Cancer's Possible Implications and Impact on the Australian Health Care - Essay Example

?Within a health economic framework, discuss and analyse one chronic disease issue and the possible future implications and impact that they may haveon the Australian Health Care System. Introduction Australia’s public health framework focuses on disease prevention and promotion since 2001. The country’s model for chronic disease management aims to ensure delivery of care during the continuum. Disease prevention strategy starts at the primary level in the healthy population, then to secondary prevention and early detection in the at-risk population and ends with disease management once disease is established besides management and tertiary prevention for people with complex chronic diseases. Although strategies may vary from region to region, they are characterized by the aims of improved access, reduced health inequalities and better outcomes for those with chronic diseases through the policies of self-care, continuity and quality of care (Snodden 2010). Chronic disease As defined by the World Health Organisation, a chronic disease is one, which is of permanent nature with residual disability and caused by irreversible pathological changes. 12 chronic diseases identified by the Australian Institute of Health and Welfare (AIHW) as having a significant impact on the country’s health care system (Zwar, et al. 2006) are “coronary heart disease, stroke, lung cancer, colorectal cancer, depression, diabetes, asthma, chronic obstructive pulmonary disease, chronic kidney disease, oral diseases, arthritis and osteoporosis.” (Zwar, et al. 2006, 8). As already mentioned, chronic diseases are managed at primary care level by general practitioners and other professionals of primary health care with tie-ups with specialised agencies. The Bettering the Evaluation and Care of Health (BEACH) report states that most of the above chronic disease are treated at the primary care level except lung cancer and colorectal cancer (Zwar, et al. 2006). Australia’s health system Australia’s health system is considered one of the best in the world with the country’s universal medical insurance scheme Medicare providing access to health care for all. Because of the robustness of the system, life expectancy has increased, childhood and maternal mortality rate, incidence of cancer and heart disease have reduced. Demographic changes to the population are characterised by the increase in the population of people over 65 years. Their population has been estimated at 2.9 million (13.3%) in 2009 as against 1.1 million (8.3 %) in 1971. In spite of the overall achievement, health status of the indigenous peoples is far below the status of mainstream communities. Thus, Australian health system is under constant challenges due to rise in demand, constrained capacity and insufficient health care professionals and infrastructure as are with any other industries such as banking, transport etc. Rise in demand is due to combination of factors such as higher expectations from the health seekers who are now better informed, increasing burden of diseases arising out of problems affluent living conditions attendant with risk factors, increased life span and people’s ability to use advancements in the medical field. These problems of plenty are responsible for ever increasing burden of chronic diseases that make up 70 % of Australia’s health burden which is expected to increase to 80 % by 2020 (Boyages 2010). Since cancer diseases especially lung cancer and colorectal cancer are not being managed at the primary care level, this paper will choose cancer as one chronic disease that is impacting on the country’s health care system. Cancer epidemiology AIHW reports that in 2007 alone new cancer cases diagnosed were about 108,368, 57 % of which were males. There is a risk for 1 in 3 in males and 1 in 4 in females to be diagnosed with cancer before they the age of 75 years. Most common types of cancer were prostate cancer (19,403 cases0, bowel cancer (14,243 cases), breast cancer (12,670 cases, skin cancer (10,432 cases) and lung cancer (9,703 cases). It is significant to note that risk of cancer increases with age increase. The change in pattern of incidence is also noticeable. New cases every year have doubled between 1982 and 2007. In 1982 the new cases were 47,352 where as in 2007, new cases are 108,368 as already seen above. Mortality rates show that an average of 109 people are dying of cancer every day as could be inferred from the fact that 39,884 died in 2007 of whom 22,562 were males and 17,322 were females. Thus, cancer has been the second most common cause of death in 2007. Lung cancer had the highest mortality i.e 7,626 deaths. Deaths in other forms were 4,407 from bowel cancer, 2,938 from prostate cancer, 2,706 from breast cancer and 2,552 from lymphoid cancer. The mortality has also increased by 60 % from 1982 i.e 24,992 deaths in 1982 as against 39,884 deaths in 2007. Average survival rate of five years in all types of cancer is 61 % with females 64 % and males 58 %. The survival rate has also increased from 41 % in 1982 to the present level of 61 % (AIWH and AACR 2008). National Priority Area Cancer became a National Health Priority Area (NHPA) in 1986 as part of the National Health Service Improvement Framework for Cancer. NHPA is the initiative for Australian National and Territory governments to work together on the national priorities. Cancer occurs at different sites in the body making it a chronic and complex set of disease. Not all cancers have the same outcomes. They differ from one another in causes, treatments and outcomes for the people in their ‘cancer journey’. In the complex health care system of Australia, governmental initiatives for cancer control are also diverse. The Federal Government has the leadership role in policy making in public health while the State and Territory governments take responsibility for health care delivery and management and in doing so they maintain direct relationships with the health care providers. They regulate their professions. There are Cancer Councils apart from the National Cancer Control Initiative, the National Breast Cancer Centre and Clinical Oncological Society of Australia with crucial roles in research, education for prevention and detection and management. Additionally, there are consumer groups, community organisations, general practitioners, allied health professionals, professional bodies, educational institutions and the private sector engaged in cancer related activities (AustrailanHealthMinistersConference 2005). Among the eight priority cancers, bowel cancer is noted for its high incidence and lung cancer for its high mortality. The prostate cancer and breast cancer are of the highest incidence in males and females respectively. In disadvantaged socio-economic groups, lung cancer is high. Cancer occurs in people during their economically important years from 25-65. It is responsible for one-third of deaths in males and one-quarter of deaths in females. (AIHW 2003). Although Australia has track record of tackling cancer both in terms of survival and quality of life indicators, it can show better results by implementation of best practice treatment from the time of diagnosis. Since the disease requires specialised care, care delivery is made through different settings of surgery, chemotherapy and radiotherapy through a vast number of health professionals. Cancer care is given community settings rather than in acute care settings. The National Service Improvement Framework for Cancer was first to be developed and has been an example for other areas of chronic disease conditions. The framework has the following underlying principles for its development. They are strategies starting from the stage of preventing to the care at the end of life. Prevention is an essential component since it determines the reduction in future incidence of new cases each year. The framework is again dependant on need of the cancer patients, carers, families and communities to reduce the disease burden and distress. To provide best care possible to all Australians, development of appropriate service models is to be made for people living in different geographical locations. The framework also recognises that some communities and individuals need special programs to enable them to gain access to care. Notable among them are people from different linguistic and socio economic backgrounds and Aboriginal and Torres Strait Islander peoples. Although cancer care is delivered in hospital settings, the patients spend their large part of their cancer journey in the community, where primary care providers such as GPs and community nurses have crucial roles to ensure continuity of care. The five main phases of the framework based on people’s expectations (AustrailanHealthMinistersConference 2005) are “1) reduce the risk of developing cancer, 2) measures for early detection, 3) best treatment and support during treatment, 4) best treatment and support after and between periods of treatment and 5) if incurable, best end-of-life-care.” (AustrailanHealthMinistersConference 2005, 7) The framework has recommended eight priority actions to achieve changes identified in the above phases. They are 1) establishment of integrated cancer services network to enhance continuity of care from risk reduction stage up to the end of life care stage. 2) accreditation for cancer services and authenticating the practitioners. 3) Proper payment schedules to specialists and general practitioners through development of funding structures. 4) Development of monitoring from national, state and territory levels all aspects of cancer control. 5) inform consumers about behavioural and genetic risks of cancer, its prevention, early detection, diagnosis and treatment and supportive care. 6) Establish national approaches to aid primary health care providers to provide high quality of treatment and care including risk assessment, detection, referral to treatment etc. 7) Have culturally appropriate programmes for improvement of cancer control. And 8) Review at least once in three years, the evidence, gaps in research and opportunities. (AustrailanHealthMinistersConference 2005). Submissions to National Health and Hospitals Reforms Commission. Cancer council Australia and the Clinical Oncological Society of Australia (COSA) made the following submissions to the National Health and Hospitals Reforms Commission (NHHRC): Achievements so far made should not be lost. There is great scope for reducing cancer burden through primary prevention and improved detection and to reduce the inequities to people in remote areas and the indigenous people. Access to radiotherapy has been poor and is fragmented and hence this should be a priority of the reforms process. There is 40 % undersupply accentuated by lengthy waiting lists. Unless workforce shortages and administrative inefficiencies are resolved, National Access Guarantee cannot be implemented. Although flexibilities in healthcare roles are important for an efficient health system, cancer management being complex, must be in accordance with clinical standards. Cancer should not be categorised as “acute” or “terminal” since it is chronic for increasing number of patients. Cancer being complex, its treatment should not be based on quotas and be free from budgetary constraints. The reforms would be more effective if brought under a national electronic health strategy. And that there should be full be full implementation of National Bowel Cancer Screening Program without delay. It points out the evidence of under investment in disease prevention. Commonwealth control of primary care is essential besides improved links between hospital and GP sectors. Any GP involvement in the management of complex cancer like chronic conditions must be under clinical supervision since greater flexibility would result in greater risk. Infrastructure funding for research now available only in universities should be broad based (CancerCouncil&ClinicalOncologicalSocietyOfAustralia n.d). The NHHRC’s 94 recommendations, which the Commonwealth Government has accepted, include many recommendations that will have major impact on the cancer patients’ complex and changing needs. The National Health and Hospital Network (NHHN) envisaged by the reforms commission will be funded by the Commonwealth Government to ensure the hospitals’ working to the national standards. The report aims at consolidating the hitherto fragmented health care funding and accountabilities that will result in a fundamental redesign of the Australian health system. Disease prevention has been made a priority for cancer management since one thirds of cancers are preventable. Although 70 % of the national health budget is consumed by the chronic conditions including cancer, hardly two percent has been spent on prevention. The reforms envisage an allocation of $ 390 million for the next five years for practice nurses intended for patient education on weight control, tobacco and alcohol cessation. The Federal budget for 2010-11 has allocated $ 27.8 million for smoking reduction in the highly inaccessible disadvantaged population. The budget has also increased tobacco tax by 25 %. (Martell 2011). Conclusion Chronic disease conditions have been the major areas of concern of Australia’s health reforms and cancer is a disease, which requires care at secondary level, though care at the primary level is also equally essential especially for disease prevention, detection and community care. Health economic framework is essential for cancer care since as awareness among the public increases as also life style conditions, demand for services also increases. Disease prevention strategies are essential in order to allocate more funds for those suffering through savings of costs by prevention in the long run. National Health Service Improvement Framework for Cancer working in conjunction with the reforms of NHHRC should result in better outcomes in the management of cancer. References AIHW. Cancer in Australia 2000. Australian Institute of Health and Welfare , in AustrailanHealthMinistersConference,"National Service Improvement Framework for Cancer." National Health Priority Action Council,Available at accessed 25 May 2011 AIWH, CA ( Cancer Australia), and (Australsian Association of Cancer Registries) AACR. Cancer survival and prevalence in Australia; cancers from 1982 to 2004. Cancer Series no 42. Cat. No.CAN 38. 2008. http://www.aihw.gov.au/cancer/ (accessed May 25, 2011). AustrailanHealthMinistersConference. "National Service Improvement Framework for Cancer." National Health Priority Action Council,Available at accessed 25 May 2011 Boyages, Steven. "Australia's challenge: chronic disease and health care ." Diversity Health Institute . Diveist-e issue 3,2010 2010. www.dhi.gov.au/clearing house (accessed May 25, 2011). CancerCouncil&ClinicalOncologicalSocietyOfAustralia. 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