Australia ranks high in global health system comparison

Australia ranks first among OECD countries for equity and healthcare outcomes, and holds third place for overall healthcare performance, behind Norway and the Netherlands. 
 
These findings form the latest 2021 Commonwealth Fund healthcare report from the US, an international comparison of healthcare system performance of 11 high-income OECD countries.
 
Countries are ranked for performance across five domains: access to care, care processes, administrative efficiency, equity and health outcomes.
 
When the previous report was published in 2017, Australia ranked second overall behind the UK, with highest scores in efficiency and health outcomes, with equity the poorest performing domain.
 
And while the Australian healthcare system continues to rank well, there is room for further improvement, according to Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform.
 
He told newsGP that better outcomes could be achieved if all areas of the system performed the same as general practice.
 
‘Getting in the top three [of OECD countries] is good, and overall general practice performance was very good. But we would have done even better if the whole health system performed as well as general practice and primary care,’ Dr Wright said.
 
‘Although we’ve dropped from second-best performing system overall down to third and we have fallen in the rankings for access to care and care process … we still rank first in healthcare outcomes and now rank first in equity.’
 
The equity ranking is compared to the 2017 report showing it as Australia’s lowest performing domain.

According to Dr Wright, the slip in ratings for care processes − safe and coordinated care – is related to areas outside of general practice.
 
‘Out of the 11 surveyed countries, Australia has the highest reported rates of post-operative sepsis after abdominal surgery, and the second highest rate of post-operative clots following joint replacement,’ he said.
 
‘So the measures where we fall down are not related to general practice care.’
 
Other significant findings show that Australia’s health system functions well in terms of spending, with less spent on healthcare as a percentage of annual income than all other countries in the survey other than New Zealand.
 
‘We’re getting very good outcomes, given that amount of spending,’ Dr Wright said.
 
‘The domain of access to care covers both whether the care is affordable, and whether it can be accessed quickly. It’s not just about getting the care, it’s whether you can afford the care.’

Dr Wright highlights general practice is the most accessible part of the health system, as well as the area with the lowest out-of-pocket costs. 
 
‘It’s certainly not general practice that is affecting our ranking; if anything, general practice is leading the pack in terms of giving patients access and affordable care,’ he said.
 
‘With nearly 90% of GP visits being delivered with no out-of-pocket costs, costs are coming from elsewhere in the system.’ 
 
The percentage of cost-related access issues to healthcare was highest for the US in lower-income populations at 50%, compared to 27% for higher-income populations. Australia ranked fourth highest, with 24% for lower-income and 19% for higher-income populations.
 
Overall, the US ranks highest in healthcare expenditure as a percentage of GDP, at 16.8%, compared to Australia’s 9.4%.
 
In terms of access, Australian patients reported having high levels of access to face-to face care when needed, but lowest levels of same-day responses to questions by email or phone. Dr Wright notes, however, that this has potentially changed since the introduction of telehealth after the report’s survey was completed.
 
The UK, previously ranked first for overall performance, now sits in fourth position, while the US continues to rank last, as well as across four of the five domains. 

‘Overall, this is an important report which provides some insights into how different health systems compare, and on balance, the Australian health system is performing well,’ Dr Wright said.

‘And general practice performance is particularly good.’
 
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