Bupa calls for health reform to shift upstream

Australia’s next phase of health reform should place prevention at its centre, with the health system struggling to keep pace with the country’s escalating burden of chronic disease, according to a new Bupa reform paper.

Australians can expect to live to 83 years of age, yet a new international study reveals that almost 14 of those years are now spent living with illness or disability. That equates to around one-sixth of life and represents the second-worst result globally, behind only the United States.

The paper, Building a More Accessible, Modern and Sustainable Health System, sets out a vision for a health system better equipped to address the chronic disease burden affecting 15.4 million Australians.

Launched today at Parliament House in Canberra, the paper argues that the system needs to pivot towards prevention and earlier intervention. Its recommendations span expanded access to preventive and primary care, faster adoption of innovative care models, improved access and affordability in specialist services, and measures to strengthen the sustainability and viability of Australia’s health system.

Bupa APAC CEO Nick Stone said, “The next generation of healthcare will require bold, practical reform. Prevention should be at the centre of Australia’s next phase of health reform.”

“An ageing population, rising chronic disease, workforce shortages, growing out-of-pocket costs and increasing financial pressure on governments and households are already affecting how Australians access care. Customer expectations have also changed dramatically. Too often, the system is organised around health episodes, institutions and locations rather than the journeys, continuity of care and outcomes that people face,” he added.

Australians pay $44 billion annually in out-of-pocket healthcare costs, while three in five consumers live with at least one chronic condition and two in five live with two or more. The financial burden facing patients is now translating directly into delayed care. Research by the Australian Bureau of Statistics, La Trobe University and Patients Australia shows up to 20% of Australians are delaying or skipping specialist appointments because of cost. The Grattan Institute estimates more than one million Australians each year miss out on seeing a specialist because they simply cannot afford to do so.

The paper identifies workforce shortages as one of the most significant emerging threats to both access and affordability. Australia is facing a projected shortfall of more than 8,600 GPs and 12,800 specialists by 2048, while four in ten GPs are already aged 55 and above.

“Preventive health represents one of the greatest opportunities to improve health outcomes, reduce long-term costs and ensure the sustainability of the health system. Improving health outcomes through better management of chronic disease and reduced hospitalisations is key and reorienting our healthcare system towards prevention… is a large part of the solution to tackling chronic disease,” the paper states.

The scale of the opportunity is highlighted by almost 788,000 preventable hospitalisations recorded in 2023-24, at a cost of $7.7 billion. Evidence cited in the paper shows prevention initiatives generate a median return of $14.30 for every dollar invested, positioning prevention among the most effective investments available to the health system.

Yet current funding arrangements have not kept pace with contemporary healthcare needs, according to the paper. It points to lower returns for longer consultations involving complex patient needs or chronic conditions, with existing settings favouring consultations and interventions after illness develops rather than preventive care and sustained disease management.

“While Medicare’s fee-for-service design funds individual episodes of care, it is poorly suited to prevention and coordination. As demand for health services continues to increase, investment alone will not be enough. We must look at preventative health models to help slow this rise,” the paper says. “GPs frequently need specialist input on a discrete question, but the MBS provides no dedicated mechanism for brief specialist advice outside a formal consultation, and case-conferencing items are ill-suited to routine secondary consultation.”

Mental health is another area where Bupa argues the system needs to shift intervention upstream. More than 300,000 mental health-related presentations to public emergency departments in 2024-25 highlight the need for earlier support, with the paper calling for greater flexibility to fund evidence-based mental health care in community and digital settings before people reach crisis point.

“Mental health is one of the most substantial and persistent pressures on Australia’s health system, workforce and economy. Rebalancing towards prevention and out-of-hospital care would improve system efficiency and increase the return on existing investment,” the report says.

Stone emphasised that meaningful reform would require shared responsibility across the health sector, with governments, clinicians, insurers, providers and consumers needing to work together to reshape how care is delivered.

“We welcome the important steps the Government has already taken to lay the foundations for reform in several of these key areas. Our recommendations are intended to complement those efforts and support a health system that is more connected, prevention-focused and centred on the needs of patients,” Stone stated.

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