Health care quality & performance

Health care is considered ‘accessible’ when it is available at the right place and time, taking account of different population needs and the affordability of care. Accessibility of the health system can be measured by patient waiting times and bulk-billing rates for general practitioners (GPs).

The ability to provide uninterrupted care or service across programs, practitioners and levels over time. This can be measured by indicators such as unplanned hospital readmission rates.

It is important to examine trends and patterns in life expectancy, mortality rates in infants and children, deaths due to suicide and major causes of death. This can help evaluate health strategies and guide policy-making. Examining causes of death provides further insight into the events contributing to deaths, reflecting changes in behaviours, exposures to disease or injury, social and environmental circumstances, data coding practices as well as impacts of medical and technological advances.

Health care is broadly regarded as ‘effective’ when it achieves the desired outcomes for patients, clinicians and the community. Effective health care may include public health programs such as national immunisation schedules and cancer screening. It may also include improvements to health standards and primary care that lead to fewer hospital admissions and deaths.

Health care is considered efficient when the right care is delivered at minimum cost. One way efficiency can be measured is by the cost per hospital separation. A sustainable health system maintains, renews and innovates resources to continually improve efficiency and respond to emerging needs. Net growth in the health workforce is an indicator of sustainability of the health care system.

A person’s health is influenced by their behaviours. The impact of many health problems experienced by Australians could be reduced or prevented entirely by changing behaviours related to such things as tobacco smoking, being overweight or obese, high alcohol use, physical inactivity and high blood pressure.

Health conditions such as low birthweight, cancer, diabetes, infections, injury or psychological distress can impose significant costs on society in terms of health system use, days off work because of illness or to care for people who are ill, and reduced quality of life. The incidence and prevalence of conditions across the community can provide an overall picture of the health of the community, representing the outcomes of all the factors that shape our health.

Chronic diseases, residual injuries, permanent damage or defects from birth can impair how well a person functions day to day. How people experience and cope with a disability can be greatly affected by the opportunities and services provided for them. Human function can be measured by alterations to body structure or function (impairment), activity limitations and restrictions in participation. Severe or profound core activity limitation can be measured by calculating the percentage of people who ‘sometimes’ or ‘always’ need help with core activities of daily living (mobility, self-care or communication). The likelihood of having a severe or profound core activity limitation generally increases with age.

Personal biomedical factors, such as blood pressure and blood glucose levels, carry both short and long term risks for health. These are often influenced by health behaviours, such as diet and exercise, and social factors, such as financial stress or occupational stress.

Health care safety is measured by how effectively harm, or the risk of harm, to patients is minimised; for example, by measuring the frequency of healthcare-related infections (such as Staphylococcus aureus, or ‘golden staph’) or rate of seclusion in mental health services. By avoiding or reducing the risk of harm in the health system, adverse or unanticipated events in hospital can be prevented.

Socioeconomic factors – such as income, employment, housing and education – can affect a person’s health. People who are disadvantaged in one or more of these areas may have difficulty accessing health care, and this may in turn impact on their overall health and wellbeing.

Quality is a multi-faceted concept which can be defined in different ways. At a broad level, quality reflects the extent to which a health care service or product produces a desired outcome (B. Runciman, A. Merry and M. Walton, 2007, Safety and Ethics in Health Care, Ashgate, Burlington, VT, p. 297). At a more detailed level, the National Health Performance Framework views quality as a guiding principle in assessing how well the health system is performing in its mission to improve the health of Australians. The Framework's nine dimensions for the assessment of health system performance include appropriate, effective, responsive, continuous, sustainable, accessible and capable, all considered relevant (along with the safety dimension) to the quality of health care services. In its report Charting the Safety and Quality of Health Care in Australia (2004), the former Australian Council for Safety and Quality in Health Care presented information relating to the dimensions of effectiveness, appropriateness, accessibility and responsiveness as relevant to the quality of health care in Australia. Complementing the information on those dimensions was information on safety, and also on equity, or the degree to which all Australians could benefit equally from health care service provision.

Physical, mental and social wellbeing is affected by an individual’s perception, emotions and behaviour as well as their ease of movement and levels of any discomfort. Mental health is fundamental to the wellbeing of individuals, their families and the community as a whole. Wellbeing can be measured by self-assessed health status and the prevalence of psychological distress in the population.