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How will health services cope with a super-sized Australia?

The Medical Journal of Australia has published an article which looks at the devastating impact of population growth on public hospitals in Australia, as well as the more general impact of increased urbanisation, urban sprawl, and the reduced 'walkability' of neighbourhoods.

Here is an extract focusing on the problems public hospitals are already having coping with the demands of the current population.

"The Garling inquiry concluded in 2008 that the New South Wales health system is in a state of crisis.[13] This finding also applies to the rest of the states, with the possible exception of Victoria.[14]

An independent analysis by the Australian Medical Association has concluded that Australian public hospitals are dysfunctional, operating at full or above-full capacity, and urgently in need of increased capital funding. An important finding was that major metropolitan teaching hospitals operate on a bed occupancy rate of 95% or above. The report noted that hospital overcrowding was the most serious cause of reduced patient safety.[15]

It is clear that, even at Australia’s current population ...[*16A] the public health system is struggling to cope with demand. Changes will be required to deal with a vastly increased, yet still ageing, population and the attendant multiple comorbidities, many attributable to increased urbanisation.

Practical measures might include disinvestment (reallocating health resources from existing practices, procedures, technologies, and pharmaceuticals that do not deliver much health gain for their cost); investing in prevention; increasing the health workforce; and emphasising community health. Other measures might include increasing the role of practice nurses and expanding the role of pharmacists.

The increasing pressure on health services as a result of increased immigration might provide further motivation for a move to a single level of funding, with the federal government taking over responsibility for hospitals from the states. At the very least, this might end the “blame game” and cost-shifting that currently blights the system.

In his 2004 documentary Super size me, Morgan Spurlock suffered severe adverse health consequences after a 30-day period of eating super-sized meals at McDonald’s.16 Prime Minister Rudd’s vision of a super-sized Australia, while it might have some short-term economic benefits, will put further strain on the health system.

The plan to dramatically increase the population of Australia has to be debated and critically evaluated, and a population policy must be developed. In particular, health care professionals must engage with the federal government to ensure that it commits to and delivers on comprehensive national health and hospital reform, matching its appetite for unfettered, economically expedient migration to this country.

If this is not done, we — the citizens of a “big Australia” — will all, like Spurlock, suffer the damaging health consequences of super sizing."

NOTES

[13] Garling P. Final report of the Special Commission of Inquiry: acute care services in NSW public hospitals. Sydney: New South Wales Government, 2008. http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_finalreport (accessed Aug 2009).
[14] Penington DG. Does the National Health and Hospitals Reform Commission have a real answer for public hospitals? Med J Aust 2009; 191: 446-447.
[15] Australian Medical Association. AMA public hospital report card 2009: an AMA analysis of Australia’s public hospital system. http://www.ama.com.au/node/5030 (accessed Mar 2010).
[16] Gregory AT. A counterweight to fast-food advertising [film review]. Med J Aust 2004; 180: 590.
[*16A] The author, writing at the end of 2009, underestimates Australia's population by about 2 million people, so we have left this number out. Australia's population was estimated by the Australian Bureau of Statistics (ABS) to be 22,306,143 on 13 April 2010 at 05:45:22 AM (Canberra time). Refer to the ABS population clock here: hhttp://www.abs.gov.au/ausstats/abs%40.nsf/94713ad445ff1425ca25682000192af2/1647509ef7e25faaca2568a900154b63?OpenDocument

Source

Deborah Pelser, "Super size me: is a big Australia good for our health?"

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There are three Treasury intergenerational reports. IGR1, in 2002, told us that by 2041-42, the ageing of society would put the budget in deficit by 5 per cent of GDP. Yet by 2007, IGR2 had virtually halved the forecast deficit that year to 2.7 per cent of GDP. And now IGR3 has halved it again to a forecast deficit of just 1.3 per cent of GDP!
These numbers are clearly underplaying the cost of health care!

The 2010 Intergenerational Report’s estimate of 4.1 per cent of GDP needed for extra health care and aged care by 2050.

The share of Australia’s population that is aged 65 and over has grown from 8.4% in
1971 to 12.8% in 2001, and is projected to reach 18% by 2020. The amount of GDP spent on health care has fluctuated only very slightly between 7.5% and 8.5% of GDP for most of the time.

The Productivity Commission report (2004) indicates that there will be an increase in the percentage of GDP spent on health from current levels of seven per cent to about 11 per cent in 20 years.

The number of people aged between 65 and 84 years will more than double over the next four decades and the number of very old people, they are classed in this report as people aged 85 and over, will quadruple from about 400,000 today to around 1.8 million in 2050.

Nationally, GDP growth will slow to under 3 per cent. It means that living standards will grow at a slower pace than what they have over the last 40 years.

This all points to a future Australia which is bigger but not better. The pressures on the health Budget for example would be massive. Today a quarter of all total spending is spent on health, on age-related pensions and aged care. By 2050 it says these things will take up half of all spending.

Our "ageing population" is the result of the baby boomer era and high immigration over 40 years ago. Adding more people to offset our older people will blow out our numbers further down the track!

An article published in the Medical Journal of Australia by Dr Deborah Pelser says that the influx will hit all the major towns and cities and will push up the levels of chronic disease in them.

“The Federal Government has said that to meet the challenge of a growing population, cities would have to increase their urban density. But increasing urbanisation was linked to higher rates of obesity, asthma and depression unless it was accompanied by appropriate town planning.” said Dr Pelser.
THE MEDICAL NEWS
"There is a lot of research to support the fact that the less green area available to a population the more likely they were at a risk of developing diseases such as diabetes, chronic neck and back pain, asthma, migraine, some types of cancer and even schizophrenia".

"Prime Minister Kevin Rudd's vision of a super-sized Australia, while it might have some short-term economic benefits, will put further strain on the health system.” said Dr Pelser.

Hospitals: bed numbers Mr D. DAVIS (Southern Metropolitan) —

"My adjournment matter is for the Minister for Health, and it concerns the number of hospital beds in Victoria. We are at an interesting point in the debate on health care in our state and our nation. The Prime Minister has put forward a proposal which seeks to take a higher level of control of the health system in Victoria, and the Premier has put an alternative proposal.

There seems to be a serious situation where a large ingredient is missing from both proposals, and that concerns the need for greater numbers of hospital beds.

We have seen over the period of this government the number of hospital beds decline, as best it can be worked out. We know the government has been secretive and determined to hold back on the bed numbers and the spread of beds in Victoria — where they are actually positioned in different hospitals and the type and nature of each bed around the state.

We also know that Productivity Commission data, the recent report on government services and the commonwealth Department of Health and Ageing’s report on the state of our hospitals shows that Victoria has the lowest number of public hospital beds per 1000 of population. At 2.3 it is clearly the lowest of any state.

It is no wonder that we have serious problems in our hospitals like, for example, 2566 patients spending more than 24 hours on trolleys in emergency departments waiting to get into hospital beds, into intensive care or waiting for procedural treatment in one of the hospitals. The beds are full, and there is simply no capacity.

Our hospitals often operate at over 95 per cent capacity, and the auditor and others who are knowledgeable about these things say that if you are operating well over 85 per cent, you are more likely to have serious problems with moving people through the hospital system. Neither the federal nor the state proposals have any detail about additional beds and beds into the future given we know Victoria’s population is growing and ageing and we have fewer beds than we had when this government came to power.

What I seek from the minister is a full audit of bed numbers in Victoria. I seek that he audit those bed numbers and publish the lists of where the beds are positioned and the types of beds. This will be an important step in enabling us to get a grip on the number of beds in Victoria, but both the federal and state plans need more beds."

From: http://www.parliament.vic.gov.au/downloadhansard/pdf/Council/Feb-Jun%202010/Council%20Feb-Jun%202010%20Daily%2013%20April%202010.pdf

(Dave Davis is a Liberal Party Minister. You can read more about him here: http://daviddavis.com.au/about/