Challenges in health services and health systems research

The relationship between emerging trends in healthcare systems and the consequent research priorities will be explored.

Governments and policy makers in developed countries are increasingly focused on the management of chronic disease, reflecting demographic changes and shifts in the burden of disease. Systems of quality improvement and reward are increasingly based on performance in chronic disease management. There is some evidence that countries with well-developed systems of primary care, such as Australia, achieve better health outcomes at less cost. In the past 15 years, almost all developed countries have undergone some type of health care reform. There has been a major focus on reducing costs; often involving shifting services from secondary to primary care. While there are few international comparisons, most suggest a complex relationship between the strength of primary care within the overall health services system and good performance, particularly with regard to lower costs of care and particularly relevant measures of health.

Aims for 21st century health systems
What, then, are the issues which are shaping contemporary general practice in developed countries? There are several imperatives: Safety, effectiveness, patient-centredness, timeliness, efficiency and equity. A study by the Nuffield Trust (Dargie, 1999) projected the shape of healthcare for the first fifteen years of this century. The study identified six issues that need to be addressed in the process of formulating health systems policies:

• Peoples’ expectations and financial sustainability
• Demography and ageing
• Information and knowledge management
• Scientific advance and new technology
• Workforce education and training
• Systems performance and quality (efficiency, effectiveness, economy
and equity)

Each of these six issues requires innovative thinking and priority setting on the part of the health sector, such as the delivery of health services in new and creative ways. Furthermore, there is a clear need for a finely tuned research, development and evaluation strategies to match these goals.

An evidence-based approach to podiatry workforce enhancement and service provision in Western Victoria

Aims & rationale/Objectives : The objectives of this workforce and service enhancement project include: (i) establishing the magnitude of podiatry needs; and (ii) developing a model that can be used to enhance podiatry workforce and podiatry services.
Methods : Surveys to podiatrists and health agencies to determine vacancies, waiting lists, work practices and recruitment methods. Desktop analysis of predictive data for burden of disease and population changes per local government area (LGA). Meetings with podiatrists and their professional association, health care agencies, universities, and Local and State Governments.
Principal findings : Results showed
Long podiatry waiting lists (up to 12 months)
Podiatry vacancies and service gaps
Absence of qualified foot assistants
A high chronic disease burden
A population age mix that is predicted to change dramatically over the next 25 years in favour of those who are 60 years of age or older
Ineffective recruitment methods
The workforce enhancement model that emanated from the meetings with the steering group includes podiatrists as well as auxiliaries such as foot-care assistants who work together in an interprofessional model of care that expands across the region. In addition to training foot-care assistants and the development of a podiatry teaching clinic to enhance student placement, the model builds onto a current continuous professional development program for allied health professionals.
Discussion : Although the allied health workforce (including podiatry) is playing an increasingly important role in the prevention and treatment of chronic diseases, rural areas in particular are disadvantaged by recruitment and retention problems. The podiatry workforce shortage is compounded by ageing populations. Age is associated with increased podiatry usage due to chronic diseases such as diabetes, cardiovascular disease and osteoarthritis.
Implications : A strategic plan developed in consultation with stakeholders aims to improve rural podiatry services in a sustainable manner. The project will be implemented when adequate funding is allocated this year and will be evaluated on its impact on services.
Presentation type : Paper

Critical perspectives on refugee policy in Australia : proceedings of the Refugee Rights Symposium hosted by the Institute for Citizenship and Globalisation, Faculty of Arts, Deakin University, December 5, 2002

Keynote addresses: What next for Australia's refugee policy? / Peter Mares -- One year after Tampa: refugees, deportees and TPVs / Chris Sidoti -- Academic papers: The tension of re-other-ing bodies / Snezana Dabic -- Acting for asylum: the nexus of pro-refugee activism in Melbourne / Helen Hintjens & Alison Jarman -- Biopolitics and the 'problem' of the refugee / Matthew Holt -- Temporary protection of refugees: Australian policy and international comparison / Fethi Mansouri & Michael Leach --The not-so-special benefit and non-mutual obligation: refugees on a TPV and income support arrangements / Greg Marston -- Family separation: Somali women in Melbourne / Celia McMichael & Malyun Ahmed -- Embodying exile: protest, performance, trauma and effect in the formation of East Timorese refugee identities / Amanda Wise -- Personal and Community Sector Perspectives -- A personal experience of the TPV policy / Mueen Al-Breihi -- A city of refuge?: protecting the social and cultural rights of refugees in Brisbane / Renae Mann -- Temporary protection visas, recovery from trauma and personal identity / Helen Martin -- All I ask for is protection: young people seeking asylum in Australia / Samira Mohamed.

Into the protecting arms: the League of Nations and the extension of international assistance to unprotected persons in the Middle East and Europe, 1926 - 1928

The refugee dilemma in Europe in the years between the two world wars had a number of aspects: humanitarian, political, and diplomatic. It raised questions of migration, questions of international law, and questions of the fate of hundreds of thousands of individuals. Refugees were visible from the very last days of the war and remained a matter of serious international concern even beyond the outbreak of war again in September 1939. The refugee dilemma in Europe was, firstly, a humanitarian crisis because the size of the refugee population was without precedent. It was also a political problem because national governments had to contend with questions about the refugees' legal status and their legitimacy under national and international law, as well as balance humanitarian concerns with national political interests. The humanitarian and political aspects together created a crisis for the international community newly united in the League of Nations. One of its first great acts-to take these refugees into its protective care-was not even prescribed for it in its Covenant. But the refugee crisis facing Europe was so great that member states were united in the belief that the League had been established precisely to undertake a task of this kind.

Limitations of market driven sustainability : the case of environmental management systems for food production in Australia

Environmental Management Systems (EMSs) address environmental risks in supply chains and certification of environmental claims. Governments supporting EMSs have encouraged producers to respond to anticipated consumer environmental concerns. Attempts at implementing EMSs have rarely been in direct response to market demand but are usually farmer organisation driven – to forestall increased regulation. In Australia, consumer demand for foods produced to environmentally sustainable standards is minimal because consumers don’t believe these products offer special benefits. EMS implementation is expensive and onerous; and the products require a market premium. Food consumers have difficulty differentiating the terms organic, environmentally-friendly, and sustainably-produced in food labelling.

Building e-literate societies through e-governance in Kerala

E-Governance as a concept defines and assesses the impact of technologies on the practices and administration of governments and the relationships between public servants and society. E-government solutions have the ability to reduce the costs of providing

Wait no more : the use of private dental services by welfare recipients in Australia

Dental services in Australia are available both privately and publicly. However, access to public dental services, like access to public hospital services for non-urgent treatment, is subject to a considerable waiting period. Moreover, access to public dental services is restricted to certain categories of welfare beneficiaries who qualify for a health care card. Because of the waiting time for public treatment, there is a frequent call for more public dental resources. This paper addresses the issue of what the waiting time for public dental services represents. One view largely confirmed by our research is that state governments are using the waiting time as a way of trying to push more and more people into the private sector. We find that more and more health care card holders are using the
private sector for dental services.

The privatisation experience in the Australian banking and insurance sectors: an explanation of the change in ownership structures

Deregulation has been a feature of the evolution of financial markets in the past two decades. Extending this trend has been the move to privatise government-owned financial institutions. In the 1990s, Australian governments progressively sold publicly owned banks and insurance institutions. One outcome has been that few of these privatised financial firms exist today, having been absorbed in mergers and acquisitions within the financial services sector. This paper uses an information cost framework to explain the experience of privatised banks and insurers. Our approach points to a dynamic process of organisational change that has influenced the outcomes of privatisation in the financial services sector.

Children's active free play in local neighborhoods : a behavioral mapping study

Many Australian children are more sedentary than they should be, and almost one in five are currently overweight or obese. Some children may face difficulties finding opportunities to be active, having poor access to safe public open spaces or having low independent mobility limiting their access to places to play. This study aimed to examine children's access to places in their neighborhood for active free play and how these vary by age, sex and socioeconomic status (SES). Behavioral maps of the local neighborhood were completed by children (8-12 years) from five primary schools across different areas of Melbourne. Children living in low SES outer-urban neighborhoods had to travel greater distances to access local parks compared with those in inner-urban mid and high SES areas. One-third (32%) of children reported an independent mobility range of <100 m from home. In conclusion, for some children opportunities to engage in active free play in the local neighborhood may be limited due to lack of parks in close proximity to home and restricted independent mobility. It is important to collaborate with local governments, urban planners and community groups to improve access to neighborhood parks and to promote a sense of neighborhood safety.

Healthcare in continuum for an ageing population: national self monitoring or remote offshore monitoring for Australia?

Australia is a country, similar to other developed nations, confronting an ageing population with complex demographics. Ensuring continued healthcare for the ageing, while providing sufficient support for the already aged population requiring assistance, is at the forefront of the national agenda. Varied initiatives are with foci to leverage the advantages of lCTs leading to e-Health provisioning and assisted technologies. While these initiatives increasingly put budgetary constraints on local and federal governments, there is also a case for offshore resourcing of non-critical health services, to support, streamline and enhance the continuum of care, as the nation faces acute shortages of medical practitioners and nurses. However, privacy and confidentiality concerns in this context are a significant issue in Australia. In this paper, we take the position that if the National and state electronic health records system initiatives, are fully implemented, offshore resourcing can be a feasible complementary option resulting in a win-win situation of cutting costs and enabling the continuum of healthcare.

The role of sister city relationships in the enhancement of trade : Latrobe City (Australia) and Taizhou (China)

Traditionally the role of Sister City relationships has been a political and cultural one involving local governments across the world. Over the decades this role has been questioned in both its efficacy as well as its
focus. Hundreds of Sister City relationships have developed and in Australia velY few can be said to have produced long term and worthwhile outcomes. New interpretations of the /ill1ctionality of Sister City relationships in Australia (and elsewhere) has resulted and has shifted towards an inclusion of a consideration of the commercial utility of such relationships and not solely cultural (0 'Toole 2001). Today especially with current strong trade relations with China, new models are sought to provide sustainability and long term prospects to such relations. This paper examines the possibility of special sister city relations between
Australian and Chinese cities using their sister city links. Specifically an examination in this paper is undertaken of the City of Latrobe and Taizhou as a case study of interest which provides sustainable trade potential between two strong small medium enterprise (SME) economies.

Ein Blick Down Under. Selbstmanagementinitiativen und Patientenschulungen in Australien

The growing burden of chronic disease and the current nature of healthcare systems which are structurally ill-equipped to cater to the complex needs of patients with chronic conditions has led to governments and healthcare providers seeking alternative ways to improve patients own capacity to actively self-manage their chronic condition. In Australia, there has been a focus on patient education and self-management programs within the healthcare system to achieve this. These programs aim to empower patients through providing information and teaching skills and techniques to improve self-care and doctor-patient interaction with the ultimate goal of improving quality of life. Patient education and self-management programs have been supported through several national government initiatives and implemented within the healthcare setting. This paper describes the current position of patient education and self-management within the Australian healthcare system. It further describes a new collaboration project between an Australian and a German research team which aims at translating an assessment questionnaire used in Australia for the evaluation of self-management programs, the “Health Education Impact Questionnaire” (“heiQ”); this instrument is expected to be of significant use in the German rehabilitative system.

Biopharmaceutical innovation and industrial developments in South Korea, Singapore and Taiwan

South Korea, Singapore and Taiwan are well known as export-oriented developmental states which for decades employed industrial policy to target particular industries for government support. In the past fifteen years, these three countries all identified the biopharmaceutical industry as a strategic sector. This article explores, through economic analysis, the rationale for this decision and the strategies chosen for linking into the global bio-economy with the objective of catching up in biopharmaceuticals. The paper identifies three comparative advantages enjoyed by these countries in the biopharma sector: (1) public investments in basic research; (2) private investments in phase 1 clinical trials; and (3) a potentially significant contract research industry managing latter-stage clinical trials. Governments employ a range of industrial policies, consistent with these comparative advantages, to promote the biopharmaceutical industry, including public investment in biomedical hubs, research funding and research and development (R&D) tax credits. We argue that the most important feature of the biopharmaceutical industry in these countries is the dominant role of the public sector. That these countries have made progress in innovative capabilities is illustrated by input measures such as R&D expenditure as share of gross domestic product, number of patents granted and clinical trials, and volume of foreign direct investment. In contrast, output indicators such as approval of new chemical entities suggest that the process of catching up has only just commenced. Pharmaceutical innovation is at the stage of mainly generating inputs to integrated processes controlled by the globally incumbent firms.

Moving beyond 'rates, roads and rubbish' : how do local governments make choices about healthy public policy to prevent obesity?

While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which creates the physical and social environment required to prevent obesity.