of data on patient outcomes and patient feedback on their hospital experience. But, bizarrely, it overlooks PROMs, or patient-reported outcome measures.
PROMs are a critically important addition to the measurement of Australia’s health system because they are the only metric that directly captures what we care about most: whether health procedures we have actually make us feel better. Did the hip replacement leave us with less pain and able to walk around easily? PROMs should be integral to any new measurement of our health system.
The proposed report acknowledges equity, with a plea for measures that enable policymakers to focus on:
key populations, such as culturally and linguistically diverse communities, people with chronic conditions, people with mental health conditions, Aboriginal and Torres Strait Islanders, and older people.
However, it recommends only the mean outcome of each measure be reported. The mean is notorious for being a measure that disguises inequality. A satisfactory mean outcome can mask the fact some people are suffering really bad results in terms of their outcomes or the rate at which they experience adverse events. If we are serious about making our health system accountable for the equity of its outcomes, it’s essential we look at the range of outcomes experienced.
Similarly, we need to look at how access and affordability varies. People in rural areas face higher levels of out-of-pocket costs and have to wait longer to see a GP.
What about affordability of care?
With out-of-pocket health costs in Australia among the highest in the world, and with many people deferring or not seeking care because they can’t afford it, affordability should be an explicit part of any data we’re measuring.
The proposed report’s focus on individuals is too limited: the health system should seek to improve the health of populations and strengthen the resilience of communities.
We know that what’s measured gets managed. This means the data we have will shape tomorrow’s policy agenda. Unless the new report is strengthened and broadened, Australia will miss an opportunity to dramatically improve how we measure the things that really matter in health care.