Given Australia’s ageing population, and the expected increase in the demand for care for chronic and aged patients, there will be significant pressure on the resources available to the health sector.  The recent Federal Budget has withdrawn expected future funding for the hospital sector in particular.

Government and policy makers will, therefore, need to review a range of options and strategies to maximise resource useage and minimise cost.

Associate Professor Scott concludes:

“In the US, approximately 30% of health care expenditure is wasted on activities that add no value to care;  the corresponding figure for Australia is unknown, but is likely to be significant.”

Despite significant increases in health budgets over the last decade, with health care expenditure in Australia growing from 8.2% of GDP ten years ago to 9.3% of GDP now, gains in life expectancy and reduction in disability burden since 2000 have “flattened  out considerably”.  

The ten strategies identified in the paper include:

Minimise errors in diagnosis

The cost of delayed, missed and incorrect diagnosis is substantial and could be minimised.  The costs of over-diagnosis, over-servicing and unnecessary intervention could be improved.

This obviously has implications for clinicians, as well as for the health system as a whole.

Minimise practices that provide little benefit or cause harm

There is a role for clinicians and the specialty colleges to move to evidence based approaches to clinical decision making, assessment of new drugs and treatments.  Reviewing existing drugs and treatments, policies and guidelines issued by specialty colleges, health departments and others involved in the health sector, could assist.

Unproven interventions, without clinical evidence, should be deferred or avoided.

Select care options on the basis of comparative cost effectiveness

This may be somewhat controversial, which requires an assessment of cost effectiveness, rather than simple clinical decision making on the benefit to a patient.  Nonetheless, clinicians and specialty colleges have a responsibility to consider resource allocation within the health sector, and, where clinically appropriate, could take into account comparative cost effectiveness of particular treatments, drugs, and practices.

Target clinical interventions to those who derive the greatest benefit

This again is controversial, since it seeks to allocate health resources in a potentially discriminatory manner, but suggests that interventions be made in that part of the health population which derives the greatest benefit.  This raises serious legal and ethical questions, but is a conversation that may be necessary.

Review end of life approaches and decision making

This is a very controversial area, but recognises that a sensible conversation will look at the effectiveness of intervention, the clear direction and directive given by the patient, the necessity of particular treatments and interventions, and the need to provide a tighter legal framework in this area.  Formal advanced care directives are under discussion by government at the moment, but inevitably social policy, ethics and legal implications will arise.

Clearly the involvement of patients in shared decision making and allowing patients to have greater involvement in their case management has the potential to improve outcomes.  There is sufficient research to show that the level of patient involvement in their own care does correlate with the success of care and the outcomes that can be achieved.

Minimise operational waste

An obvious strategy which seeks to make use of the limited resources that will be available and actively seeks to identify waste within a complex and cumbersome health system.

System change and integration

Health institutions need to become more evidence based, standardised and nimble enough to change in the face of new evidence and new information and research.

A coordinated system that actively operates through primary health care and acute health care, linking to the aged care sector effectively, can minimise waste, reduce error and produce a better case managed result for patients.

Achieving this outcome requires a substantial investment of resources itself, and significant changes to the way health care is delivered in Australia currently.

This summary of some of the implications of this important article provides suggestions for a way forward for an overhaul of the health system.  Whilst the social policy and legal issues need to be carefully considered, the question is whether there is a political will, within a structure that divides health between Federal and State governments, to achieve these outcomes.

Some of the benefits of these strategies are obvious, but undertaking the work to achieve them is not always possible.

[Associate Professor Ian Scott “Ten Clinician-driven Strategies for Maximising Value of Australian Health Care” Australian Health Review, Vol. 38, No. 2, May 2014 page 125]