This article on the value of care was prompted by Health Minister, Mark Butler MP and Sabra Lane on Australian Broadcasting Corporation (ABC) the article can be found here.
Medicare Taskforce Report
Recently the Medicare Taskforce released a high-level 12 page report to talk about improvements to Medicare and what the Australian Government, lead by Mark Butler MP will do about it. By no means is this a detailed report, rather it’s a high-level overview of what the government is thinking and helping them buy time and gauge public opinion. Some of the key concepts from this report include:
– Allowing funding for blended care. Something we’ve heard a lot about in the news, where it’s inter-discipline teams working together to support a patient.
– Voluntary patient enrolment
– Fix rural healthcare – and that’s about all they say about that. Simple really.
– Improving primary care access including after hours
– “Strengthening funding to support affordable care” – improving the value of healthcare is the Holy Grail most health administrators have been striving for, for decades.
– Allowing nurses and pharmacists to do simple procedures, for example, birth control scripts.
– Help private health networks and local health networks better integrate with GP’s.
The Real Issue with the Value of Care
But this is all stalling and posturing the real issue with Medicare is that we are running out of money and no one wants to reduce the quality of care we receive.
If you look at healthcare spending as a percentage of GDP over the last few years, it’s actually out of control and that was before covid. These rising costs are largely due to the aging population and rising chronic conditions. If you look at the Productivity Commission Research Paper on Efficiencies in Health released in 2015, it states that in 2015 healthcare spending as a percentage of the GDP was 4.2% and the reason, they wrote in the research paper was that they felt in 40 years (2054) healthcare would be 5.7% of GDP spend which was deemed unaffordable. So the Research Paper was put out to work out, how we can improve efficiencies in healthcare.
But since that Research Paper, we have seen healthcare spend as a percentage of GDP grow at a rate far greater than predicted. From the 5.7%, we thought we would be in 40 years – we’ve actually been growing at 1.4% every year. So in 2019, (before covid)
our healthcare spending as a percent of GDP was 9.9% and was projected to be somewhere around 18% by 2024.
A far cry from the 5.5% prediction in 2054.
And so it is clear that our healthcare spend can’t continue as it has been continuing. And so the blustering and stalling before we have to deliver the bad news about Medicare reforms, GP’s moving to private healthcare etc etc. However, the Research Paper recommended one way to reduce healthcare spend was to focus more on proactive care and preventative care. As a broad spectrum estimation across all health, we know that preventative care can save up to 90% of healthcare costs. This means, hypothetically if every disease was preventable and we implemented preventative care perfectly our healthcare spending would be 0.99% of GDP rather than 9.9%.
But no need to aim for that, let’s just focus on stopping the 1.4% growth every year. This transformation of healthcare is something that Medicare has a key influence on promoting and driving new models of care focused on prevention and improving the value of care we provide.
But if you look at this Medicare Task Force report, there’s no real talk of preventative or proactive care. And when you listen to the lobbying groups, for some reason the silence is deafening around preventative care. Even though we all know that to save costs and improve the value of healthcare we should be focusing on preventative care. Why is this the case?
Why Aren’t We Doing What Everyone Knows Will Fix The Root Cause?
The lack of focus on preventative and proactive care is primarily because
the healthcare system is built as ‘sick-care’ system – not a ‘health-care’ system.
We are not incentivised to keep people healthy. We are paid when someone gets a symptom bad enough to need treatment, we are paid to treat that specific symptom, not necessarily to cure them and definitely not to look at their life holistically and solve the root cause. So there are clear flaws in the system that call for structural changes in the way that we bill for health and the way that we provide budgets for health. And Medicare is a really key part of driving structural change in healthcare, that’s absolutely necessary.
When we look at the Medicare Taskforce report, we see references to rural health and improving primary care access. We talk about better integration with private health networks and local health networks, but how is that going to happen? There are no details on that, we assume it will just happen if we throw more money at it. So how are we going to do this? Under the current system, as Mark Butler says in the interview we get more GPs. Ideally, we would do this and give everyone a nurse and doctor to help them navigate the system. But clearly, this is no longer practical or fiscally responsible.
How Can We Set About Solving The Value of Care We Provide?
At Goldilocks, we believe the way forward is a hybrid level of care. We believe that there are a number of low-level jobs that nurses, doctors, pharmacists and highly trained clinicians do not need to be doing. And we see this transformation in the workforce happening in a number of different industries. Take for example manufacturing. Most low-level jobs in manufacturing are now done by robots and automation because it’s too expensive to have human workers do that. It is becoming increasingly apparent that this workforce change also needs to happen in the healthcare system.
After all, some of our most highly-paid professionals work in the healthcare sector.
Mindless, uncreative tasks shouldn’t be done by a highly paid, highly qualified and highly skilled workforce – they should be freed up to focus on the more complex issues requiring creativity and empathy.
Our vision of the future of healthcare is that much of the low-acuity care can be efficiently and effectively managed through technology with the human touch and empathy provided by upskilled casual carers at home and if/when required nurses or doctors.
There are two clear areas where technology can have a real impact:
– To perform monitoring of ‘well’ patients to allow early detection or deterioration which is absolutely necessary for preventative and proactive care
– To perform remote monitoring at home to detect deterioration and allow the clinician to remotely monitor the patient, upskill the casual carer, and keep the patient safe and reduce unnecessary readmissions
Because We Are Hero’s, We Have Already Started
And this isn’t highfalutin nonsense, we are already doing this at Goldilocks in the space of home-aged care and postpartum care. We have real case studies of how we have improved the value of care for so many patients.
But unfortunately, this can’t go ahead unless the customer pays out of pocket for it, (which some are willing to do,) but for this to occur in an evidence based manner and for clinicians to have control of it, Medicare has to be reformed so that it allows for billing for things like technology to help with prevention if and proactive care for low acuity patients. If we don’t do this, we are subject to the marketing of behemoths rather then what is most effective.
So will Mark Butler and his team be brave and start the massive reforms and restructure required for the healthcare sector and Medicare? And if they are brave enough, will they be backed by their party? And will their party get it over the line in parliament? And will the dust thrown in the air by the lobbying groups be seen for what it is?
Well, time will tell and we will be watching this space with keen interest over the coming months/years.