In Australia, three out of five people live with at least one chronic disease, and nearly two out of five with at least two simultaneously. This figure says something deeper than a prevalence statistic: it describes a structural mutation in healthcare demand, to which health systems designed to treat isolated diseases respond poorly. Australia is investing 109.9 million Australian dollars over three years to fundamentally reform care management, and is launching a national ten-year framework that explicitly acknowledges that longevity has changed the nature of the problem.
The essentials
- Longevity extends the period lived with multiple simultaneous diseases, making the “one disease, one specialist” model structurally inadequate.
- Three Australians out of five live with at least one chronic disease, and nearly two out of five with at least two, according to the Australian Department of Health, Disability and Ageing.
- The Australian government is funding a national 2026-2035 framework with 109.9 million Australian dollars over three years, centered on prevention and integrated care.
- New Zealand faces similar pressure on a differently organized primary care system, making it a useful point of comparison for the region.
- The challenge of the next decade is to gain years of healthy life, not finance more years of illness.
Longevity transforms healthcare demand
Living longer often increases the number of years exposed to chronic diseases, but the effect on years lived in good health must be evaluated separately. Demographic aging produces two distinct effects that are often conflated. The first is the increase in the number of elderly people: more people, more needs. Demographic aging increases the number of people exposed to ages where multimorbidity is frequent; it is not, in itself, sufficient to prove an extension of the individual duration lived in multimorbidity.
A patient suffering simultaneously from type 2 diabetes, heart failure, and depression does not suffer from three independent diseases. Medications prescribed for one can worsen the other. Consultations with three different specialists produce sometimes contradictory recommendations. Depression reduces adherence to diabetes treatment, which worsens cardiovascular complications. All of this creates a cognitive and logistical burden for the patient, and a coordination burden for the system, which the classical specialist consultation model was not designed to absorb.
Australia illustrates this phenomenon with particular clarity. With one of the world’s highest life expectancies, 83.2 years on average according to the Australian Bureau of Statistics, the country concentrates a growing proportion of its population in age groups where multimorbidity is the norm rather than the exception. According to the AIHW, cited by the Department of Health, Disability and Ageing, the following 10 groups of chronic diseases are associated with 89% of deaths in Australia.
According to the AIHW, all chronic diseases represented approximately 98.5 billion Australian dollars, almost 55% of health expenditures attributed to diseases and injuries in 2023-2024. Fragmented management of coexisting conditions increases complexity, healthcare utilization, and coordination needs. An integrated approach is necessary to improve therapeutic effectiveness and reduce administrative burden.
The 2026-2035 national framework: what the Australian government is financing concretely
The Australian response takes the form of a National Strategic Framework for Chronic Conditions covering the decade 2026-2035, accompanied by financing of 109.9 million Australian dollars over three years. The system rests on three pillars.
The first is upstream prevention. Part of the funds aims to reduce the incidence of risk factors common to multiple chronic diseases: sedentary lifestyle, diet, tobacco, alcohol consumption. The logic is straightforward: acting on these factors simultaneously reduces the risk of diabetes, cardiovascular disease, and certain cancers. Every dollar invested in prevention targeted at these common determinants has a potentially higher return than that of subsequent specialized treatment, even though the delays between investment and outcome complicate the political evaluation of these trade-offs.
The second pillar is integration of care. The framework pushes toward care management models that coordinate general practitioners, specialists, nursing care, social services, and autonomy support around the same patient. The general practitioner is repositioned as a coordinator rather than a simple first point of contact. This is a substantial change in role that requires tools, shared medical records, communication protocols between levels of care, and appropriate remuneration, since the current fee-for-service payment model penalizes coordination time that cannot be billed.
The third official pillar concerns care integrated at the system level, multidisciplinary, person-centered, and continuous. People living with multiple chronic diseases spend the vast majority of their time outside the healthcare system. The framework includes health promotion, education, and integrated care; subsidies can finance relevant projects, without the source guaranteeing a specific therapeutic education program. This orientation officially aims to improve prevention and care coordination, better manage multimorbidity, and reduce inequalities; the shortage of medical resources is not given as its explicit foundation. The program states it finances evidence-based prevention and integrated care initiatives; it does not document, from this source, specific efficacy of care “close to home.”
Access to these programs remains unequal depending on education level and geographic region, which constitutes a blind spot in the system. This orientation remains consistent with recommendations in international literature on chronic care.
New Zealand facing the same problem with different tools
The comparison with New Zealand is instructive precisely because the two countries share a similar demographic profile but organize their primary care differently. New Zealand historically relies on a network of Primary Health Organisations (PHOs), local structures that bring together doctors and health professionals and receive capitation-based funding, that is, based on the number of enrolled patients, not the number of procedures. This capitation logic, in theory, should favor prevention and coordination, since the organization has a financial interest in keeping its patients healthy rather than multiplying consultations.
In practice, New Zealand’s PHOs face similar tensions to those the Australian framework seeks to resolve. New Zealand experiences a documented shortage of general practitioners, particularly in rural areas; inequalities in access and representation also affect Māori and Pacific populations, without official sources uniformly establishing “medical deserts” in these communities. The administrative burden linked to coordinating complex care for patients with multimorbidity can be significant for these structures. Budget expenditures devoted to hospital and specialized services exceed those devoted to primary, community, public, and population care; characterizing this gap as chronic underfunding requires analysis of needs and comparable budget series.
Statistics New Zealand projections indicate marked progression in the share of those over 65 in the coming decades, which will mechanically increase the prevalence of multimorbidity. The New Zealand system will need to adapt; the speed and principles of this adaptation remain to be defined. The Australian model, with its explicit investments in coordination and prevention, constitutes relevant ground for observation for Wellington.
Longevity also creates less obvious effects on the social structure of care. As regional demographic data shows, aging interacts with female labor dynamics: women constitute the majority of informal caregivers for people with advanced multimorbidity, which creates tension between labor market participation and domestic absorption of care needs not covered by the formal system. An integrated care system that does not take this reality into account simply transfers the burden from the public sector to families, without resolving it.
Real obstacles to care coordination
Recognizing that coordination is necessary is simpler than organizing it. Several structural obstacles make the transition difficult, and the Australian framework will need to confront them directly.
The first is fragmentation of financing. In Australia, as in most countries with mixed healthcare systems, hospital care is financed primarily by the States, primary care by the federal government via Medicare, and aged care by a separate system. This budgetary architecture creates divergent incentives: the hospital has no financial interest in investing in prevention that would reduce its admissions, and the primary care funder does not recover savings made in hospital care. Coordination between levels of care requires coordination between levels of government, which is politically and administratively complex.
The second obstacle is shortage of general practitioners. Australia faces structural tension between growing demand for coordinated care and practitioner availability. Rural areas and disadvantaged populations suffer from insufficient access to primary care, which means the reform risks first benefiting those who already have access to quality general practitioners. Responding equitably to multimorbidity requires simultaneously expanding access to primary care, which the current funding of 109.9 million over three years cannot do alone.
The third obstacle is technological but surmountable. Effective care coordination for a patient with multimorbidity requires that the various professionals following them share coherent, up-to-date medical information. The shared medical record exists in Australia, My Health Record, but its effective adoption by health professionals remains uneven. Digital coordination tools are a necessary but insufficient condition: they do not eliminate cultural resistance or questions of medical responsibility raised by information sharing between professionals. On this point, experiences of integrating AI into public health administrations in the Asia-Pacific region show that technology alone is insufficient if data governance remains fragmented.
The capacity of systems to adapt during the 2026-2035 decade
The Australian 2026-2035 framework is a bet on medium-term transformation, and its results will only become clear progressively. The central question it poses—can healthcare systems gain years of healthy life rather than simply finance more years of illness—is also the most difficult to measure.
A first scenario would be that of successful integration: primary care strengthens, general practitioners effectively play their coordinator role, self-management programs reduce avoidable hospitalizations, and there is observable progression in healthy life expectancy indicators rather than gross life expectancy alone. This scenario assumes that initial funding triggers sustainable change in practice, that reforms in health professional remuneration follow to align incentives, and that territorial access inequalities are addressed explicitly.
A second scenario would be that of partial reform: coordination tools are deployed in urban areas with sufficient numbers of general practitioners, but rural, indigenous, and low-income populations continue to experience degraded access. Multimorbidity would be better managed for part of the population, but health inequalities would widen between groups. This scenario is most likely if the national framework is not accompanied by targeted policies to strengthen supply in underserved areas.
A third scenario, less probable but documented in other countries, would be that of institutional resistance: funding is spent on pilot programs that do not scale up, general practitioners continue to practice on a fee-for-service basis due to lack of remuneration reform, and coordination remains a stated objective without real change in practice. This scenario has occurred in similar reforms conducted in countries where primary care investment was not accompanied by coherent revision of professional incentives.
The signals that will make it possible to distinguish these trajectories are relatively precise: the rate of effective adoption of shared medical records by professionals, the evolution in the number of avoidable hospitalizations for conditions manageable on an outpatient basis, and measurable progression in access to care for populations currently most distanced from it. The Australian Institute of Health and Welfare publishes regular data on these indicators, making monitoring possible. The budgetary stakes are also real: the trajectory of health expenditures related to aging is one of the most structuring parameters for public finances in all high-income countries, and Australia is no exception.
Multimorbidity as a test of health system maturity
Multimorbidity is not a new pathology. What is new is its demographic scale and duration. Generations aging today can live with multiple chronic diseases for an extended period. Health systems were built to treat acute episodes and isolated diseases. They have progressively integrated chronic disease management, but rarely their coexistence.
Australia is undertaking serious reform, equipped with a coherent conceptual framework and multi-year financing. It is doing so under already visible demographic pressure, not theoretical anticipation. New Zealand will need to make similar choices with even tighter resource constraints and a primary care organization that presents both assets—capitation—and fragilities—shortage of practitioners in remote areas.
The coming decade will determine whether coupling prevention, coordination, and self-management can alter the trajectory of chronic diseases. The objective is to produce health where the system today produces mainly care management, not simply to reduce costs.
Sources
- Australian Government Department of Health, Disability and Ageing, New 10-year framework and program for chronic condition launched: https://www.health.gov.au/news/new-10-year-framework-and-program-for-chronic-condition-launched
- Australian Bureau of Statistics, demographic data and life expectancy: https://www.abs.gov.au
- Australian Institute of Health and Welfare, reports on chronic diseases and health indicators: https://www.aihw.gov.au
- Statistics New Zealand, demographic projections and population aging: https://www.stats.govt.nz