This report is part of a series of publications reviewing the quality of health care across selected OECD countries. As health costs continue to climb, policy makers increasingly face the challenge of ensuring that substantial spending on health is delivering value for money. At the same time, concerns about patients occasionally receiving poor quality health care have led to demands for greater transparency and accountability. Despite this, there is still considerable uncertainty over which policies work best in delivering health care that is safe, effective and provides a good patient experience, and which quality-improvement strategies can help deliver the best care at the least cost. OECD Reviews of Health Care Quality seek to highlight and support the development of better policies to improve quality in health care, to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.

This report reviews the quality of health care in Australia. It begins by providing an overview of policies and practices aimed at supporting quality of care in Australia (Chapter 1). The report then focuses on three areas that are of particular importance for Australia’s health system at present: the organisation of primary health care (Chapter 2), the implementation of national standards for hospital accreditation (Chapter 3), and rural and remote health care (Chapter 4). In examining these areas, this report assesses the quality of care provided, seeks to highlight good practice, and provides a series of targeted assessments and recommendations for further improvements to quality of care.

Australia’s health system functions remarkably well, despite operating under a complex set of institutions that make co-ordinating patient care difficult. Complications arising from a split in federal and state government funding and responsibilities are central to these challenges. State and territory governments are the managers of public hospitals, while the federal government has primary care stewardship. This fragmented health care system can disrupt the continuity of patient care, lead to a duplication of services and leave gaps in care provision. Difficulties in co-ordinating patient care are exacerbated further by an unusual split in responsibilities across primary care and community health. The federal government is responsible for “primary care” largely in the form of reimbursing general practitioners (GPs), while the states and territories oversee “community health” such as maternal and child health services. Additionally, state-run public hospital emergency departments provide primary care, particularly for people who cannot access primary care services outside standard working hours. Supervision of these health services by different levels of government can manifest in avoidable impediments such as the poor transfer of health information, and pose difficulties for patients navigating the health system. Adding to the Australian health system’s complexity is a mix of services delivered through both the public and private sectors.

This chapter reviews the policies and practices in place to measure and improve the quality and safety of health care in Australia. Overwhelmingly, there appears to be national consensus in making quality and safety a policy priority. This is marked by an improving culture of transparency and a move towards compulsory standards and hospital accreditation. This work needs to be evaluated and refined to ensure that quality improvement evolves from measurement to change management. While much of the attention has been on hospitals, quality in primary health care has received less consideration. More challenging for Australia is a highly complex health system managed by two levels of government, and a mix of services delivered through the public and private sectors. Adding to the complexity is national inconsistencies in policy and performance measurement, although efforts are being made to improve harmonisation. Clearer government accountability and more explicitly defined roles between central and local authorities will help Australia overcome some of these impediments.

Australia has a fragmented set of primary and community health services that can be difficult for patients to navigate. Attempts at planning across governments and facilities are limited, making it difficult to design robust patient pathways from primary care to hospital, and back into the community. As the evidence suggests that the number of people suffering from one or more chronic diseases will increase, it will be critical for primary health care services to adapt to models of health care delivery that require co-ordination across several health professionals. Alongside this, efforts to improve the ability of patients to be more proactive about managing their health and avoiding serious health conditions could be implemented. To achieve such a transformation to higher quality primary health care services, reform will be needed to the blunt mechanisms by which doctors are paid today. Accompanying this ought to be the collection of wellselected data that allows general practitioners to be benchmarked against their peers, to assess the quality of the services they provide.

This chapter reviews the recent implementation of the National Safety and Quality Health Service (NSQHS) Standards. The standards form the foundation of a nationally consistent accreditation system, building on a long-standing history of hospital accreditation administered at regional and local levels. The arrangements seek to improve co-ordination and reduce fragmentation and duplication of the standard setting and assessment functions across the health system. While the new system provides for greater feedback of performance for governments, further clarification of roles at different levels of government is still required to streamline hospital performance oversight processes. The standards have been well received across the system, with key stakeholders endorsing the consultative approach to their development, enhanced clinical relevance and alignment with existing national and regional programmes. Broader application of the standards beyond the acute hospital sector will require development of further guidance, along with careful consideration of existing accreditation arrangements in mental health and primary and community care. The standards address important but relatively uncontested safety issues. Follow through on the planned evaluation of the standards is important.

Australia’s geographical vastness compounds the complexity of its health system and poses unique predicaments for health service delivery. While efforts have been made to address some of these problems, much of the policy conversation thus far has revolved around improving access and workforce shortages that are critical in some parts of the country. Little is known about the quality and outcomes of health care services delivered to rural and remote communities in Australia. Adding to the challenge, Aboriginal and Torres Strait Islander people continue to considerably trail the non-Indigenous population in relation to life expectancy and other health status indicators. In Australia’s most remote areas, Aboriginal and Torres Strait Islander people account for almost half the population, highlighting the importance of culturally competent services. While more health professionals would help, strong governance, innovations in funding, creative thinking and a smarter use of technologies are all required. While efforts to improve access to health care should continue, these should be accompanied by an equal emphasis on measuring and improving quality.