The future for health care in Australia is exciting. New knowledge; refined and targeted technologies; and the intention to personalise health care practice offers hope of better health outcomes for all Australians. We face the ever-present task of improving our health systems to ensure they have the capacity, and are accountable for translating that hope into reality. What if we made the 2020s the decade in which we worked together to reshape our health systems to ensure that future health care meets the needs of all Australians: informed and preferred care – always personalised?
This opinion piece proposes five health system goals – or, at the very least, approaches to test – over the next decade to remove inequity and inefficiencies from health care and remain consumer – rather than provider-centric.
1. Implement collaborative leadership – with consumer, health and social care leaders working in genuine partnerships to drive policy and strategy, research and practice
Leaders translate vision into mission and mobilise teams to achieve strategic outcomes. Consumer-centred health systems that achieve what people need and value require leadership that incorporates consumer evidence, perspectives and priorities. Collaborative leadership gives authenticity to claims of person-centred, socially and culturally inclusive health care; continuing to exclude consumer leaders achieves the exact opposite.
This approach has already been developed in the United Kingdom and piloted here in Australia with Consumers Health Forum Collaborative Pairs Australia
2. Apply consumer-centred principles to decision-making
Policy, strategic priorities and resourcing decisions could be guided by evidence-informed consumer-centred principles that, in part, positioned health care as a human right with equity of access and outcome for all Australians, in the context of family, community and culture. We could make better decisions, delivering what consumers value. Ignoring consumer principles asserts that consumer perspectives are irrelevant to health decision-making. This approach has been proposed in the recently released consultation report of the Medicare Benefits Schedule (MBS) Review Taskforce Consumer Panel has as one of its four recommendations: Apply principle-based decision-making to build a consumer-centred MBS
3. Assess performance against consumer- centred measures of value
Value in health care is typically measured in terms of (comparative) therapeutic and cost effectiveness. What consumers want, need and prefer is often reduced to the anecdotal. In 2014 Health Foundation in the United Kingdom proposed in ‘Person centred care: from ideas to action’ that genuinely person-centred health services measured success by:
- How far people’s preferences are supported;
- How confident and able people are to manage their long-term health conditions better;
- The extent to which the NHS has been successful, working in partnership with others such as social care, housing and the voluntary sector, supporting people to achieve their outcomes.
Some primary care services are tackling this challenge:
… we are striving to achieve the vision of real person-centred care. We utilise many tools to do so, including patient reported outcomes measures such as the PROMIS 29 questionnaire … By asking patients about how they feel about all aspects of their health and wellbeing, this tool assists us in focusing on what truly matters as opposed to “what is the matter” with our patients. Dr Walid Jammal
When health plans become individualised, driven by the person’s priorities and goals, and are applied across sectors (including health, disability, aged and community care) and settings (home, work, community and institutions), we will know we are all working towards what people need and value. And when we see patient reported outcome measures used across services and systems, we will know we have supportive governance in place for consumer-centred care. Until then, we are delivering what health professionals and industry deem important, with limited evidence that this is what consumers value.
4. Acknowledge and integrate self-management as the foundation of health care planning
Self- management is the most extensive and efficient health care system in Australia. Why couldn’t we incorporate people’s self-directed efforts and resources to be – and stay – well in all levels of our care planning?
Depending on life circumstance, people invest significant resources in self-care and wellbeing. The family of a child with cystic fibrosis, type 1 diabetes, epilepsy or anxiety and depression works hard every day to keep the child – and their family -as well as possible. Adults who have the resources might invest in gym memberships, complementary treatments and active community lives. All do so with their personal health and wellbeing goals in mind. And carers and communities support and enable people on a daily basis to achieve their goals. Acknowledging this commitment and investment and incorporating it into cross sector, community-focussed health plans get us closer to more effective, efficient and meaningful health care. Ignoring the investment of individuals, families and communities in people’s health care potentially wastes resources and overlooks opportunities to achieve health and quality of life.
5. Develop social contracts with equity and outcome targets to address inefficiencies and provider-centric decision-making
The Organization for Economic Cooperation and Development (OECD) monitors and reports on wastage in health services. If we believe that health care is for all Australians then we need to redirect wasted resources to equitable, high value practice. Communities, who fund our health care systems through tax dollars, private health premiums, charity donations and direct out-of-pocket costs, want to see a system that considers the relative value of care. They don’t want people to miss out.
Choosing Wisely Australia is one response to the challenge of low value care. Professional standards bodies and government authorities acknowledge system-gaming by some practitioners and policy-makers and communities grapple with the emergence of high cost diagnostics, therapies and devices – often for low prevalence conditions where people have no other alternative or hope. We could bring community leaders to the table or, better still, take ‘the table’ to communities, to ensure that pricing for new products and services, and decisions about funding, are taken in the context of a wider view about what people want, need and value.
Can we choose not to do this?
If we believe health and social care is:
- a community priority and commitment – rather than a for-profit industry
- intended to deliver the services people need and value
- for everyone, in particular those most in need
- fundamentally part of the everyday lives of families and communities – supported by professionals and institutions, not directed by them
then we can set goals to better fulfil that vision. In ten years’ time, we could be looking at health and social care systems which are collaboratively led; strategic decision-making that is informed by consumer-principles; quality processes that continuously improve the health care people want need and value; efficiencies gained by integrating people’s goals and self-management into care planning; and greater accountability for providing health care in ways people need, want and value. Now that’s exciting.