The Victorian community is serviced by a range of health services including public hospitals, community health services and bush nursing services. These public health facilities provide a broad range of services including in-patient and out-patient medical and surgical services, rehabilitation, mental health, aged care and primary health care services. A key component of Victoria's health system is the provision of health services through a system of regional self sufficiency, which enables patients to access the care they require close to home.
Advantages of Victoria's Health System
There are a number of unique aspects of Victoria's health system the VHA believes helps to ensure Victorians receive high quality health services across the state.
1. The Boards of Governance Structure
In many states in Australia health systems are still governed at the State or Territory level. Where Victoria differs is in the election and appointment of health service boards of directors under the Health Services Act 1988. This model facilitates good governance and offers unique opportunities for planning systematically and debating issues at a local level.
It is boards that set the strategic directions of health services that are then implemented by the chief executive. In effect, boards act as a consumer watchdog and thereby offer sound risk management. This may be one reason why Victoria has avoided the clinical governance scandals that have emerged in other states.
2. Innovative Programmes
Victoria continues to seek innovative solutions to addressing the health needs of the population. Programmes such as the Hospital Admission Risk program (HARP) has demonstrated reduced hospitalisations. Sustainable Farm Families has shown innovation in improving rural health and has been rolled out nationally. The Rural Maternity Initiative has provided flexible maternity services for people living in regional areas, increasing access to maternity services in many locations. Many projects funded under the Go for your Life campaign improve individual physical and social health outcomes.
3. Community Health Services
Victoria's network of community health services continues to demonstrate both proactive and reactive care that encompasses patient-centred primary health care and preventative health approaches. Very often these services are at the forefront of targeting disadvantaged communities, who may otherwise slip through the system.
4. System Efficiency
Recurrent expenditure per person, weighted by population in Victoria is $1,238, compared to the national average of $1,213. While Victoria has 2.3 beds per 1,000 weighted population (lower than the national average of 2.6) its performance in relation to elective surgery is above the national average. Victoria also leads the way in treating hospital patients in alternative settings. In Victoria, 3.11 per cent of all hospital patients were seen in their homes. Victoria's Hospital in the Home (HITH) program accounted for 75 per cent of all HITH activity in Australia.
5. Safety and Quality
Hospitals must also be safe. Currently 98 per cent of Victorian Hospitals (141 of 143) were accreditated in 2006-2007, compared to the national average of 85 per cent. As the health care system treats more patients in the community there is a need to improve clinical safety in these settings. The Clinical Governance in Community Health Project is leading the way in ensuring stringent clinical safeguards are implemented in community settings.
Challenges Facing Victoria's Health System
Multiple challenges impact on the ability of Victoria's health system to deliver safe, timely, quality and client-centred care. These include:
- An ageing population
- An ageing workforce and a skills shortage
- Rising rates of chronic disease
- Higher population growth straining infrastructure capacity
- Population mobility straining local services in regional and coastal areas
- A growing proportion of ageing non-English speaking background clients with special needs
- A complex funding system that stymies reform and feeds the "blame game" between state and federal governments
To sustain the current delivery of services to Victorians into the future will require major innovation in modes of service delivery, models of care, the creation of new healthcare workers and investment in preventative health strategies to minimise hospital admissions.
Systemic Reform
The VHA has consistently advocated for systemic reform of Victoria's health system to increase both its capacity and efficiency and to improve individual patient outcomes. At the core of the VHA's approach is a belief in the universality of health care and the need to both educate and involve the community in any reform process.
Central to the reform process is the need to realign health policy from the current bed-based acute focus to ambulatory case management approaches. This will require significant resources for capacity building to address population health needs and allow local area-based planning that focuses on preventative health approaches in the community. It will also involve developing a set of key performance indicators (KPIs) to better measure the effectiveness of the health system and replace the outdated emphasis on hospital waiting lists.
