Affordability of health system huge issue for consumers

THE health system is multifaceted and extremely complex, and there are many views on how well it does. What does it look like from the perspective of people who receive the care it delivers?

We surveyed more than 5000 Australians in the Australian Health Consumers Sentiment Survey, 2021 to elicit their views and experiences as health consumers. Participants were recruited from the general population via established market research panels. This unique dataset will inform a deeper understanding of grassroots sentiment and is key to realising a safe, accessible and equitable health care system that involves and engages consumers.

Working together, the Consumers Health Forum of Australia, the Australian Institute of Health Innovation, and the National Health and Medical Research Council (NHMRC) Partnership Centre for Health System Sustainability, have now released preliminary findings of this unique population-based survey of Australian adults aged over 18 years, undertaken previously (December 2018, with 1024 respondents) and now in October 2021 (5100 respondents). What did people think about the system, and how satisfied were they with it?

The survey, supported by the Commonwealth Department of Health and the Australian Commission on Safety and Quality in Heath Care, is a barometer of opinions and experiences of health care among the Australian population and a unique resource to inform policy and practice. It is purpose-designed to help identify critical improvements, such as in affordability and equitable access to care.

We sought national representation on geographical location, age group, sex, and simultaneous collection of detailed socio-economic data. Compared with 2018, additional questions regarding health service use during the COVID-19 pandemic were included in 2021.

What did Australians tell us?

Although fewer consumers had face-to-face appointments with GPs in 2021 (66% compared with 85% in 2018), telehealth consultations increased to 37% in 2021, up from only 6% in 2018. Encouragingly, 71% of consumers who used telehealth said the quality of the consultation was as good or better than face-to-face — a compelling reason to continue supporting, but also continuously improving, this initiative.

Over half (59%) of the 5100 respondents self-reported at least one long term chronic condition, such as back pain, arthritis, mental disorders and asthma. Almost a quarter (24%) were identified as having serious levels of psychological distress, as measured by the Kessler-6 Psychological Distress scale.

Health consumers value the health system, with 84% reporting satisfaction with the services they received, up from 67% in 2018. This is the highest level of satisfaction recorded since 2008, when precursor surveys were first conducted. In fact, 30% of respondents reported that their confidence in the Australian health system has increased since the COVID-19 pandemic.

Confidence in being able to afford needed health services was identified as a significant issue for consumers in 2018and this did not improve in 2021. Almost a third (30%) of consumers living with chronic conditions reported that they were not confident that they could pay for needed care if they became seriously ill, and 6% of the 2021 cohort indicated that there was a time in the past 12 months when they couldn’t pay for health care or medicine. This can be extrapolated to 1.5 million Australians with affordability challenges, and indicates that our health system is far from equitable.

Disconcertingly, more than 23% of consumers reported being disrespected or discriminated against when accessing health care, with people who identified as Aboriginal and/or Torres Strait Islander, those who speak a language other than English at home, and people living with chronic conditions more likely to indicate this.

Opinions about residential aged care services deteriorated in 2021, with 24% of people rating these services as “bad” or “very bad”, compared with 17% in 2018, which is unsurprising given the findings of the Royal Commission into Aged Care Quality and Safety.

The increasing focus on self-management during the COVID-19 pandemic highlights the need to understand the capacity of Australians to deal with their own health care. Over 20% of respondents reported low capacity for managing their own health.

Low capacity for self-care was related to younger age, lower income (less than $2000 a week), lower educational attainment, and having a chronic health condition, especially a mental health disorder. Clearly, expecting people to understand how to monitor their pulse, respiratory rate and even oxygenation using pulse oximetry at home, as described on the HealthDirect website, is a somewhat ambitious and unrealistic expectation. This is especially true for people who report limited access to needed care and medicine because of cost and those with limited capacity for self-care.

Conclusion

Despite ongoing disruptions to the Australian health care system as a result of the COVID-19 pandemic, overall, Australians’ perceptions of their health care system improved in 2021 over 2018, perhaps indicating a greater appreciation of the skills of health care workers on the frontlines of care. However, significant concerns were expressed over inadequate workforce capacity, especially in rural regions, affordability of care and medicines, the perceived poor quality of aged care facilities, and unacceptable levels of disrespect and discrimination while accessing care.

What’s next?

The Australian Health Consumer Sentiment Survey is an invaluable resource not only for informing policy and practice now but also for providing a benchmark to evaluate improvement initiatives over time. By repeating this survey every 2 years, Australia can map care over time, monitor progress and uncover drivers of change.

Acknowledgements

Our sincere appreciation goes to many people involved in this work, particularly Dr Louise Ellis, Dr K-lynn Smith, Genevieve Dammery, Chrissy Clay, James Ansell and Jenna Gray, and to all of our respondents: thank you sincerely for sharing your views with us.

Professor Jeffrey Braithwaite is the Founding Director of the Australian Institute of Health Innovation, Macquarie University, and leads the NHMRC Partnership Centre for Health System Sustainability.

Leanne Wells is the Chief Executive Officer of the Consumers Health Forum of Australia.

Associate Professor Yvonne Zurynski is Associate Professor of Health System Sustainability at the Australian Institute of Health Innovation, Macquarie University, and co-lead for the Observatory on Health System Sustainability within the NHMRC Partnership Centre for Health System Sustainability.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.