In health care, consumers are more than just here to help
by Leanne Wells and Jeffrey Braithwaite
The customary response to the daunting rise in costs shadowing health care is to reach for that toxic mix of service cuts and tax/fee increases.
Now however, fresh attention is going to the concept of health system sustainability. We’re seeking to build a system to last; one of which we can all be proud.
In spite of accelerating demand for hospital and aged care and fears that governments face the prospect of overwhelming health costs eating up an increasing proportion of budgets, we know already that there are significant areas of avoidable or wasteful expenditure in the health system. According to some, this amounts to 30 per cent of overall costs in Australia.
There is ample scope to act: whether it be to reduce avoidable admissions to hospital of people with chronic illness, curtail the thousands of unnecessary but expensive scans and procedures, give more focus to preventive health measures or more firmly mandate Primary Health Networks in their regional service commissioning role to effectively serve as stewards of more effective localised community responsive health systems.
Whatever measures we are to take, they will only succeed with the support and active participation of the people who are most directly affected: consumers and patients.
Curious as it may seem in this age of consumer power, in health care the consumer is too often left out of the design and decisions concerning health care that impact on them and their carers most directly.
Long term health budget repair and health system sustainability won’t be achievable without major reform. We need to remake our health care system to be less focused on centralised administration and hospitals, and more focused on devolved funding and community based solutions. Health care isn’t about organisation charts and structures: it’s all about people.
So the development of a national partnership on health sustainability anchored by the National Health and Medical Research Council and partners* that will involve consumer input through the Consumers Health Forum gives our universal health system a much better chance of recovery and survival.
Consumer involvement is more than a mantra. Research at the Kings Fund in London declares there is clear evidence that people are not as involved as they want to be in decisions about health care, “yet when they are involved, decisions are better, health and health outcomes improve and resources are allocated more efficiently”. And we would add: clinicians and patients are happier and better at their respective roles carer and cared for, and joint decision-makers about that care.
Consumer involvement generates trust and confidence in services, acceptability of ‘tough decisions’, personalised care and value for money and compliance with prescribed treatment.
Consumers are the most powerful agents for change and improvement, whether it be through involvement in treatment policies such as the Choosing Wisely campaign which highlights poor or unproven treatments, or more widely in playing an active role in the decision-making about health care priorities of organisations like the Primary Health Networks.
The Consumers Health Forum of Australia has with the NHMRC made a joint statement that guides consumers involvement in research, encouraging research literacy of consumers and supporting researchers to work with consumers in areas such as translating research into programs and services.
Patient experience systematically analysed can provide valid and powerful evidence to tell us more about why certain trends are observed and experienced.
In the real world, there are cautionary tales and promising horizons. A striking example of the continued failure to act on consumer experience has been demonstrated in mental health. Despite the frequent conclusion of the 32 statutory inquiries into mental health between 2006 and 2012, that the system remains in crisis, there has been little or no improvement in rates of help seeking.
The establishment of the 31 PHNs as regional commissioners of health services opens great potential for people power, through such bodies as Consumer Advisory Councils and deliberative practices such as citizen juries to have a say in the best provision of limited services.
We hold several ambitions for this new centre. Chief among them will be that it is exemplary in its own practices of consumer involvement and that it will investigate and document new evidence about how health system funders and designers can harness consumer insights.
In the end, a sustainable health system has to mean something to the 25 million of us who seek care from that system right through the year. It’s time to put patients right at the heart of the system.
*The NHMRC Partnership Centre for Better Health on the theme of Health System Sustainability is funded to the value of $10.75 million over five years by the NHMRC, the Bupa Health Foundation, NSW Health and the University of Notre Dame Australia.