Australian Health Performance Framework
The Australian Health Performance Framework (868KB PDF) (the AHPF) provides a navigation tool to support reporting on Australia’s health and health care performance. It supersedes the National Health Performance Framework and the Performance and Accountability Framework and should have primacy over other sector-specific frameworks. It is intended that, over time, other existing sector-specific health performance frameworks will be linked to the AHPF.
The AHPF conceptual framework (77KB PDF) highlights the different factors that affect the health of the Australian population (whether internal or external to the health system) and emphasises the interrelationships between factors within the health system.
The framework was endorsed by the National Health Information and Performance Principle Committee (NHIPPC) on 7 September 2017 and by the Australian Health Minister’s Advisory Council (AHMAC) on 22 September 2017. In May 2019, AHMAC endorsed an initial list of AHPF indicators for reporting from August 2019.
Dimensions of this framework
Are the factors determining good health changing for the better? Where and for whom are these factors changing? Is it the same for everyone?
This domain takes into account factors that influence the health status and health care needs of Australians. Factors within this domain may be external to the traditional view of the health system. Reporting of health determinants in relation to the performance of the health system highlights the need for services within the health system and also the need for multi-sectoral approaches, where appropriate, to improve health outcomes. These determinants include health behaviours, personal biomedical factors, environmental factors and socioeconomic factors.
Sub-dimensions of this framework
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.
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. These indicators focus on behaviours that are known to put a person’s health at risk.
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.
These indicators focus on biomedical factors that are known to put a person’s health at risk.
Physical, chemical and biological factors in the environment such as water, food and soil quality can impact our health and wellbeing. Healthy workplaces, safe water, clean air, safe houses, communities and roads are integral for good health.
Future releases of the AHPF will include indicators that report on environmental factors.
Is the health system (by itself, and with others) working to prevent illness, injury and disease? Is it delivering safe, effective, and accessible coordinated care appropriate for each individual? Is the health system efficient and sustainable?
This domain captures the activities and qualities of the health care system. It can be applied across all sectors, settings and organisational levels, as needed. The dimensions identified within this domain highlight the need for health care delivery to be safe, accessible, and of high quality. Measures within this domain can be viewed from both patient and provider perspectives and capture both activity levels (where relevant), outputs and the outcomes of care. These activities and qualities include issues of effectiveness, safety, appropriateness, continuity of care, accessibility, efficiency and sustainability.
Sub-dimensions of this framework
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 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.
Healthcare is considered ‘appropriate’ when it puts the patient’s needs and expectations first and is culturally appropriate. In addition, consumers are treated with dignity, confidentiality and encouraged to participate in choices related to their care. Appropriate healthcare may be measured by patient reported experiences (PREMs).
Indicators within this dimension will be included in future releases of the AHPF.
Continuity of care is 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.
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).
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.
How healthy are Australians? Is it the same for everyone? What are the best opportunities for improvement?
The health status domain reflects the status of individuals, cohorts and populations in terms of conditions, functioning and well-being. It includes impairments, disabilities and handicaps that are a consequence of disease. Health can be measured and described, for example, by the incidence and prevalence of conditions across the community, providing an overall picture of the health of the community, and representing the outcomes of all the factors that shape our health.
Sub-dimensions of this framework
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.
Physical, mental and social wellbeing is affected by an individual’s perceptions, 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.
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.
This domain reflects the importance of broad contextual issues of demographics, community and social capital, governance and structure, financing, workforce and infrastructure. It also includes issues of information, research and evidence to influence decisions and actions at all levels and across all sectors. These issues provide essential context for current decisions at all levels and are key issues for the planning of a sustainable health system.
Indicators within this domain will be included in future releases of the AHPF.