'Whack-a-mole' approach to healthcare must change

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After many years of working in the Australian health care system, we believe more can be done to implement meaningful, sustainable health care reform.

In this article, we propose ways in which health system reform could be approached that deliver integrated, person-centred care.

Although some principles of a person-centred system are already in place, or partially or fully agreed in the National Health Reform Agreement, a number of principles are not in place. These should be further considered along with mechanisms to deliberately integrate processes across the system to reduce fragmentation – a source of clinical risk, frustration and delays to care delivery.

Much has been written in the past 12 months about the challenges currently facing the Australian health system (here and here). We believe the outstanding, and widely supported, model of universal health care is wobbling, despite 10% of Australia’s gross domestic product being spent on health care services.

The system is facing pressure from multiple issues including:

• increasing workforce and capacity challenges;
• an ageing, multimorbid population; and
• fragmented and poorly coordinated health care (here, here and here).

Across Australia, it seems there is appetite for reform. Significant reform proposals and activities are under way at both a state and federal level (such as the Strengthening Medicare Taskforce).

The Taskforce is critical, but much of it is focused on individual sectors (eg, disability, aged care or primary care), which we believe creates the risk of perpetuating fragmentation. This in turn creates additional clinical risk, workforce and user frustration, additional costs, and delays to accessing timely care (see here, here, here and here).

What is less evident is an overarching vision and plan for the Australian health system as a whole which considers the challenges and opportunities of these different sectors, the experience of their users, and the interfaces between the different sectors. 

The deeply interconnected nature of our health system and related sectors demands an overarching, integrated vision of how these components work effectively together to:

• ensure clinical risks driven by system fragmentation are optimally identified and managed;
• minimise the chance of competing activity or activity that pulls in different directions, and as a result is less effective; and
• avoid creating health system “whack-a-mole” where one component of the system is improved, only for it to have downstream impacts on other sectors.

An overarching approach and vision are important: in the absence of a map, how will we know where we are going or when we get there? In addition, how will we ensure we are successfully achieving improvements without agreement on what that success looks like?

The authors propose that the health system vision and strategy, as well as key underpinning processes and documents are reviewed to ensure they:

• overtly address fragmentation;
• consider common and high risk interface challenges and ways to address these; and
• are both person- and workforce-centred.

What would a truly person-centred health system look like?

A person-centred health system

Person-centred care is an essential element for the delivery of high quality care.

The Picker Principles have been widely adopted as supporting meaningful person-centred care and we support the adoption of these principles when considering health system reform.

The National Health Reform Agreement articulates action on a number of these points, but we believe more could be done to ensure a shared, person-centred vision for our health care system.

Using the Picker Principles, we have developed the following possible system examples.

We believe ongoing health care reform is required to deliver an integrated health system that spans preventive health, primary care, hospital medicine as well as related sectors such as disability, community health, public health and residential aged care.

A person-centered approach to reform, that also explicitly addresses fragmentation, is essential to ensure patients and their families remain our primary focus.

However, reform cannot be achieved without also considering the most essential aspect of health care service delivery: our workforce, which we will discuss next week in part two of this series.

Associate Professor Cate Kelly is a Board Director, Health Care Consultant and an Honorary Clinical Associate Professor at the Department of Medicine at The University of Melbourne.

Associate Professor Douglas Johnson is the Director of General Medicine, Medical Services at the Royal Melbourne Hospital and an infectious diseases and general medical physician.

Read InSight+ next week when Associate Professors Kelly and Johnson will discuss the what considerations are required to deliver workforce-centered reform of our health care system.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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