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Future Directions of SA Health within the Casemix Context. Dr Tony Sherbon Chief Executive, SA Health. 2008 Casemix Conference Adelaide, South Australia. Presentation format. Context Why do we need reform Brief overview on the national health reform agenda

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future directions of sa health within the casemix context

Future Directions of SA Health within the Casemix Context

Dr Tony Sherbon

Chief Executive, SA Health

2008 Casemix Conference

Adelaide, South Australia

presentation format
Presentation format
  • Context
  • Why do we need reform
  • Brief overview on the national health reform agenda
  • Detailed overview of the reforms planned and underway in SA
  • How casemix can support these reforms
  • Demographics
    • SA’s population is around 1.6M, with approx 28,000 Indigenous people
    • SA has the oldest population in Australia (15.2% are over 65 in SA compared to 13.2% nationally)
    • SA has the lowest birth rate in Australia (11.6 per 1,000 population compared to 12.8 nationally)
    • 74% of all people in SA live in metropolitan Adelaide
    • 16% of the state’s land mass is classified as remote and 74% as very remote

Data sources: ABS Australian Historical Population Statistics, ABS ERP, ABS Census Geography Data

  • Health Status
    • 83% of SA people surveyed rate their own health as good, very good or excellent
    • SA life expectancy is 78.6 years for males & 83.6 females (both within 0.1 of national average)
    • SA has the lowest infant mortality rate in Australia at 4.0 deaths/1,000 live births (4.8 nationally)

Data sources: South Australian Monitoring & Surveillance System, ABS Australian Historical Population Statistics, ABS Deaths

  • Risk factors profile in SA
    • 21% of people 15+ are current smokers
    • 57% of people are classified as overweight or obese
    • 28% of people 16+ are at risk of harm from alcohol
    • 47% of people are not doing enough physical activity
    • 90% of people 19+ are not eating 5 serves of vegetables per day

Data source: South Australian Monitoring & Surveillance System

  • Prevalence rates for chronic diseases in SA
    • 7.2% of people have Diabetes
    • 12.9% of people have Asthma
    • 7.8% of people have Cardiovascular disease
    • 4.1% of people have Osteoporosis
    • 20.4% of people have Arthritis
    • 11.9% of people have Mental Health condition

Data source: South Australian Monitoring & Surveillance System for people 16 years and over

why we need reform
Why we need reform
  • Patient Activity Levels
    • Total public hospital separations in 2007-08 were 368,328; 11.4% growth since 2003-04
    • Total public hospital ED presentations in 2007-08 were 362,901; 17.2% growth since 2003-04
    • 3.1 public hospital beds per 1,000 population (highest in the nation)
    • In 2006-07 had:
      • RSI of 1.06
      • DOSA of 80%
      • Only 64% of ED patients seen on time
      • 1,441 people on elective surgery waiting lists, with 850 of them waiting more than 12 months

Data sources: ISAAC, EDDC, BLIS, Australian Hospital Statistics

why we need reform1
Why we need reform
  • Changing demographics
    • Ageing population
    • Prevalence of chronic disease
  • Increasing demand
    • Community expectations
    • Technological improvements
  • Workforce shortages
    • Ageing of the workforce
    • Decreasing numbers entering the workforce
  • Increasing cost
why we need reform population changing profile
Why we need reform - Population: Changing profile

Data source: Planning SA High Series (July 2007)

why we need reform projected admissions
Why we need reform –Projected admissions

Data source: AIMS (Hardes) Model

why we needed reform projected labour demand and supply
Why we needed reform – Projected labour demand and supply



Data source: John Spoehr (2004) Sleepers Awake: demographic change, ageing and the workforce.

national reform initiatives
National Reform Initiatives
  • Elective Surgery Reduction Plan
  • $5bn public hospital infrastructure funding
  • COAG considering reforms & funding
    • Complex chronic disease management
    • Hospital and health workforce reform (including activity based funding)
    • Prevention
    • Cancer
    • Indigenous health
    • e-Health
national reform initiatives accountability focus
National Reform Initiatives – Accountability Focus
  • COAG OOMS performance indicators and outcome measures
  • Funding tied to performance against indicators
  • Greater accountability and transparency through public reporting
  • More opportunities for comparability between jurisdictions
  • All leading to much more emphasis on data, measurement and casemix
south australia s health reform
South Australia’s Health Reform

South Australia’s Strategic Plan

98 targets for the next decade

Targets for improving wellbeing across preventative health and life expectancy

South Australia’s Health Care Act

Legislative changes to governance arrangements

New external accountability body - HPC

South Australia’s Health Care Plan

Significant capital investment

Better coordination of hospital services

Strengthening out of hospital sector

sa health care plan 2007 2016
SA Health Care Plan 2007-2016

Right care, Right time, Right place

Increased focus on primary health care, health promotion and disease prevention

Better coordinated hospital services

Improved management of disease

Sets the framework for

Service redistribution

Demand management

Clinical engagement

Workforce development

Infrastructure investment

sa health care plan 2007 20161
SA Health Care Plan 2007-2016
  • Outlines most significant investment in health care in South Australia’s history
    • new state-of-the-art hospital facility
    • investment in other major hospitals
    • better coordinated hospital services
    • GP Plus Health Care Services
    • improved information technology
    • a responsive health workforce for the future
system architecture

Major Hospitals

Special Purpose Hospitals – Glenside, Hampstead, St Margaret’s

General Hospitals – Country & Metro

GP Plus Health Care Services–Metro & Country

System Architecture


Networks & Statewide


GP, Private, NGO, Commonwealth and Community Sector

Community & individual capacity for own health and wellbeing

service re distribution
Service Re-distribution

Health Care Plan

The new MJMH (central), FMC (south) and LMHS (north) will form the backbone of the state’s high level critical and complex hospital services.

Three general hospitals in metropolitan Adelaide, TQEH, Modbury Hospital and Noarlunga Hospital providing services to their local communities.

Separate Country Health Care Plan has been developed, reviewed and is currently under consideration by the Minister for Health.

demand management
Demand Management

GP Plus Health Networks and GP Plus Health Care Centres

Integrated services and continuing care beyond hospitals contributing to a reduction in the number of hospital admissions and rate of unplanned readmissions

Health Improvement Plans

Developed for geographical populations within Network regions

Population health approach, dealing with issues of equity in health status and access to health services

Other Statewide Plans

Specific plans dealing with chronic disease, older people, prevention, palliative care, stroke, child health, women’s health and men’s health

clinical engagement
Clinical Engagement

Clinical Senate

Eight Statewide Clinical Networks

Future Directions Committee


Increased clinician involvement in service planning

Better coordination of services

More engagement leading to higher staff satisfaction and higher staff retention rates

workforce development
Workforce Development

Workforce innovation - New roles

Lifestyle advisors

Nurse sedationists

Physician assistants

Workforce Strategy Committee

Increased local training

Sustained immigration

casemix context in sa
Casemix Context in SA
  • Casemix funding implemented in SA in 1994-95 & remains the primary funding tool for hospitals
  • Population based funding model is run in parallel to casemix but only to ‘inform’ budget setting process
  • SNAP data are captured for non-acute and sub-acute services but not currently used for funding
  • Casemix is used extensively for performance monitoring and benchmarking
  • Classification and costing of patient services is applied in demand analysis and service planning
  • Concept of weighted patient activity to describe patient workload and resource consumption is accepted by other government agencies (in particular DTF and AGs)
casemix underpinning reform
Casemix underpinning reform

> Casemix data used for:

    • Role delineation and service planning
    • Demand analysis
    • Benefit analysis of different models of care
    • Supporting the Health Performance Council in its monitoring role
  • Undertaken first step in classifying patient encounters within the Out of Hospital sector through development of a OOH Minimum Data Set
challenges for casemix
Challenges for Casemix

Standard terminologies and classifications beyond the acute inpatient setting (including uptake of SNOMED CT)

Consistency in the way we describe conditions and procedures in the hospital sector and out of hospital sector, and how patient encounters are costed, so we can:

Gauge the efficacy of treatment (with assistance of data linkage)

Gauge the quality of treatment (re-admits and re-presentations)

Measure the extent of substitutable services between the sectors and the financial impact of alternative models of care

Casemix funding should be linked to outcomes where possible

Clinical outcomes

Safety and quality

Classify services consistently across both sectors and fund based on patient conditions and outcomes, not place of treatment