Australia and New Zealand health policy最新文献

{"title":"Issues facing the future health care workforce: the importance of demand modelling.","authors":"Leonie Segal,&nbsp;Tom Bolton","doi":"10.1186/1743-8462-6-12","DOIUrl":"10.1186/1743-8462-6-12","url":null,"abstract":"<p><p> This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market - means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical allocation methods, such as the personnel-to-population ratios which are essentially circular in their rationale rather than evidence-based. This article highlights the importance of evidence-based demand modelling for those seeking to plan for the future Australian health care workforce. A model based on population health status and best practice protocols for health care is briefly outlined.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2009-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-12","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28157415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment costs and priority setting in health care: A qualitative study.","authors":"John McKie,&nbsp;Bradley Shrimpton,&nbsp;Jeff Richardson,&nbsp;Rosalind Hurworth","doi":"10.1186/1743-8462-6-11","DOIUrl":"https://doi.org/10.1186/1743-8462-6-11","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to investigate whether the public believes high cost patients should be a lower priority for public health care than low cost patients, other things being equal, in order to maximise health gains from the health budget. Semi-structured group discussions were used to help participants reflect critically upon their own views and gain exposure to alternative views, and in this way elicit underlying values rather than unreflective preferences. Participants were given two main tasks: first, to select from among three general principles for setting health care priorities the one that comes closest to their own views; second, to allocate a limited hospital budget between two groups of imaginary patients. Forty-one people, varying in age, occupation, income and education level, participated in a total of six group discussions with each group comprising between six and eight people.</p><p><strong>Results: </strong>After discussion and deliberation, 30 participants rejected the most cost-effective principle for setting priorities, citing reasons such as 'moral values' and 'a personal belief that we shouldn't discriminate'. Only three participants chose to allocate the entire hospital budget to the low cost patients. Reasons for allocating some money to inefficient (high cost) patients included 'fairness' and the desire to give all patients a 'chance'.</p><p><strong>Conclusion: </strong>Participants rejected a single-minded focus on efficiency - maximising health gains - when setting priorities in health care. There was a concern to avoid strategies that deny patients all hope of treatment, and a willingness to sacrifice health gains for a 'fair' public health system.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2009-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-11","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28152638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Working in disadvantaged communities: What additional competencies do we need?","authors":"Elizabeth Harris,&nbsp;Mark F Harris,&nbsp;Lynne Madden,&nbsp;Marilyn Wise,&nbsp;Peter Sainsbury,&nbsp;John Macdonald,&nbsp;Betty Gill","doi":"10.1186/1743-8462-6-10","DOIUrl":"https://doi.org/10.1186/1743-8462-6-10","url":null,"abstract":"<p><strong>Background: </strong>Residents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities.</p><p><strong>Methods: </strong>A two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps.</p><p><strong>Results: </strong>There was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult to engage. A number of additional competency areas were identified and three training modules developed.</p><p><strong>Conclusion: </strong>The generic workforce needs assessment tool was easy to use and interpret. It appears that the public health workforce involved in this study has a high level of understanding of the relationship between the social determinants and health. However there is a skill gap in identifying and undertaking effective intervention.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2009-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28131765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educating the public health workforce: Issues and challenges.","authors":"Mary Louise Fleming,&nbsp;Elizabeth Parker,&nbsp;Trish Gould,&nbsp;Melinda Service","doi":"10.1186/1743-8462-6-8","DOIUrl":"10.1186/1743-8462-6-8","url":null,"abstract":"<p><strong>Background: </strong>In public health, as well as other health education contexts, there is increasing recognition of the transformation in public health practice and the necessity for educational providers to keep pace. Traditionally, public health education has been at the postgraduate level; however, over the past decade an upsurge in the growth of undergraduate public health degrees has taken place.</p><p><strong>Discussion: </strong>This article explores the impact of these changes on the traditional sphere of Master of Public Health programs, the range of competencies required at undergraduate and postgraduate levels, and the relevance of these changes to the public health workforce. It raises questions about the complexity of educational issues facing tertiary institutions and discusses the implications of these issues on undergraduate and postgraduate programs in public health.</p><p><strong>Conclusion: </strong>The planning and provisioning of education in public health must differentiate between the requirements of undergraduate and postgraduate students - while also addressing the changing needs of the health workforce. Within Australia, although significant research has been undertaken regarding the competencies required by postgraduate public health students, the approach is still somewhat piecemeal, and does not address undergraduate public health. This paper argues for a consistent approach to competencies that describe and differentiate entry-level and advanced practice.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How do government health departments in Australia access health economics advice to inform decisions for health? A survey.","authors":"Lynne Madden,&nbsp;Lesley King,&nbsp;Alan Shiell","doi":"10.1186/1743-8462-6-6","DOIUrl":"https://doi.org/10.1186/1743-8462-6-6","url":null,"abstract":"<p><strong>Background: </strong>Government anticipates that health economic analysis will contribute to evidence-based policy development. Early examples in Australia where this expectation has been met include the economic evaluations of breast and cervical screening. However, the level of integration of health economics within health services that require this advice appears uneven. We sought to describe how government health departments in Australia use specialist health economic advice to inform policy and planning and the mechanisms through which they access this advice.</p><p><strong>Methods: </strong>Information describing the arrangements for gaining health economics input into health decision-making was sought through interviews with a purposeful sample of economists and non-economists employed by all departments of health in Australia (state, territories and national). The survey was undertaken in August 2004. To aid interpretation of the results eight health economic functions were identified. As a comparison, four other government departments in NSW provided information about their access to economic advice.</p><p><strong>Results: </strong>All health departments except one reported being current users of health economics expertise. A variety of arrangements were described to source this, from building organisational capacity with self-sufficient in-house units to forging links with external sources. However, specialist positions for economists or health economists employed within health were few. A framework mapping these arrangements for sourcing advice with the eight common health economic functions to be met is presented. All other non-health government departments approached accessed economic advice, with three having in-house units.</p><p><strong>Discussion: </strong>A small health economics capacity in Australia has been established over the past 30 years through a variety of structural and strategic mechanisms. Health departments value health economic advice and use a variety of arrangements to obtain this. These arrangements have strengths and weaknesses depending upon the task to be undertaken. The lack of uniformity of approach suggests that health departments are still seeking the best ways to incorporate this form of specialist advice into mainstream decision-making.</p><p><strong>Implications: </strong>Summarises ways that governments source specialist services. Demonstrates how to describe an organisation's need for specialist services as a set of functions. This approach could be applied to assessing need for other specialist areas of advice.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multidimensional classification of public health activity in Australia.","authors":"Louisa Jorm,&nbsp;Su Gruszin,&nbsp;Tim Churches","doi":"10.1186/1743-8462-6-9","DOIUrl":"10.1186/1743-8462-6-9","url":null,"abstract":"<p><strong>Background: </strong>At present, we have very limited ability to compare public health activity across jurisdictions and countries, or even to ascertain differences in what is considered to be a public health activity. Existing standardised health classifications do not capture important dimensions of public health, which include its functions, the methods and interventions used to achieve these, the health issues and determinants of health that public health activities address, the resources and infrastructure they use, and the settings in which they occur. A classification that describes these dimensions will promote consistency in collecting and reporting information about public health programs, expenditure, workforce and performance. This paper describes the development of an initial version of such a classification.</p><p><strong>Methods: </strong>We used open-source Protégé software and published procedures to construct an ontology of public health, which forms the basis of the classification. We reviewed existing definitions of public health, descriptions of public health functions and classifications to develop the scope, domain, and multidimensional class structure of the ontology. These were then refined through a series of consultations with public health experts from across Australia, culminating in an initial classification framework.</p><p><strong>Results: </strong>The public health classification consists of six top-level classes: public health 'Functions'; 'Health Issues'; 'Determinants of Health'; 'Settings'; 'Methods' of intervention; and 'Resources and Infrastructure'. Existing classifications (such as the international classifications of diseases, disability and functioning and external causes of injuries) can be used to further classify large parts of the classes 'Health Issues', 'Settings' and 'Resources and Infrastructure', while new subclass structures are proposed for the classes of public health 'Functions', 'Determinants of Health' and 'Interventions'.</p><p><strong>Conclusion: </strong>The public health classification captures the important dimensions of public health activity. It will facilitate the organisation of information so that it can be used to address questions relating to any of these dimensions, either singly or in combination. The authors encourage readers to use the classification, and to suggest improvements.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening field-based training in low and middle-income countries to build public health capacity: Lessons from Australia's Master of Applied Epidemiology program.","authors":"Mahomed S Patel,&nbsp;Christine B Phillips","doi":"10.1186/1743-8462-6-5","DOIUrl":"https://doi.org/10.1186/1743-8462-6-5","url":null,"abstract":"<p><strong>Background: </strong>The International Health Regulations (2005) and the emergence and global spread of infectious diseases have triggered a re-assessment of how rich countries should support capacity development for communicable disease control in low and medium income countries (LMIC). In LMIC, three types of public health training have been tried: the university-based model; streamed training for specialised workers; and field-based programs. The first has low rates of production and teaching may not always be based on the needs and priorities of the host country. The second model is efficient, but does not accord the workers sufficient status to enable them to impact on policy. The third has the most potential as a capacity development measure for LMIC, but in practice faces challenges which may limit its ability to promote capacity development.</p><p><strong>Discussion: </strong>We describe Australia's first Master of Applied Epidemiology (MAE) model (established in 1991), which uses field-based training to strengthen the control of communicable diseases. A central attribute of this model is the way it partners and complements health department initiatives to enhance workforce skills, health system performance and the evidence-base for policies, programs and practice.</p><p><strong>Summary: </strong>The MAE experience throws light on ways Australia could collaborate in regional capacity development initiatives. Key needs are a shared vision for a regional approach to integrate training with initiatives that strengthen service and research, and the pooling of human, financial and technical resources. We focus on communicable diseases, but our findings and recommendations are generalisable to other areas of public health.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of public health: the importance of workforce.","authors":"Vivian Lin,&nbsp;Rebecca Watson,&nbsp;Brian Oldenburg","doi":"10.1186/1743-8462-6-4","DOIUrl":"10.1186/1743-8462-6-4","url":null,"abstract":"<p><p> Health workforce has become a major concern and a significant health policy issue around the world in recent years. With recent international and national initiatives and models being developed and implemented in Australia and other countries, it is timely to understand the need and the rationale for a better trained and educated public health workforce for the future. Much more attention should also be given to evaluation and research in this field.Through this thematic series on Workforce and Public Health, we have drawn on the diverse nature of public health, workforce implications, education and training and national and international case examples of ongoing improvements and issues in this sector.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Educating public health physicians for the future: a current perspective from Aotearoa New Zealand.","authors":"Chris Bullen,&nbsp;Pat Neuwelt","doi":"10.1186/1743-8462-6-7","DOIUrl":"https://doi.org/10.1186/1743-8462-6-7","url":null,"abstract":"<p><p> Persisting, and in some cases widening, inequalities in health within and between countries present significant challenges to the focus and practice of contemporary public health, and by association, to public health education. As public health physicians and academic educators of medically- and non-medically trained public health practitioners, we call for a radical re-think of current approaches to public health medicine education and training in order to address these challenges. The public health physicians of the future, we argue, require not merely technical knowledge and skills but also a set of values that underpin a commitment to ethical principles, social equity, human rights, compassionate action, advocacy and leadership. Furthermore, while they will need to have their action firmly grounded in local realities they should think, if not speak and act, from an informed awareness of global issues. Drawing from our experience in Aotearoa New Zealand, as well as with marginalised communities overseas, we proffer our suggestions for the process and content of public health physician education and training for the future, with the intention of stimulating debate.</p>","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2009-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28103482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health research policy: a case study of policy change in Aboriginal and Torres Strait Islander health research.","authors":"Sophia Leon de la Barra,&nbsp;Sally Redman,&nbsp;Sandra Eades","doi":"10.1186/1743-8462-6-2","DOIUrl":"https://doi.org/10.1186/1743-8462-6-2","url":null,"abstract":"<p><strong>Background: </strong>There is considerable potential for health research to contribute to improved health services, programs, and outcomes; the policies of health research funding agencies are critical to achieving health gains from research. The need for research to better address health disparities in Indigenous people has been widely recognised. This paper: (i) describes the policy changes made by the National Health and Medical Research Council (NHMRC) from 1997 to 2002 to improve funding of Aboriginal health research (ii) examines catalysts for the policy changes (iii) describes the extent to which policy changes were followed by new models of research and (iv) outlines issues for Indigenous health policy in the future.</p><p><strong>Methods: </strong>This study had two parts: (i) semi-structured interviews were conducted over a four -month period with seven individuals who played a leading role in the policy changes at NHMRC during the period 1997-2002, to describe policy changes and to examine the catalysts for the changes; (ii) a case study was undertaken to evaluate projects by recipients of NHMRC People Support awards and NHMRC Capacity Building Grants in Population Health Research to examine the types of research being undertaken five years after the policy changes were implemented. The proposals of these researchers were assessed in terms of whether they reported intending to: evaluate interventions; engage Indigenous community members and organisations; and build research capacity among Indigenous people.</p><p><strong>Results: </strong>Seven policy changes over a period of five years were identified, including those to: establish an ethical approach to working with Indigenous people; increase the influence of Indigenous people within NHMRC; encourage priority research directed at improving Indigenous health; and recognise Aboriginal and Torres Strait Islander health research as a priority area including a commitment to an expenditure target of 5% of annual funds. Seven catalysts for this change were identified. These included: a perceived lack of effective response to the health needs of Indigenous people; a changed perception of the role of NHMRC in encouraging research to maximise health gains; and leadership within the organisation.The case study analysis demonstrated that 45% of all People Support recipients intend to engage Indigenous community members and organisations in consultation, 26% included an evaluation of an intervention and two (6.5%) were granted to an individual from an Indigenous background. Six of seven Population Health Capacity Building Grants that were awarded to study Indigenous health between 2004 and 2006 included an intervention component; these grants supported 34 researchers from Indigenous backgrounds.</p><p><strong>Conclusion: </strong>NHMRC made significant policy changes from 1997 to 2002 to better support Indigenous health as a result of external pressure and internal commitment.The poli","PeriodicalId":87170,"journal":{"name":"Australia and New Zealand health policy","volume":"6 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2009-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/1743-8462-6-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"28010272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}