Tue Nov 28

How does Australia's health system stack up internationally? Not bad, if you're willing to wait for it

Written by Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of Melbourne

When things are going bad in the health system, we are reassured we’ve got one of the best health systems in the world. But we’re rarely told where we actually stand relative to others.

A new report ^[1] from the Organisation for Economic Cooperation and Development (OECD) shows where Australia is doing relatively well – and not so well. The report is more than 200 pages with dozens of charts and tables.

Here we highlight five charts showing Australia’s relative performance. Overall, Australia’s health system performs well, but can come after long waits. And our use of antibiotics is trending in the wrong direction.

1. We spend less than average but live longer than average

Despite the rhetoric about the unsustainability of the health system, Australia performs well. When mapping health expenditure against life expectancy, Australia (marked by the red dot) sits in the best performing quadrant – and has done so for the past decade.

In contrast, the United States is stuck in the worst performing quadrant for the whole period – significantly higher spending than other countries with worse life expectancy.

The life expectancy measure is used here but it involves an implicit assumption that the principal impact on life expectancy is from the health system, which is not really the case. Nevertheless, it is a good measure of overall system performance and combined with spending provides a good measure.

2. Most Australians rate their health as good or very good

The vast majority of Australians (about 85%) rate their health as good or very good, with Australia performing better on this metric than most other similar countries. Often good health is conflated with good health care, and the data show that Australia also has more doctors per head than other countries.

The founding charter of the World Health Organization (WHO) recognised that health is not just the absence of disease, but a “state of complete physical, mental and social well-being ^[2]”. This points to a flaw in the nexus between good health and more health professionals. The WHO focus on well-being helps to explain why it is not surprising that, looking across countries, the number of doctors doesn’t appear to be a key determinant of performance on self-rated health.

3. It’s harder to get a bed in aged care

About 30% of people in OECD countries are over 65, while the Australian proportion is about 20%. The proportion of over-65s is rising everywhere.

A minority of older Australians (14%) use aged care, with most of these using home care. However, monitoring access to residential aged care (represented here by the number of long-term care beds per thousand population over 65) might act as a “canary in the coal mine”, highlighting where access problems exist.

In Australia, access to aged care beds is falling, by about 27% between 2011 and 2021. We started in the middle of the pack so this is a concern and probably contributes to more Australians being stuck in acute hospitals, rather than being in more appropriate accommodation in residential aged care. This “exit block ^[3]” in turn leads to problems of ambulance ramping.

4. Australians wait too long for public hospital hip replacements

Most publicly funded health systems are characterised by long waiting times for access to planned procedures such as hip replacements. Some waiting is to be expected as part of efficient management of operating theatre scheduling. But long waits, especially when the person is in pain, reflect poorly on management of the public hospital system.

The data shows that almost two-thirds of people waiting for hip replacement surgery in Australia waited more than three months. This is marginally worse than the OECD average. Unfortunately, our performance is deteriorating.

A number of states, such as Victoria ^[4], have developed strategies to improve the performance of the planned procedure system, or have identified opportunities for efficiency improvements in public hospitals ^[5] which would help address this issue.

Although it’s understandable that planned procedures were affected ^[6] by the first few years of the COVID pandemic, governments should have adapted their funding and provision systems to bring waiting times back to the pre-pandemic levels.

5. Our use of antibiotics is going in the wrong direction

Antibiotics have saved millions of lives. But public health experts have long recognised the emerging problem of antimicrobial resistance ^[7], where inappropriate use of these drugs can lead to their reduced effectiveness over time.

Worldwide campaigns to promote appropriate use of antibiotics are bearing fruit and across the OECD, use of antibiotics is going down.

Unfortunately, Australia’s trend is in the reverse direction.