Australia has one of the best healthcare systems in the world. However, it can be complex, and both patients and clinicians acknowledge that finding your way around is not always a straightforward process.
The Australian healthcare system has grown and evolved as new healthcare models, medical technologies, evidence and specialties have emerged. Responsibility for delivering and funding health care is shared by the Australian and state and territory governments, as well as non-government funders such as private health insurers and individuals.
The mixed model for funding and delivery, and increasing specialisation of health care, can unfortunately result in a system that is more focused on how the service will be funded, rather than on the consumer’s holistic healthcare needs.
Supporting consumers to navigate the healthcare system ……. should focus on both empowering and equipping consumers with the tools to navigate ….
Supporting consumers to navigate the healthcare system effectively requires action on a range of fronts. It should focus on both empowering and equipping consumers with the tools to navigate the healthcare system, as well as reducing the complexity and integrating health care to improve ease of navigation. This support begins at the system level and is the responsibility of all health services and clinicians.
The Australian Commission on Safety and Quality in Health Care (the Commission) works with health services to recognise the value of, and support the implementation of systems and processes for, partnering with consumers. Ensuring that consumers are empowered to effectively navigate the healthcare system is vital to these partnerships, and health literacy plays an important role.
Supporting health literacy
Health literacy is about how people understand health and the healthcare system, how they apply health and healthcare information to their lives, use it to make decisions and act on it. It is a balance between the skills, knowledge and capacity of an individual and the complexity of the healthcare system.
Health literacy ….. is a balance between the skills, knowledge and capacity of an individual and the complexity of the healthcare system.
Health literacy is variable for many different reasons. Supporting consumers to be better equipped to understand the healthcare system – and reducing the complexity of information, options and pathways – can help to navigate the healthcare system more easily.
The Commission encourages health service organisations to take more responsibility for health literacy and to empower consumers through the requirements of the National Safety and Quality Health Service (NSQHS) Standards, the Australian Charter of Healthcare Rights (Charter), and tools such as the Question Builder.
National Safety and Quality Health Service Standards
The Commission developed the NSQHS Standards in collaboration with the Australian Government, states and territories, private sector providers, clinical experts, patients and carers. They are designed to protect the public from harm and to improve the quality of health service provision.
…. it is essential to establish good relationships with GPs, who have knowledge and understanding of individual patients, which means they are less likely to fall through cracks.Dr Liz Marles,
Director of Hornsby-Brooklyn GP Unit and Clinical Director at the Commission
The eight NSQHS Standards provide a nationally consistent statement about the level of care consumers can expect from health services. Within the Partnering with Consumers Standard are a set of actions that require health service organisations to communicate with consumers in a way that supports effective partnerships and reduces barriers to health literacy.
The NSQHS Standards have been an important lever for change within our health system since 2013, when hospitals and acute health services began implementing the standards.
Providing information and sharing decisions
Another mechanism for change has been the Charter, which encourages Australians to take an active role in their health care. It establishes what we can expect and help we should receive when navigating the system.
The Charter’s seven rights provide a baseline for both consumers and health services to provide clear information in a format that the consumer understands, as well as enabling shared decision making with clinicians and others who they want included.
Our free online tool Question Builder, developed in partnership with Healthdirect Australia, is a practical tool to support consumers. It guides patients in preparing questions they may want to ask their healthcare professional at an appointment, whether seeing a doctor for a new condition, having a check-up, talking about a recurring condition, or discussing medication, a test or surgery.
Reducing complexity through integration
Beyond supporting consumer empowerment, and driving health service organisations to simplify their own information and systems, more work is needed to reduce the complexity of the way different parts of the healthcare system interact – improving transitions and integration of care.
As people become more unwell with chronic illnesses, including mental illness, their care needs increase and it can become harder for them to navigate the system. Those who are most vulnerable may also have challenges with access to technology, transport, finances and other personal supports. The separate governance, funding and management of acute, subacute and primary health care creates a divide in the healthcare system, which can lead to challenges in delivering integrated and coordinated health care.
The Commonwealth Department of Health’s draft Primary Health Care 10 Year Plan provides measures for Primary Health Networks (PHNs) and Local Hospital Networks (LHDs) to integrate and review funding arrangements to ensure better transition between the sectors and care providers.
Integration in practice
Hornsby General Practice (GP) Unit in NSW is an example of effective integrated services. The Practice is linked to Hornsby Ku-ring-gai Hospital with the ability to offer multi-disciplinary clinics. Chronic disease nurses assist with patient navigation for very complex patients (LHD funded), and an integrated care coordinator assists Aboriginal patients with patient navigation (PHN funded).
There is also a small Medical Benefits Scheme (MBS) rebate for practice nurse consultations where a patient has a GP management plan. In addition, a mental health nurse facilitates engagement with general practice for those with chronic mental illness, a group that is often poorly connected with primary care, by acting as care coordinator and liaising with case managers.
According to Dr Liz Marles, Director of Hornsby-Brooklyn GP Unit and Clinical Director at the Commission, PHNs are fundamental in facilitating integrated services and linking with LHDs. Where possible, Dr Marles says it is essential to establish good relationships with GPs, who have knowledge and understanding of individual patients, which means they are less likely to fall through cracks.
Where to from here?
It is important that health systems and clinicians continue to support and empower consumers to be active partners in their own health care, and embed mechanisms that integrate acute, subacute and primary health care, particularly for those who are most vulnerable. The COVID-19 pandemic has demonstrated that innovation in how healthcare is delivered and accessed is possible. A complex health system can still be effective if people are provided with the right means to access and navigate it.
About the author
Professor Duggan is the Chief Medical Officer, Australian Commission on Safety and Quality in Health Care. Professor Duggan is a highly respected gastroenterologist with significant operating and leadership experience in a range of healthcare settings. Professor Duggan is Chair of the new Australian Government Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC) and is a member of the Expert Panel of Ahpra and Medical Board of Australia Review of the Regulation of Health Practitioners in Cosmetic Surgery.