With Australia spending approximately 9.7% of its GDP on health care in 2016 (Source: OECD), Australia’s health-care system relies on a private, parallel health-care sector in addition to the network of public hospitals and primary care centres, to deliver health services to the population. Hospital care in Australia is delivered by 1325 hospitals out of which 54.2% are public hospitals, 36.9% are private for-profit hospitals and 9% of not-for profit private hospitals. Of the 10.6 million hospitalisations in 2015-2016 in Australia, 59.2% of them were to a public hospital institution and 49.8% to private.
The private hospital sector is growing in size and in complexity with an increasing presence of for-profit firms operating several hospitals. Private hospitals have a strong focus on elective surgery, and many day only/elective surgery facilities are progressively private-owned. In addition to fully owned private hospitals, some private hospitals are also contracted to provide public healthcare facilities such as the Joondalup Health Campus owned by Ramsay.
For the longest time (since the 80s) the model of healthcare in Australia has primarily been provider /sector centric. This may be due for a change with the emphasis increasingly becoming consumer/patient centric wherein the consumer experience and not provider experience is compared against the capital and operational expenditure. Focus will be shifted on patient experience & satisfaction and quality outcomes due to increasing health literacy of the consumer and impact of various technological advancements within the healthcare domain such as a push for digitizing health records, AI etc. By becoming provider-agnostic, collaboration & coalition between various healthcare /non-healthcare groups becomes possible. This in turn would improve quality of care-a key KPI in a consumer centric healthcare model along with other KPIs such as quicker turnaround of diagnostics.
The Federal Government-Australian Commission on Safety and Quality in Healthcare along with State and local authorities formulate nationally consistent reporting methods to monitor the level of care consumers can expect from health service organisations. Quality of Care data has not been completely normalised between Public and Private Healthcare Systems in Australia. ACSQH along with Australian Institute of Health and Welfare is working to develop a national set of safety and quality indicators could provide a basis for future comparisons between public and private hospitals. The public hospitals possess a sophisticated infrastructure with standardised protocols in place and are answerable to National Safety and Quality Health Service (NSQHS) independently. Amongst the private hospitals, they have established a range of key performance indicators to measure patient satisfaction and quality of care to comply with. In either, there is an obligation to be audited around standards of care. At a first glance of the gold standard indicators such as Average Length of Stay (5.7 days in public vs 5.2 days in private), Hospital-associated Staphylococcus aureus bacteraemia (SAB) (6.7% in public vs 4.1% in private) and Waiting times for elective surgeries (42 days in public vs 20 days in private), the private hospitals seem to fare better than their public counterparts. However, lack of comparable and reliable hospital-level data limits these comparisons. Additionally, understanding the gap in the indicators used above is particularly onerous as comparing public hospitals offering complex and emergency services for acute cases with private hospitals who provide predominantly elective surgical procedures and specialised day patient services could be analogous to comparing apples with oranges. Additionally, most urban/ semi urban private hospitals also tend to be smaller in size (lesser number of beds) in comparison to urban public hospitals.
Another topic of conversation is redefining our views on what constitutes Quality of Care. As it stands, both public and private healthcare providers have a strong emphasis in complying with process indicators to reflect quality of care. How well these process indicators translate to real time results on patient care will have a direct impact on the patient experience. To help patients make informed decisions, certain healthcare providers in the US have made individual surgeon/clinician outcomes data publicly available. Whilst this may seem a way to gauge quality of care for the patients in the USA, it may be of less relevance in a predominantly public healthcare system. We need to move away from compliance with process and talk about reliable and actionable indicators of quality to truly understand and better patient outcomes and quality of care.