Could Australian health reformers learn from the experience of efforts to integrate health and social care in Canterbury, New Zealand? These and other questions are raised below by Leanne Wells, CEO of the Consumers Health Forum of Australia.
Leanne Wells writes:
The prospect of higher taxes to meet future hospital costs has revived questions about what we might do differently to counter the notion that rising health care costs are somehow inescapable.
That the talks between the Prime Minister and state and territory leaders canvassed the idea of a single, integrated health system and of reshaping Medicare to reduce the dysfunctional cost and blame-shifting that weakens our health system is a refreshing development.
It acknowledges that the future of health care need not be a grim choice between higher costs or fewer services.
Premiers spoke of extending Medicare into hospitals to remove the incentives for Commonwealth and state-cost shifting to each other, and more importantly to facilitate better and more effective care for patients.
We have previously welcomed the Health Minister’s reviews into Medicare benefits, primary health care and mental health as important steps in improving the health system, particularly if we can better integration across all these elements of frontline care.
But the overall assessment of the performance, supply and demand in the health system gets blocked and obfuscated by our federal-state funding arrangements and the siloed nature of our health system.
Australia does however, have an opportunity right now to begin reshaping the system, to boost primary care in the community and reduce demand on hospitals. That opportunity is the Primary Health Networks, 31 of which are being rolled out with minimal publicity.
The spread of chronic illness and ageing of the population are two key factors making the need for substantial change in our health system ever more urgent. A credible primary health system would involve GP-led team arrangements in which integrated services including other health professionals like physiotherapists and psychologists were coordinated to focus on the patient’s needs.
This would be particularly valuable for those with chronic and complex conditions like diabetes who too often end up in hospital because of the lack of coordinated community-based services.
And it would be particularly valuable for the taxpayer. The moderately increased cost of boosting community-based services would replace the much higher costs of hospital care.
Canterbury in New Zealand has developed an integrated health and social services system, which has won international respect for its success in supporting community-based care wherever possible.
Tellingly, from an Australian perspective, a central goal of the Canterbury concept is “one system, one budget”. By drawing all players into the patient-focused decision-making process, including doctors, patients, allied health and home-care providers, Canterbury has significantly reduced demand for hospital care.
What is more, it has reduced patient waiting times. “The biggest waste we have in our health system is patients’ time. Historically we have designed health systems that build in waiting at every point and which bounce patients from one part of the system to another. By focusing on removing waiting we can make far better use of the existing resource. We are convinced that 30 per cent of what we do is wastage,” says Canterbury’s chief health executive, David Meates.
Back in Australia the Primary Health Networks – or PHNs – have started with little fanfare and amid uncertainty about just how they will achieve the stated aim of improving health care in the community.
If Australia is to develop coordinated, regional primary health arrangements which meet both the needs and the capabilities of a contemporary health system, it will require a clear direction. Both funders and communities alike will want to know that services and spending are being directed to the right care for those who need it most.
This is where consumer involvement can play a pivotal role in developing a genuine, comprehensive primary care system that meets the needs of growing numbers of people with chronic illness and keeps them out of hospital.
The establishment of the PHNs to assess local health needs and commission local services is an ideal time for the development of consumer-driven approaches to making decisions about which services to prioritise and fund.
Our concern is that PHNs may not be resourced and authorised adequately enough to seize the opportunities to develop as modern, relevant, consumer-focused organisations. To risk them becoming white elephants would be to deny patients and clinicians the opportunity to work in local alliances to innovate in health care. More fundamentally, it would deny our communities the promise of a more effective primary health care system throughout Australia, with services designed and delivered closest to where they live and work.
Anybody who has had experience with chronic illness – themselves, family or friends – knows our health system for all its treasures fails to provide an acceptable level of coordinated and effective care for the chronically ill.
Yet we know that with the right focus and organisation such a level of care should be well within our health system’s capabilities.
That focus must centre on consumers and patients.
Experience in New Zealand and England is showing that where consumers are supported to take a central role in governance, design and evaluation of services, the better the outcome for them and for the cost to the system.
With so many Australians now living with chronic conditions requiring regular attention, we are seeing fundamental changes in patient needs, away from the sole attention of a single doctor towards the provision of more coordinated care and support by teams of nurses, allied health professionals as well as community service providers. It should also mean consumers are being encouraged to take responsibility for healthier lifestyle.
Health Minister Sussan Ley has made it clear what she sees as the core work of the primary health care: that everyone is best served when people receive health care earlier. And she said the Medicare Local review had found that many patients were still experiencing fragmented care, which had negative effects for them and for costs to the health system.
“New and innovative models for funding and delivery of primary health and medical services can improve coordination of patient care across services to ensure money is focussed on keeping people well,” Ms Ley said in an article for CHF’s Health Voices earlier this year.
If we are to meet the Minister’s aspirations for “new and innovative models”, the prospect of higher taxes makes it more timely than ever for governments and health providers to pay more than lip service to the ideals of consumer-influenced and patient-focused care.
We need to put consumers in the driving seat to designing a better system. They are the ones who can really tell governments whether a system is working or not.