Beyond the Fragments: Preventing the Costs and Consequences of Chronic Physical and Mental Diseases
Year: 2015
Type: book
Abstract: Australia has a proud record of good policymaking to improve population health.Similarly ground-breaking policy approaches are required now to cope with the profound shift in the nature of illness in recent decades.Infections and injuries have become less common; chronic diseases such as diabetes and heart disease and mental health disorders have become much more so.Chronic diseases aren't 'cured' by a visit to a GP or a single medical procedure.These diseases are often incurable, escalate without the right kind of care, and need to be managed, sometimes over decades.They often require the expertise of several types of health care professional and self-management by patients and their families.Beyond this, local communities can do much to tackle the risks and obstacles to living well through health education and health promotion, the creation of a built environment that encourages physical exercise as part of everyday activity, tackling sources of unhealthy food, and cracking down on violence and abuse.In Australia and elsewhere in the developed world, the remedies for the ills we now face are societal and involve systems, structures and ways of living that are far beyond the remit of healthcare.Nonetheless, the healthcare system retains a vital role in treating and managing chronic conditions, and it is becoming clear that it hasn't kept pace with the vast and paradoxical societal changes which mean that more people are living with chronic physical and mental illnesses whilst the population overall is healthier and living longer.The vast bulk of Medicare funding pays for one-off visits.In 21st century Australia a patient is more likely than ever to need several types of health care, but there has been little progress in creating a joined-up care experience.Too often, patients navigate around a fragmented system, endlessly repeating their stories to multiple professionals in multiple settings or undergoing repeated diagnostic tests.The separation of responsibilities for streams of healthcare funding between the Commonwealth, states and territories means that it will be difficult to find a national solution to the fragmentation, inefficiency and increasing ineffectiveness of current arrangements.Encouragingly, the Federal Government has established a Primary Health Care Advisory Group to review these issues and it is hoped that this group will produce realistic macrolevel proposals -and that the government will listen and act.Additionally, the context set by the Reform of the Federation White Paper, published in 2014, offers an opportunity for changes to governments' current responsibilities for health services and new collaboration arrangements.This paper is part of an Australian Health Policy Collaboration series outlining the compelling evidence about the challenges of making our health systems fit for 21st century conditions.It has a very specific focus on the needs of people with chronic and complex conditions which often involve concurrent physical and mental health problems.Evidence tells us that integrated responses to complex interactions produce better outcomes; achieving this will mean moving beyond the fragmentation that characterises our current approach.This paper suggests that we need to start thinking about integrated care as a broader shift away from fragmentation and towards improved population health.Achieving this will require coherent action at various levels, from government to the clinical front line.It is time to change course in policy, funding and service models.
Author: Maria Duggan
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Deakin University
OpenAlex ID: W2585024509