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Objective. This article provides a policy analysis of the Australian government's National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. Methods. The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. Results. The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. Conclusions. It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms. [ABSTRACT FROM AUTHOR]

Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5–16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform. [ABSTRACT FROM AUTHOR]

Introduction. Five years ago Australia, and the world, placed itself on heightened alert for pandemic influenza, based on concerns about the potential spread of the avian influenza virus. This prompted a flurry of preparation activity involving general practice, with information from various sources; government, colleges and divisions of general practice. Method. To assess how general practitioners and practice nurses perceive this information, practice nurses and general practitioners were interviewed as part of a larger project exploring the role of the Australian general practice sector in an influenza pandemic. Results were validated by two focus groups and scenario sessions. Findings. Participants perceived that non-government organisations rarely gave useful information during a pandemic outbreak. Local divisions were perceived as having a practical and useful role, providing hands-on support to practices during a pandemic outbreak. Our participants did not perceive any coordination in the delivery of information sent by all the organisations involved in a pandemic response and therefore rejected our second hypothesis. Conclusions. More planning needs to go into the coordinated response of the general practice sector to a pandemic, and such a response should include the support of local Divisions, both as a conduit for information and to assist practices to develop response plans. [ABSTRACT FROM AUTHOR]

Public health and primary care have a huge impact on the demand of hospital services which is reflected in regional differences. In general, hospitals have strategies based on functionality and do master these functions quite efficiently. However if the total cost per capita eventually rises due to a high demand on hospitalisation, the benefit will be lost. A systems approach is needed to face this dilemma. The relationship and interdependence between cost, productivity and the measures on health play a significant role in understanding and assessing service delivery in hospitals. The session will highlight some of these elements and factors, including further need for studies such as EuroHOPE and others. The content of the workshop is as follows: Prof. Terje Hagen from the Department of Health Management and Health Economics in the University of Oslo will present the scope and first preliminary results of EuroHOPE, (European Health Care Outcomes, Performance and Efficiency), a European four-year research project launched to evaluate the performance of European health care systems in terms of outcomes, quality, use of resources and costs. Dr. Anna Stavdal, Vice President WONCA (World Organisation of Family Doctors) will give an overview from the primary care and general practice angle, regarding the demand for hospital services. Dr. Jorma Penttinen, Chief Medical Officer from Kuopio University Hospital will reflect on the rising demand on hospital services, with a special emphasis on the costliest 10 per cent of patients based on own research. Associate Prof. Paul Dugdale from the Australian National University will give a presentation on health policy responses to rising rates of multi-morbid chronic illness in Australia and New Zealand The session will be moderated by Dr. Risto Miettunen MD, CEO of Kuopio University Hospital, Finland. Dr. Miettunen is a nominee for the Governing Council in the IHF. [ABSTRACT FROM AUTHOR]