Australian Health Care Reform Alliance Summit – Canberra, 15-16 July 2014

The Australian Health Care Reform Alliance held a summit in Canberra in July. Four members of HCCA attended: Russell McGowan, Bill Heins, Fran Parker and Sue Andrews. We encourage consumer representativeness to share reports on events they attend and Sue Andrews has provided the following report on the summit.

The AHCRA summit brought together its peak body membership as well as a range of speakers offering expert health research and industry perspectives in the context of the election of the Abbot government in September last year, and more specifically the measures  in the May 2014 Federal budget. Overarching concerns were the dismantling of government infrastructure to deliver health reform and a range of budget initiatives that will, if implemented, seriously threaten our universal health care system, particularly the MBS and PBS copayments, and plans to privatise primary health care.

Speakers challenged and critiqued the current government’s rationale for its budget measures -seeing ‘health’ only as a budget issue, a lack of understanding about the complexities of the health care system, particularly the importance of preventative health and primary health care. Speakers such as Peter Martin, Economics  Editor of The Age newspaper, argued against  the government’s proposition that our health system is not sustainable. We may spend more but we get good services and good health outcomes overall. He highlighted the research that indicates that people are willing to pay taxes to fund good quality, equitable healthcare. Adam Elshaug   (Menzies Centre for Health Policy) noted that a significant amount of money is spent on ‘low value and no value’ healthcare and argued for an ongoing review and assessment of MBS items, many of which are overused and others cause harm.  Michael Armitage, CEO, Private Healthcare Australia put a case for increased involvement of the private health care providers in contributing to higher quality and lower costs of healthcare.

The session about ‘What happened to health reform?’ included presentations from Tony Sherbon on the fate of National Funding Reform and Activity Based Funding for acute care/hospital services; Heather Yeatman, President of  PHAA, emphasising the need for clarity about the difference between  ‘health’ and ‘healthcare’; and Paresh Dawda from Ochre Health in Canberra, pointed out that countries with strong primary healthcare systems have lower overall costs and generally have healthier populations.

A Members panel offered a range of different perspectives about where things are at and what needs to be done  -  a grim picture of fragmentation, withdrawal of resources – human and financial, lack of investment in professional training, lack of attention to models of care that work ie that meet the needs of patients/consumers/citizens. The crucial role of the consumer voice was discussed and the importance of always involving consumers and their advocates in these debates, taking account of models of care that work ie consider the evidence, evidence based decision making.

At the end of the summit a communique was crafted which drew together the key issues  discussed at the forum and provided that basis for subsequent discussions with Parliamentarians. It includes: Concern about the shift away from a universal system, value of primary health care, qualified support of PHNs, issues of sustainability, health workforce issues, continue improvement of oral healthcare system, stronger role of consumers, as well as AHCRA strategies for better engagement with the broader community about all these issues.

The main challenge at this point in time was about how to engage with a Government perceived to be driven primarily by ideology rather than a broader understanding of the complexities of our health care system and an evidence based policy approach. A government that is committed to introducing a system that is based on principles of users pay, increasing privatisation, deregulation, and minimal Commonwealth government involvement in funding.  These are critical issues that will adversely affect all consumers of healthcare and about which HCCA needs to keep a watching brief.

Sue Andrews

A Healthier Future for all Australians - NHHRC Interim Report

It is an exciting time for those committed to strengthening our public health system. The National Health and Hospital Reform Commission today issued their Interim report, A Healthier Future for all Australians.

At 392 pages, the interim report is an impressive document. The Commission has done well to address the many issues raised in the submissions and consultations. Over the coming days (and weeks) we will continue to work through the document to identify ways in which it may influence health services in the ACT.

The Report warrants a big tick by consumers. The Commission has picked up on many of the things consumers have been saying for a long time.

In particular we are pleased to see the report comment on the importance of coordination of care between the various levels of health care. there is strong support for personal held medical records. This is very positive as it is a strategy that ensures all of the pieces of information that are important to our care are transferred and available to the personnel who are involved in decisions about our health. This will provide health professionals with a better, more complete picture and they will be better placed to make decisions that will result in safer interventions.

The Report also acknowledges the lack of resources for step up and step down facilities and other transition care services. The importance of the sub-acute care “glue” that links acute with community care is recognised. The need to enhance such programs including step-up and step-down programs is strongly supported. The report notes the variation across the country in the development of such programs and proposes increased access, improved funding, including infrastructure. This is something consumers are very keen to see extended.

We have a health system that is built in divided responsibilities between levels of government. This has resulted in disintegrated care and gaps in services which has not always serviced consumers well. The Commission is looking to strengthen primary and community based care. This move has the potential to provided integrated care and help consumers to overcome the confusing system.

The report presents the Commission’s reform agenda under four themes, which are:

• Taking responsibility: individual and collective action to build good health and well-being – by people, families, communities, health professionals, employers and governments;
• Connecting care: comprehensive care for people over their lifetime;
• Facing inequities: recognise and tackle the causes and impacts of health inequities; and
• Driving quality performance: better use of people, resources, and evolving knowledge.

Having identified these four themes the Commission discusses in more detail the elements comprising the themes and the strategies to achieve them.

There is recognition of the consumer empowerment perspective as a strategy to build healthier communities and people, which considers how individuals can take greater responsibility for their own health. This strategy is seen as relying heavily on health literacy - proposed as a component of a National Curriculum at both primary and secondary education levels. HCCA supports this positive move. Unfortunately the Report does not go on to address the imbalance of power between health professionals and health consumers –this is a critical part of the equity jigsaw. This imbalance is institutionalised and will not be addressed by better information alone. the system will need to have more strategies to enable consumers to take a stronger role in their own health care. While the establishment of citizen juries is proposed as a systematic mechanism to formulate health care priorities, the report does not seek to empower consumers through direct participation in the health care system or processes. We hope that there will be further considerations on ways in which health services can build on more consumer involvement.

Building health promotion and prevention capacity is supported but there needs to be a specific focus for individual consumers, organisations, and businesses on identified issues covering well-being, chronic conditions, self management and lifestyle issues. As part of this theme there needs to be a strong emphasis on improving health outcomes for both populations and individuals not just increased health outputs. Health services need to be linked to health outcomes.

The Interim Report is a good start and we will continue to follow the work of the Commission with great interest.

e-health

e-health is a convenient shorthand for national electronic health information. for consumers the electronic tag is important as the electronic/digital element provides the potential to provide consumers and health care providers with accessible up-to date health information of a good quality. however, it is important to recognise that the "e-" is the technology. The technology will allow the data to be easily updated, readily accessed and can assist in achieving better quality and uniformity data. The e-technology will provide the medium and a stimulus for better health information that is more accessible to consumers.

Report on CHF Workshop on “Delivering e-health for consumers”
held in Canberra on 12/13 June 2008


I recently participated in the Consumers Health Forum (CHF) national workshop to discuss electronic health information (e-health), the potential areas of benefit and concern and consumers’ expectations. There were useful sessions that gave participants up-to date information about national strategies, priorities and policies that were being developed in the e-health information realm. These were presented by the Commonwealth Department of Health and Ageing, the National e-Health Transition Authority and CHF. There was also a valuable session the issues around e-prescribing. These presentations provided a structure for the subsequent debate and discussion.

The workshop promoted discussion on a number of aspects of e-health with the objective of defining a number of activities in the development of national e-health priorities that consumers see as being a priority. The range of consumer foci and priorities around e-health are however diverse and include a personal health record; greater e-health information emphasis on wellness and issues such as environmental conditions; the content of, access to and protection of national e-health information data; the desirability of mandatory participation versus voluntary participation; e-medication summaries; remote prescribing and medication review; e-discharge summaries/plans; e-“save-my-life’ basic health record; e-referrals; e-pathology results and digital imaging.

These issues are ones that were seen as important from a consumer point of view, assisted health care providers in improving care and provided a suitable basis (or building block) on which the broader e-health network can be developed. There was not a unanimous view from the consumer participants at the workshop on some of the issues, for example the voluntary versus mandatory issue and the priority ranking. These are therefore, e-health issues on which consumers may be called to express a view as e-health develops and may need to be better informed.

Tony