Saq065 amrau report Internal V11

1.5 Antimicrobial resistance and Australia

Australia is a developed country, comparable in geographic size to western Europe or the US mainland, and has a population of approximately 22.7 million.²¹ The Australian health system comprises a set of public and private service providers in multiple settings, supported by a variety of legislative, regulatory and funding arrangements. Responsibilities for healthcare costs are distributed across the three levels of government, nongovernment organisations and individual Australians. Public-sector service provision is the responsibility of state and territory governments for public hospitals; and a mixture of Australian Government, and state, territory and local governments for community and public health services. From 2008 onwards there has been extensive health system reform in Australia, affecting the way services are delivered and funded.

Overall coordination of the public healthcare delivery system is the responsibility of Australian Government and state and territory government health ministers, collectively referred to as the Standing Council on Health (SCoH), supported by the Australian Health Ministers’ Advisory Council (AHMAC). The major health funding agreements are bilateral agreements between the Australian Government and each state and territory, with the broad parameters being agreed multilaterally by SCoH. Strategic public health and other partnerships are negotiated in similar ways. There is a variety of organisations with strategic function and oversight for health-related matters in Australia. The National Health and Medical Research Council advises governments, other organisations and health workers on a wide range of health matters, and allocates substantial medical research funds provided by the Australian Government. Other relevant government agencies include the Health Care Committee, the Australian Health Ethics Committee and the Research Committee that oversees most Australian Government medical research funding. The Australian Government Department of Health and Ageing advises the ministers with portfolio responsibility for health and aged care. The Health Insurance Commission and its Medicare offices administer enrolment in Medicare, claims for Medicare benefits, pharmaceutical benefits and other Australian Government programs. The states and territories have varying arrangements for advising their ministers, and for administering public hospital and other healthcare programs.

Between 2009 and 2010, Australia’s total public-sector health expenditure was around $121.4 billion, or 9.4% of its gross domestic product.²² During this time, more than two-thirds of this expenditure was funded by the Australian Government; state, territory and local governments funded the remaining amount. The Australian Government’s major contributions include the two national subsidy schemes – the Medicare Benefits Scheme (MBS) and the Pharmaceutical Benefits Scheme (PBS, which includes the Repatriation Pharmaceutical Benefits Scheme [RPBS]). The Australian Government and state and territory governments also jointly fund public hospital services. These schemes are supplemented by social welfare arrangements, with larger rebates provided for individuals or families who receive certain income-support payments (such as for unemployment or disability). Additional government programs aim to improve access to health services in regional and remote Australia, or provide access to allied health services for people with chronic and complex conditions (such as diabetes or mental illness). There are also special healthcare arrangements for members of the Australian Defence Force and their families, and for war veterans and their dependants. Private health insurance schemes contributed 8% of the funding for the overall health system during 2009–10, with accident compensation schemes contributing another 5%. Finally, individuals make out-of-pocket contributions to the costs of services, mostly in the private sector, amounting to 18% of total funding during 2009–10.²²

Australia is well served by high-quality, accredited pathology laboratory services in both the public and private sectors, which generate key information on bacterial isolates and their antibiotic resistance patterns. Such data are critical to coordinated AMR surveillance systems.

Australia, however, has no national coordination of these data. Existing national and state-based AMR surveillance activities are often voluntary, and they operate without systematic oversight and leadership at the national level. Before the formation of the Antimicrobial Resistance Standing Committee (AMRSC; see Section 1.6), there had been no national coordination of activities, comprehensive national reports on antibiotic use and resistance, or capability to readily link antimicrobial usage and resistance data at a national level. Moreover, there is no single entity that fulfils such a role at a national level.

One of the deficits in Australia’s ability to respond to the threat of AMR is the lack of information on how widespread the problems are, whether there are different clinical practices in different places that have produced better or worse outcomes, and whether initiatives that seek to address AMR are successful. This is primarily due to the lack of comprehensive systems to measure antibiotic consumption or AMR levels in different settings.

Australia has the data needed to measure AMR; however, it exists within separate laboratory information systems of the various private and public-sector pathology providers across the country. For example, large numbers of community and hospital patient samples are submitted for bacterial culture and antibiotic susceptibility testing of any potential pathogens that are isolated and identified. The pattern of susceptibility and resistance for individual bacterial isolates is recorded in the laboratory computer database as an antibiogram, with the information then being returned to the treating clinician to guide therapy. By retrospectively reviewing large amounts of data over periods of time, a ‘cumulative antibiogram’ can be generated for each bacterial species of interest. The cumulative antibiogram information can then be used to guide empiric treatment approaches, develop guidelines and monitor changes in resistance patterns over time or between locations. Data measuring antibiotic consumption are more fragmented. Hospital usage is collected through the National Antibiotic Usage Surveillance Program (NAUSP), while most community usage data is collected by Medicare Australia for the Department of Health and Ageing. Some progress has been made in recent years to improve the collection of hospital data through NAUSP, which is explored further in Section 3.2.8. The integration within a comprehensive and coordinated system of surveillance and reporting is important to the efforts of NAUSP and DoHA.