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The cost of chronic disease in Australia: ABC’s 7.30 report

In the years 2017–18, just over 47 per cent of Australians had one or more chronic conditions. This is an increase of five per cent from the 2007–08 figures of just over 42 per cent.

Chronic disease accounts for  37 per cent of hospitalisations and is putting an enormous strain of the health system. A report from the Grattan Institute put the cost of preventable hospital admissions due to "ineffective management" of chronic disease at $320 million a year.

ABC’s 7.30 program recently investigated the issue. They put the figure at 11.4 million Australians living with chronic disease, or one in two, and Ben Harris, a health policy expert at Victoria University’s Mitchell Institute, told 7.30 this is too high.

"About a third of chronic disease is preventable, yet we only spend 1.3 per cent of our health budget on preventing disease.

"We need to do better with prevention and managing chronic disease. We need to start treating people, rather than treating diseases," he said.

The series, entitled ‘The Health Divide’, found that although Australians have one of the highest life expectancies in the world, with good access to healthcare compared to countries like the US, more could be done to tackle chronic disease.

“Our health system is designed to cure, and that means something has to go wrong first," Harris said.

The best thing you can do for your health is be wealthy

AMA chief medical officer Brendan Murphy argued that the sustainability of the current system is a pressing issue. He told 7.30 that the cost of healthcare is growing greater than the growth in GDP every year and this is resulting in higher out of pocket costs for patients.

Harris argued that the fee for service medicine model is no longer helping Australians. He pointed to figures which show that wealthy communities do a lot better health-wise, people in lower socio-economic areas are more likely to have chronic disease, and much more likely to die early.

In fact, 49,000 more people die a year in low-socio-economic areas than wealthy areas.

“The best thing you can do for your health is be wealthy,” Harris said.

According to Harris, steep fees charged by specialists is another barrier to care, as are long waitlists at public hospitals.

We also see a stark health divide between rural and remote communities versus cities.

Although one third of the population resides in rural areas, some communities do not have full time GPs and if you live in rural areas you are statistically more likely to live a shorter life than your counterparts in the cities. Government stats show that as of 2011 mortality rates in rural areas are 1.4 times higher than those in major cities.

You are also between 2.5 times and 4 times more likely to die due to diabetes and, for suicide, between 1.8 and 2.2 times.

Access to healthcare is an ongoing issue, as is convincing healthcare professionals to move to rural communities. Despite having one of the highest rates of doctors per person in the OECD, there are still significant rural shortages.

Bridging the divide

Alison Verhoeven, chief executive of the Australian Healthcare and Hospitals Association, said a recent announcement by health minister Greg Hunt, that he would institute a national preventative strategy, is a positive step, but more effort and more funding is urgently needed.

“One way to address this would be to better target health services at achieving outcomes, rather than simply funding more activity,” she told Nursing Review.

“It will require funding different approaches to health service delivery, including using team-based approaches to care where every health professional works to the top of their licence.”

Verhoeven argued for more reliance on health coaches, allied health professionals or any services that might aid the nation in improved health.

“Some services might be provided to groups of people, or using digital technologies such as remote monitoring and feedback, or mHealth apps.

“While many of these ideas are already being put into practice across the health system, the funding has to be in place to ensure equity of access to care. Co-designing services with consumers is needed to ensure that they meet patient needs and desired outcomes and investment in new technologies and treatments needs to be undertaken in a way which ensures all Australians can access the best care, not just who can pay for it themselves.”

Dr Amy Nguyen, of Australian Institute of Health Innovation at Macquarie University, said that embracing digital transformation can ease the burden of chronic disease on the nation, especially in the elderly.

Initiatives such as My Health Record give treating clinicians the tools they need to correctly treat disease.

“Digital health is important in this, given issues with access and mobility in the older population. Mobile health apps that educate the patient and support them in self-managing their conditions is helpful, as well as providing access to their health information such as through having a My Health Record,” she said.

“Data is plentifully collected but little of it is being used to predict chronic conditions. Use of big datasets from GPs, hospitals and aged care facilities to examine vulnerable groups, genetic causations and associations, medication usage, etc. could provide more information about modifiable risk factors to prevent chronic disease.”

The way we currently use data and treat chronic disease is costly to the health system and can cause misdiagnosis, poor medication management and avoidable presentations to emergency departments.

“Health information being kept in data silos means that tests (pathology, imaging, etc) are being repeated and this duplication is costly to the health system, as well as the patient,” she said.

“These factors are particularly important in chronic condition patients as they usually see many different healthcare providers for their conditions, and thus have abundant yet fragmented health information.”

Overall, the experts are suggesting a complete overhaul is needed to reduce the burden preventable chronic disease are placing on the economy and overall wellbeing of the nation.

"We know that people in high socio-economic areas are able to pay co-payments. We know that co-payments for medical specialists in Australia last financial year were $1.5 billion in out-of-pocket costs," said Mitchell Institute's Harris.

"One in 13 Australians did not visit a medical specialist that they were referred to because of cost.”

For Verhoeven, it is about how we view funding.

“We need a mindset shift to recognise health expenditure by governments is an investment in a healthy country and a healthy economy, but that investment has to be well-targeted," she said.

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