Allied health: The untapped potential in the Australian health system

Thursday, December 3, 2015

Australians receive healthcare by three main workforces; allied health, medical and nursing. Although comprising about 25% of Australia’s healthcare workforce, allied health and its contribution remains poorly understood and largely invisible in the Australian system. There is strong evidence demonstrating the benefits of allied health in improving patient outcomes, minimising risk and harm from illness and improving health system efficiency and capacity to meet increased demand in a cost-effective manner. Despite this, the existing health model, funding arrangements and culture prevent us from effectively accessing these benefits at a system level. A transformational change in the Australian health system in how, where and by whom care is provided is necessary. This will entail cultural change in health that needs to be embraced, if not led, by doctors alongside the realignment of funding models.

The challenges facing the health system are well documented: population ageing and increasing demand, chronic disease and multi-morbidity; technology increasing the domains of care; and escalating healthcare costs. Consumers are increasingly engaged and seeking empowerment in their care. Information communication technology (ICT) has transformed business models and modes of interaction (social, knowledge transfer and commercial) with instantaneous outcomes and consumer sovereignty becoming the new norm.

Other industry sectors have responded with transformative change in how they do business to survive and capitalise on an ICTenabled and consumer dominant environment. The health industry, however, has remained fundamentally unchanged. The essential business model, provider-focused transaction and funding models are similar to those of the 1950s. At that time, the health system was constructed to combat infectious disease and maternal/perinatal mortality — life and death metrics. This “medical model” focused on acute, episodic care provided in hospitals by doctors and nurses. Allied health was not incorporated in the “medical model” funding, having largely developed since the 1960s, tending to war and poliomyelitis survivors living with serious ongoing disability. Since then, allied health has been added “at the edges” rather than developing an integrated model of care and funding.

In 2015, chronic disease is our major problem. Quality of life and wellbeing, social and economic participation are the community’s health metrics. Nearly 35% of Australians aged over 45 years have two or more lifestyle-related chronic conditions. Co-morbidity requires radically different approaches for managing both the cost and demand pressures on our health institutions and the implications of chronic ill health on individual’s labour and social participation. Chronic condition care needs are complex and long term. They require multiple professional interactions, which means moving away from more disease-specific approaches and instead recognising the importance of shared health determinants and risk factors. They also tend to be characterised by the need for intensive periods of intervention as well as monitoring and education over time.

Allied health practises in an evidence-based paradigm, providing diagnostic capability, functional restoration and improvement in quality of life. This is focused on the need for effective ways of keeping people healthy in their homes and actively connected to family and community, returning them to work and other life functions, for better social and economic participation. These social determinants all have an impact on the individual’s health status and population health outcomes. Allied health’s contribution to health, well-being and wealth creation is made along the continuum of care and therefore, takes a whole of health view. This recognises the absolute need to expertly manage those with the highest needs, to help people maintain function and independence, and support those with early risk factors to prevent them becoming the future “tip of the complexity triangle”.

Allied health’s non-episodic therapeutic paradigm has particular resonance in the management of chronic conditions. There is substantial evidence demonstrating the impact of allied health interventions (such as exercise, nutrition, good foot health and mental health) on chronic diseases such as diabetes, cardiac and respiratory health; as well as reducing acute exacerbations of chronic and multi-morbid conditions, and hospital admissions.

Allied health also plays a key role in acute health services in diagnostic technologies, in minimising risk and harm from disease (swallowing dysfunction, functional decline or medication error), mitigating lengths of stay and facilitating effective and sustained discharge. Economic evaluations have shown that increasing allied health services reduces length of stay and reduces medication error, providing large cost savings at organisation and system level. Nevertheless, the health and funding models have not adapted to this new capability in healthcare and potential to manage chronic conditions better; and when acute health services have a funding shortfall, allied health is usually among the first casualties.

Changing the funding model requires a fundamental cultural shift, and it has to start with our doctors. Individually and intellectually, most doctors embrace multidisciplinary health teams as best practice and providing best patient outcomes, and work as key players in interdisciplinary teams. However, collectively, the culture of health is conservative and medicine within that milieu historically wields undue power and decision-making influence. This extends to influence over the roles of other health professions and around how resources are allocated.

This influence is rooted primarily in the conservative culture of health and custom, rather than in evidence-based and contemporary practice knowledge. The changes that have transformed other business sectors will need to start here and be embraced, if not led, by our senior doctors. It should be informed by evidence of safety, clinical appropriateness, efficacy and cost effectiveness rather than “how we have always done it”.

The health system of the 2020s should be based on achieving best health and consumer outcomes, the most effective and costeffective management in the most effective and cost-effective setting by the most effective and cost-effective provider. The expertise exists to improve our management of chronic disease, but it is not currently provided for in the health system. As funding drives behaviour (both provider and consumer), the funding models and culture of the health system must change to support this. The health model and culture needs to genuinely involve the consumer and all three healthcare workforces.

This article was written by Chief Allied Health Adviser of Victoria Kathleen Philip for The Heatlh Advocate. To see the full edition, click here.