Croakey recently published this report on an Integrated Care Simulation run by the Australian Healthcare and Hospitals Association (AHHA) in Canberra that invited around 85 health leaders to come together to road test three major potential health policy initiatives:
- the introduction of bundled care packages for people with chronic diseases
- a role for private health insurers in the financing of primary care services
- the formation of Primary Health Networks.
Mark Metherell was a rapporteur for the AHHA during the event and provides his insights in this post below.
Mark Metherell writes:
Integrated care does not come easily in Australia. Even in a dream. That was one conclusion you could take from the integrated care simulation staged by the Australian Hospitals and Healthcare Association.
Jennifer Doggett and Marie McInerney have already given Croakey a very comprehensive description of the day’s simulation.
The impression that this rapporteur came away with was the scepticism evident among the actors, not about their role-play, but about the reality they were seeking to simulate. In the bundled care session, the challenge of what to do for the chronically-ill patient about to become a media cause celebre developed predictably into a fight over Commonwealth-State demarcations and cost-shifting. The superior Commonwealth officer said the matter would be sorted within six months. To which his State counterpart responded: “He would be dead by then.”
Patient-centred care? That means the patient “sits in the centre and we will tell you what to do”, said the Commonwealth’s man.
It took little prodding for the various parties to flock to their silos: governments, providers, NGOs. When the rapporteur tried to ascertain what the government officers were discussing, he was told to submit an FOI.
As the team leader said, there was a lot of discussion in the silos about patient needs without consulting the patient.That is with the exception of an NGO worker whom the patient said was the best friend he had had in 10 years.
When it came to the scenario on expanding primary health insurance into primary care, there was a short delay until the person to play patient appeared. “The patient is lost in the system,” was a comment that took on heavier meaning as the simulation unfolded.
The uninsured patient’s need for cancer surgery and support for her children
, was deployed to highlight the potential of a deteriorating public health system as a consequence of the potential competition for resources triggered by PHI expansion.
The State Health Minister expressed concern about the equity of the proposal, pressure on public hospitals and out-year funding.
The surprise announcement that the Commonwealth would boost private health insurancerebates to 60 per cent, in return for members opting out of Medicare and PBS eligibility, swung State interests on side. There were concerns about higher premiums but the lure of more revenue for public hospitals from insured patients, injected an upbeat tone into the State lobby.
In all the excitement, the fate of the patient who would likely remain uninsured was forgotten.
Confusion and uncertainty floated over the session on Primary Health Networks (PHN) participation. The consumer representative pressed on the issue of how consumers’/patients’ interests would be represented without getting a clear response.
The likely scale of PHN prospects as seen by the group, ranged from one extreme of not bidding for a PHN to that of a PHN-State takeover. There were comments like: “It’s hard to know who we should collaborate with.” And ,“Consumers confused? I am confused and I am in the business”.
The availability of connected population health data that might be unlocked appealed to some. But what did not get much attention was: what exactly are PHNs meant to achieve? As one primary care expert said, there was a need for a structure that set goals based on the community’s needs and population health data. Attention quickly swung back to who would work with whom, how to balance GPs’ views from the “centre of the universe” with demands for non-GP care coordinators and managers.
And would PHNs really do better than existing State services? While the Commonwealth would not hand money to the States for health, “they will give to $2 companies”, was a rueful comment from one.
Declaration: This post reflects Mark Metherell’s personal view and is not written in his role as communications director at the Consumers Health Forum. While he was a rapporteur for the AHHA during the simulation event, this is his own independent analysis for Croakey and is not part of the Croakey Conference Reporting Service coverage of the event.