Australia in ‘upper middle’ of aged care globally: international expert

Australia’s “fragmented” healthcare system may hinder the adoption of the integrated models of care for older people working successfully overseas, a global health expert has said.

Australia’s “fragmented” healthcare system may hinder the adoption of the integrated models of care for older people working successfully overseas, a global health expert has said.

Chairman of KPMG Global Health Practice, Mark Britnell, stressed that while there was no official global league table, he saw Australia as roughly around the “upper middle” of the pack internationally in terms of aged care.

“I don’t think you should beat yourselves up, but I think there is more to learn from other people,” he told Australian Ageing Agenda in Sydney this week.

Dr Britnell has worked in healthcare for more than 20 years, travelling to over 60 countries on 200 occasions. His recent book, In Search of the Perfect Health System, examines healthcare systems across the globe.

Dr Britnell, who also sits on the World Economic Forum Global Health Council, said that each country has “something to teach and something to learn” from each other’s healthcare systems.

In terms of aged care, Dr Britnell said the Australian market was not atypical, and was facing many of the same pressures of other aged care systems around the world, including a lack of clear quality indicators, fragmented small operators, a drive for mergers and acquisitions, and issues around standards of professional accreditation and regulation.

However, he said that Australia’s fragmented healthcare funding which sees the Federal Government responsible for aged and primary care, and the states responsible for acute care or hospitals – was hindering the potential for the adoption of more integrated and collaborative models of care, such those as working successfully in countries like Singapore.

Dr Mark Britnell
Dr Mark Britnell

“I think there is a long way for Australia to go… there seems to be too many islands; primary care island, secondary care island, residential care island. The best systems are becoming much more integrated,” he said.

In his book, Dr Britnell singles out Japan, which has the world’s oldest population, as a standout model the world can learn from in terms of aged care. In particular, he praises the Japanese government’s national social insurance model, funded by a tax on all citizens over 40 that was implemented in 2000, despite much opposition.

“The reason I praise Japanese politicians is they have lived through what we are about to live through and they can see what else is coming and they showed political courage,” he said.

Global ageing

Given that by 2050 the number of people worldwide aged over 65 is expected to more than double to around 2 billion, Dr Britnell said ageing was one the biggest challenges facing global healthcare, particularly in the developed world.

However, Dr Britnell said demographic ageing continues to “stupefy” governments and aged care remained “some of the most problematic and fragmented care in any developed nation.”

However, he said the phrasing of ageing as a tsunami or burden only dehumanised those entering the healthcare system, and ageing needed to be reframed as an opportunity.

Dealing with an ageing population would require a decisive, whole-of-healthcare and whole-of-government approach, he said. In his book, he urged that there is “perhaps 20 years” to deal with the issue before it was too late.

Promising global trends

Despite the challenges, Dr Britnell said he had seen many inspiring examples from countries innovating to support older people to maintain their health and independence.

There was “no doubt” telehealth and other technological innovations like wearables would play a significant role in elder care, he said. He pointed to Singapore, where all facets of healthcare were linked by technology and where, using big data and analytics, the segments of the elderly population most at risk were being stratified.

More broadly, he said the best models had the default locus of care as the home, and no longer thought of hospitals as bricks and mortar but a part of a health system that allowed patients to flow in and out.

To achieve this model, there must be government and social incentive to boost informal carers, as well as care within the community, Dr Britnell said.

One of the best examples he had seen of this was in Japan, where people could pay postal workers, who were trained to spot signs of illness or injury, to check on older relatives during the day.

“Not only is the postman posting a letter, he’s also acting as a vicarious carer… that’s a good example of mobilising community resources,” Dr Britnell said.

Other examples included ‘virtual villages’ in the United States, and Hong Kong, where carers paid less tax and the housing system supported multi-generational households.

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