Is bigger better? Addressing the challenges of Care delivery in the 21st Century - A Tasmanian Perspective

Paul Turner
Associate Professor
eHealth Services Research Group (eHSRG), University of Tasmania

Health care systems globally face major challenges in how best to maintain the provision of high quality care for all in a manner that is economically sustainable. As populations’ age and the burden of chronic diseases grows, system affordability has become a major driver underpinning health care reform. Given the complexity of challenges faced, it is not surprising that there are different perspectives on what needs to be done, how, where, when and by whom. Unfortunately, these debates have often been fragmented with a variety of approaches advocated, each based on different measures and types of evidence to support claims of value.

An example of this fragmentation can be seen in debates around the merits of ‘super-hospitals’ versus smaller more distributed centres for care delivery. Undoubtedly economies of scale and scope are appealing but questions remain about whether average costs are always higher in smaller hospitals? Beyond efficiency, questions of effectiveness in terms of patient access and patient outcomes also continue to be hotly debated both within and beyond acute care settings. Of course, for all hospitals a key dimension of rising pressure on service delivery relates to utilisation of capacity and the ability of the hospital system to admit, treat and discharge patients safely and smoothly.

This presentation will discuss work conducted in Australia aimed at enhancing smooth patient flow including through the deployment and use of health information systems. Based on this work an argument is presented promoting stronger citizen e-health services as part of mechanisms to strengthen meaningful integration of hospital and community services for the future.