More patients, better treatment, rising costs, constrained budget—solutions please?

Thursday, April 4, 2019

An opinion piece on value-based healthcare by renowned breast cancer surgeon and commentator Professor Christobel Saunders, AO, leads topics covered in the April 2019 edition of Australian Health Review (AHR).

AHR is the peer-reviewed academic journal of the Australian Healthcare and Hospitals Association (AHHA).

‘We all know the statistics, and the disconnect, between increasing numbers of cancer patients, increasing costs of better treatments and constraining the health budget’, Prof. Saunders writes. ‘Yet we continue to struggle to find a systematic way to tackle this.’

‘Health systems are trying to do this by increasingly measuring and proscribing the multitude of steps it takes to deliver healthcare—yet we still struggle to measure the value we get out of the care we deliver.’

‘Contrast this to manufacturing industries whose mantras are “If you can’t measure it, you can’t improve it” and “The customer is always king”.’ 

Professor Saunders suggests that we may be measuring the wrong things in health: ‘If we really want to put the patient first, should we not be measuring the things that matter most to patients, including the long-term outcomes of their disease and treatment, and then improving our services based on this information?’

Prof. Saunders says that the time to implement value-based healthcare—patient outcomes divided by the cost of achieving those outcomes—is now, and the keys to making it work are ‘tantalisingly close’.

Health system improvements can also be better achieved by properly engaging clinicians in the process, according to an author team led by Associate Professor Christine Jorm from the University of Sydney.

A common barrier is ‘an expectation that clinicians take responsibility for change with minimal organisational support and do this work without extra compensation’.  A way through needs to be found. The authors suggest that ‘safer quality care cannot be achieved without clinicians’ attention to the broader system beyond the patient that is sitting in front of them’.

An author team from the Centre for Health Policy, University of Melbourne, trod the path of health system efficiency by examining revenue of consultant physicians for private consultations between 2011 and 2015. This overlapped with a Medicare freeze on such consultations from 2012 to 2018. The authors found that although there were no overall decreases in bulk-billing rates, there was a noticeable shift to charging for higher rebate consultations.

The same author team also examined use of consultant physician services in Australia by specialty and by state and territory. There were marked variations in per-capita consultant physician service use across the states and territories and both within and between specialties. These differences could not be explained through available data, with the authors suggesting answers might lie in workforce limitations, access or economic barriers, and/or systematic over- or under-servicing.

A La Trobe University team led by Professor Sandra Leggatt investigated the role of health service boards in ensuring safe, high quality care. The study data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety, and the implementation of these expectations at the point of care.

The authors suggested five specific actions boards could take. The recommended actions focus on an organisational strategy for high-quality care actively guided and monitored by the board, with the chief executive officer held accountable for implementation.

The April 2019 issue of Australian Health Review is available online. Some articles are freely available through open access, while others need a subscription or can be purchased individually.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, Primary Health Networks, and community and primary healthcare services.

Media enquiries:  Prof. Sonĵ Hall, Editor in Chief, Australian Health Review

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