One of the worst things about election-time is that money talks. We’ve seen this in the advertising campaign run by the company Primary Health Care, we’ve seen it in the tobaccon industry campaign, and now we’re also seeing it with advertisements from the Australian Health Insurance Association warning that “your private health insurance rebate is under threat”. The ad cites the Greens’ opposition to the rebate as ‘bad policy’.
Just for the record, there are plenty of health experts and organisations who think the rebate is worse than bad policy. It is often described as wasteful and inequitable as well. No less an authority than John Menadue has described it as “one of the worst pieces of public policy it is possible to imagine” and a “cancerous growth”.
It is often claimed that the rebate relieves the pressure on the public system. If that is the case, why would the organisation representing public hospitals, the Australian Hospitals and Healthcare Association, be such a critic? In its election analysis, the AHHA says it would like to see it removed.
Meanwhile, the AHHA’s Prue Power reports on new research which raises questions about the Coalition’s commitment to “hospitals-based health policy”. Mind you, the Government has stood accused of running a hospitals-based approach to health policy plenty of times in the past few years.
Prue Power writes:
“A new study, released today, questions the Coalition’s election health policy of focussing on hospital bed increases at the expense of other strategies to reduce demand for hospital care. This research has found that if the current trend in demand for hospital services persists, by 2020 a 62% increase in hospital beds will be required to meet expected demand, at a cost almost equal to the entire current Australian healthcare budget
The study by Associate Professor Ian Scott, published in the latest edition of the Australian Health Review (published by AHHA), suggests that a better approach is to pursue alternative longer-term solutions that involve both hospital and non-hospital sectors, such as improving hospital efficiency and decreasing demand for acute hospital beds.
This approach supports Labor’s strategy of strengthening preventive care in the community by improving integration and coordination across different sectors of the health system and investing in primary care services, such as SuperClinics.
The research found that Australia’s already high rate of hospitalisation, compared with other countries, shows no sign of abating. Presentations to public hospital emergency departments have increased by 4.9% per year over the last 5 years and admission numbers have increased by 3.6%.
Of particular concern, is that many of these hospitalisations could have been avoided, if better prevention and chronic disease management services were available in the community. In fact, the Australian Institute of Health and Welfare found that in 2008-09 a total 690,488 hospital separations could have been prevented.
This is one reason why increasing bed numbers is not the answer. We need to focus on increasing hospital efficiency and reducing demand for services through investing in community-based care.
This research identifies a number of ways in which hospitals could be made more efficient, including the following strategies: outsourcing public hospital clinical services to the private sector, undertaking whole-of-hospital reform of care processes and patient flow that address both access and exit block, separating acute from elective beds and services, increasing rates of day-only or short stay admissions, and curtailing ineffective or marginally effective clinical interventions.
The study also found that potentially the biggest gains in reducing hospital demand will come from improved access to residential care, rehabilitation services, and domiciliary support as patients awaiting such services currently account for 70% of acute hospital bed-days. More widespread use of acute care and advance care planning within residential care facilities and population-based chronic disease management programs can also assist.
The author concludes that overall it is more effective to focus on clinical process redesign within hospitals and capacity enhancement of non-hospital care services and chronic disease management (CDM) programs before investing heavily in creating additional hospital beds devoid of any critical reappraisal of current models of care. This clearly supports Labor’s policy to focus on demand-reduction through better community-based care and conflicts with the Coalition’s focus on hospital bed increases.
AHHA agrees with Associate Professor Scott’s call for a public debate about the role of hospitals within the healthcare system and how we can manage future population healthcare needs in a sustainable way. This research makes it clear that we need to move beyond short-term fixes towards whole-of-system solutions to delivering high quality health care to the Australian community.”