Health care, can you find it? –  in our world-leading, world-class, fragmented system

Australians have one of the most high-performing health care systems in the world. Consumers have access to universal healthcare, advanced technical and medical treatments and services, and a system of subsidises for healthcare and medicine. In support of this, we uphold strong safety regulation and robust public health guardianship.

With all this and more on offer, why do many Australians find it difficult to find and access the services that could be available to them? 

The role of navigators to healp health consumers access different aspects of medical and social care, and treatment – and other ways to support consumers and carers – is becoming essential in Australia’s complex and fragmented health care system.

Throughout this edition of Health Voices, authors reflect on Australia’s fragmented funding sources and fractured health care system that precede the rising need for better ways to support service navigation.

In the 2020 Consumer Commission Report: Making Health Better Together, the 30 commissioners found that moving between different aspects of the health system remains difficult, and barriers exist between providers, (public, private and non-profit) and different care settings.

The role of a multi-disciplinary team is critical to coordinated management of care, especially for people with chronic and complex conditions. Additionally, many aspects of health lie outside the health care system. Service coordinators, care finders, system navigators and link workers are emerging to play an integral role in supporting patients through transitions from one health care provider or support system to the next.

Health care navigators help patients move through clinical and funding logistics and are increasingly being used throughout health systems around the world. Acute need in aged care and cancer care have given rise to leading examples, but the articles in this edition demonstrate wide ranging opportunities for patient navigators to ease transitions, minimise stress, confusion and frustration and help patients find the care they need, faster.  

Navigating through the fragmented healthcare system

Health Systems Researchers, Yvonne Zurynski, Louise Ellis and Jeffrey Braithwaite, find that even from a global perspective, Australia’s healthcare system is overly complex and within this issue lies greater potential for medical errors. The fragmented system is a burden to health consumers, and more so for people residing in regional and rural locations. Consumers expect that their access to health care is not impeded by complex systems, and that clear and complete information sharing between clinicians is key to efficiency for the taxpayer and safety for patients. Social prescribing is another way care navigators connect patients to community resources and reduce dependency on medical health services.

Associate Professor Yvonne Zurynski and colleagues from the NHMRC Partnership Centre for Health System Sustainability conducted research with Consumers Health Forum on health consumer sentiment and highlight the finding that about 25% of people say they have difficulties knowing which health services to access and to which health services they were entitled. This was higher – 30% – for people with chronic illness. 

Enabling consumers to navigate through the health system

Professor Anne Duggan, from the Australian Commission on Safety and Quality in Health Care, sets the scene on patient navigation, with an overview of the funding complexities and some initiatives that support organisations to deliver better patient experiences, such as the National Quality and Safety Health Service Standards, the Australian Charter of Healthcare Rights, and tools such as Question Builder. Professor Duggan also provides an example of patient navigators in general practice. 

Care co-ordination – an antecedent to fragmentation in health care

Learne Durrington, CEO of the WA Primary Health Alliance, puts the case that care co-ordination is essential to our complex health care system, where inequity and the social determinants of health drive wider rifts between those who have capacity to access appropriate health care, and those who fall though gaps. Durrington explains that vulnerable populations also experience greater difficulty in managing treatment regimens adequately, which is yet another barrier to opportunities presented for better health. She argues that time and volume-based funding disincentivises care co-ordination, and that increasing demand, patient complexity, expectations by patients on general practice to take this on role, means that appropriate funding for coordinators and navigators needs to be found.

Healthdirect – taking the difficulty out of navigating health services

Bettina McMahon, CEO of healthdirect Australia, outlines how the service owned by federal and state governments provides free health advice and support to Australians 24 hours a day, 7 days a week.  Healthdirect Australia was in a unique position to mobilise quickly in response to the COVID-19 pandemic to help with the Australian Government vaccine rollout, by fielding calls, questions, and concerns from the worried public. The pandemic drove agility, ingenuity, and confidence in the design and delivery of digital health services, miraculously propelling new initiatives into reality at an accelerated rate.

Navigating the digital health divide

Liz Jones, from the Good Things Foundation reminds us that 1 in 4 Australians experience digital exclusion through limited access to technology devices, data volumes, connectivity, or digital proficiency skills.

With the increasing adoption of technology to access health information or consultations via video or telehealth, the risk is that the gap will continue to widen for vulnerable populations and communities. The Good Things Foundation is exploring ways to close that gap, including a partnered program with CHF, further expanding the Digital Health Navigator role.

The Future of Health is Patient-Partnered – But How Do We Get There?

Siân Slade, a researcher at the Melbourne School of Population and Global Health gives an overview of the potential opportunities for patient navigation and lays out a historical overview, scope, the intersection of terminology and funding, measurement, and workforce competency models. She also discusses how patient navigation can help people with fewer health literacy skills achieve better outcomes for their health.

Mental health peer navigators

Dr Leanne Beagley draws on experience from the field of mental health, reminding us that this sector has long engaged peer workers, and they are a valuable resource with untapped potential. Navigation is often part of the peer worker role and Dr Beagley shows how the argument for funding service navigation is well-founded, backed by research, and demonstrates how Mental Health Australia’s NDIS Community Connectors Program helped people with complex needs stabilise their lives through navigation support to access services.

Lessons learnt from navigating aged care  

Corey Irlam, Deputy Chief Executive of COTA Australia (the Council of the Ageing) and Andrew Clark, project manager for the Aged Care Navigators Project, in “Lessons learnt from navigating aged care” jointly discuss how older citizens need to overcome barriers to accessing care they are entitled to, and how advocacy groups determined that “system navigators” were essential to help older people use the system to access their best care.  Irlam and Clark go on to explore the results of a funded trial that included specialist support workers, culminating in the good news that the trial has informed a new initiative for older Australians, the National Care Finder program, beginning in January 2023.

Patient navigation in cancer care

Gail O’Brien AO supported her driven and visionary husband, Professor Chris O’Brien, in his life’s work establishing a world class comprehensive cancer facility. Devastatingly, Chris developed terminal cancer himself and passed away prematurely. O’Brien has continued to be deeply involved with the Centre that now bears her husband’s name.  The Chris O’Brien Lifehouse encompasses patients as the core of all functions and O’Brien authoritatively discusses values and how this intersects with the patient-centred model of care.

A new program supporting young mothers navigate the health system

Young people need health services that are age appropriate and easy to access, and young people who are pregnant have even more complex health care needs. Researchers, Dr Ruth Knight, Assoc Professor Belinda Luke from Queensland University of Technology and Anne Hodge from Campbell Page, a not-for-profit delivering employment, community and commercial services showcase their work in a trial with young single mothers. Read three case studies of young people in the trial, and how intervention and advocacy can improve parenting confidence, address health and mental health care needs, and intergenerational disadvantage

Independent patient advocacy

Trevor Rowe is the Healthcare Editor for IdeaSpies.  He has a background in running parliamentary committees, examining systemic issues in the administration of public policy.  He writes about his experiences as a caregiver when his mother was hospitalised and puts forward the case for using independent patient advocates to cut through red tape and healthcare power imbalances.

Relationship-centred care and patient navigation

Health Services Research, Dr Annette Peart, from Monash University, helps us to make the connection from patient-centred care to relationship-centred care, and understand how a web of relationships strengthens the consumer experience. Integrating services, shared values, incorporating the context of community and social determinants of health, all support navigation, which relies on relationships. Dr Peart discusses a pilot program in Victoria, between Turning Point, a national addiction treatment, research, and education centre, and Self-Help Addiction Resource Centre (SHARC), a leading Victorian non-for-profit, community organisation with expertise in lived experience and peer-based recovery.

Turning Point engages with consumers experiencing drug addiction and has contact with 60% of callers who are new to treatment.