Postcodes shouldn’t determine health

Public Health

By Stephen Duckett

25 Jul 2016

People ending up in hospital for diabetes, tooth decay, or other conditions that should be treatable or manageable out of hospital is a warning sign of system failure. And Australia’s health system is consistently failing some communities.

A Grattan Institute report, Perils of place: identifying hotspots of health inequalities, released today, identifies a number of geographical areas where high rates of potentially preventable hospital admissions have persisted for a decade. This is unacceptable place‑based inequality.

Using data from Queensland and Victoria, the report identifies 38 places in Queensland and 25 in Victoria that have had potentially preventable hospitalisation rates at least 50% higher than the state average in every year for a decade. There is no evidence to suggest the pattern is any different in other states and territories.

Reducing potentially preventable hospitalisations in these places to average levels would save at least A$10 million a year for the Queensland and Victorian health systems. Indirect savings, such as improving the productivity of the people affected, should be significantly larger.

Different places, different problems

Some of the areas identified as having high rates of potentially preventable admissions were in remote areas such as Mt Isa in Queensland. Others were in suburban centres such as Broadmeadows in Melbourne.

In some places, the high rates of admissions were driven by high rates of re-admissions – a small number of people each having a large number of admissions each year. In these places, better targeting care to high-risk individuals may help to reduce rates.

Yet in other places, re-admissions did not contribute to the problem at all.

Areas that have a low socioeconomic status, are regional, and/or have a high proportion of Indigenous people are more likely to experience health inequalities.

But even in Australia’s most disadvantaged areas, persistently high rates of potentially preventable hospitalisations are rare. Because many such areas have low rates of potentially preventable hospitalisations, examining why some have a problem while others do not may help to understand what needs to improve.

What can governments do about it?

The Grattan Institute’s report has three clear messages for governments and local health agencies such as Primary Health Networks.

First, make sure prevention efforts are focused in places where high rates of potentially preventable hospitalisations have existed for a while. These are the places where health inequalities are already entrenched and, without intervention, are most likely to endure.

On average, about half of areas which had a high rate of potentially preventable hospitalisations in one year had dropped back to closer to the state average the next year (55% in Victoria, 45% in Queensland). This means that if governments or Primary Health Networks make their intervention decisions based on just one year of data, they will have a false sense of reassurance that their interventions are working when in fact their success might just be the result of random chance.

Second, think local. Australia is not a uniform country and a one-size-fits-all approach will not work. Some areas may have excellent local primary health care services but, in the face of very severe disease burdens, the area ends up with a high rate of potentially preventable hospitalisations. Other areas might have poor access to primary care services.

There is no uniform pattern for the causes of high rates of potentially preventable hospitalisations. Tailored policy responses are required.

Primary Health Networks have been given responsibility to identify and address health needs in their regions. They must identify the areas with high rates of potentially preventable hospitalisations and distil why these rates are occurring. They then need to design locally tailored responses, in partnership with local health authorities and communities.

Unfortunately, there is as yet only limited evidence of what works in reducing potentially preventable hospitalisations. Governments should therefore invest in trials to reduce potentially preventable hospitalisations in places identified as having high rates.

The cost-effectiveness of interventions must be established on a small scale before they are rolled out to further areas.

This leads to the third message: interventions must be rigorously evaluated so they expand the evidence about what works. As Primary Health Networks become more sophisticated at identifying the people most in need and as the evidence from trials builds, efforts to reduce health inequalities should be strengthened and expanded beyond the priority places identified here.

The role of place in shaping people’s health and opportunity is well-established. Governments and Primary Health Networks must ensure all communities get a fair go.

Improving the health of people in these places with high rates of potentially preventable hospitalisations will, in the long-run, reduce health costs. Even more importantly, it will increase social cohesion and inclusion, workforce participation and productivity, by making many more people healthy and able to make the most of their lives.

This article originally appeared on The Conversation.  

About the author: Stephen Duckett is the Director of the Health Program at the Grattan Institute.

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