Govt can implement sensible reform without funding cuts: AHHA

The government can achieve a better functioning health system as well as savings by implementing sensible, evidence-based changes, the Australian Healthcare & Hospitals Association (AHHA) argues in its pre-budget submission.

The AHHA, which represents state health departments, public hospitals, community health services, Medicare Locals, primary healthcare providers and aged care providers, argues that it is essential that reform of the health system be evidence-based and evaluated through a structured and considered approach.

The organisation said the federal government’s recent approach to health funding reform has been to propose cuts to expenditure and the establishment of price signals, driven by the perception that health funding is out of control and unsustainable.

However, the evidence shows Australia’s health expenditure as a proportion of GDP is close to the OECD average and federal funding actually declined in real terms in 2012-13. The AHHA argues that health policy should not be merely viewed through the prism of budgetary cycles.

“Leadership in the field of health needs to represent more than just financial cuts over a four-year planning horizon,” AHHA CEO Alison Verhoeven said in a statement. “In our pre-budget submission, we outline a number of areas where the government can achieve savings and move towards a better functioning health system without the need to commit additional resources.”

The AHHA recommends a number of policy directions and budget measures that it says do not require new or additional funding, “but rather to more sensibly target and organise the existing health infrastructure Australia already has in place.”

These include the encouragement of the Choosing Wisely campaign, first launched in the US in 2012 to minimise low-value interventions. NPS MedicineWise is spearheading the roll-out of Choosing Wisely in Australia this year, working with the medical colleges and societies to identify tests, treatments and procedures that are commonly used but have no or limited benefit.

It also recommends linking the Choosing Wisely campaign to the next stage of the Medical Services Advisory Committee (MSAC) reviews of existing MBS numbers if there is agreement on a list of low value and ineffective items for which there is minimal justification for Medicare rebates.

These principles should also be applied to the PBS. The AHHA also wants the federal government to use its negotiating power to more effectively purchase pharmaceuticals at more competitive prices, as recommended by the Gratton Institute's Stephen Duckett.

There is also the opportunity to rationalise unnecessary visits to GPs by encouraging employers to require medical certificates only for prolonged sick leave and to reduce the requirement for GPs to provide annual referrals or for patients with well-maintained conditions from having to see a GP for repeat scripts.

System integration

The AHHA says it acknowledges the federal government’s continued support for the national implementation of eHealth tools and resources, which it says hold immense potential to support high quality and consistent care, as well as supporting a number of efficiencies and reduction of waste.

The benefit and value of standardised use of electronic health records are well documented for reducing duplication or over-servicing, and encouraging more efficient and more appropriate treatment, it says. EHRs also respond to the needs of both clinicians and consumers by being portable and transferrable.

“Electronic health resources also stand to better support prescribing and referrals for tests and other procedures and would align with other efforts to reduce inappropriate or unnecessary testing and medication prescription,” it says.

By encouraging the greater use of personal electronic health records, the AHHA says the move could:

  • Further integrate and support appropriate care regardless of the point of access in the system
  • Provide a greater focus on a digital healthcare system, that would also support better performance reporting
  • Enhance the capability to allow for performance reporting in real time and across a community through linked data collection and analysis to support quality service provision
  • Allow for information sharing across health services, both public and private, enabling governments and other funders to identify better utilisation of resources for health.

Other recommendations

The AHHA also says Australia needs to formally embed planning for end of life care into both health and aged care practices.

“For example, each resident assessed for entering a residential aged care facility should have a care plan prepared as part of their entry requirements,” it says. “Regardless of an individual’s age or health status, this care plan should then be reviewed on a regular basis to reflect the changing needs and wishes of the resident.”

This would have the benefit of reduced hospitalisations, a reduction in unnecessary and expensive life-prolonging care, and avoidance of unnecessary medications and surgeries.

It also recommends the government consider introducing an MBS item that supports the central involvement of GPs in end of life planning, with a link to the patient's eHealth record.

“Such an MBS item could form part of a set of linked items on chronic disease management and integrated care.”

The Commonwealth should also support greater use of Hospital in the Home services by working with the states and territories and removing funding disincentives.

It also wants more action on oral health and preventative care, stating that oral conditions are the second most expensive disease group to treat in Australia.

A greater concentration on preventative health measures, particularly for the four major non-communicable diseases of cardiovascular disease, cancer, chronic lung diseases and diabetes, should be seen not as a short-term cost but a long-term investment that can reduce health costs.

“Hospital services accounts for around 40 per cent of health expenditure in Australia,” it says. “Investment in effective prevention efforts and primary health care programs aimed at addressing these four disease groups will support reduction in hospitalisations, leading to lower hospital expenditure.”

Ms Verhoeven said the proposals in the submission represent the more effective and efficient use of existing resources and health infrastructure, not simply a call for additional public funding.

“Concerns over the level of health expenditure must not be viewed in the context of cyclical variations in the economy,” she said. “The Australian health system must instead be funded with a view to the long-term benefits of a well-functioning healthcare system.”

The AHHA pre-budget submission is available for download here (PDF).

Posted in Australian eHealth

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