Its election time and health is apparently a national priority.

We have big promises from the major parties for more spending on cancer, mental health, any number of regional hospitals and specialist research centres.

With a health system under strain and endless calls for funding boosts, politicians have put an emphasis on common conditions that have big impacts on individuals, families and communities.  This is not just about health and well-being, it is also about our economy and costs to government.  When people are sick, they not only cost the government in health services, they also cease working and often need the support of others. 

The health policy proposals put forward in this election seem to reflect consumer experiences in dealing with the health system at a time of need. 

My personal exposure was an eye-opener, even for a doctor working within the hospital system.  My sister, normally well, presented on several occasions with a range of symptoms, including discomfort, weight loss and fatigue; re-assured, watched, then referred for various specialist opinions.  At 35, too young for cancer, not sick enough for expensive or invasive tests; come back if you don’t get better.  By the time the cancer was found, it was too late, a life ultimately lost, and with it the potential to teach, to have children, to care for ageing parents, to pay tax. 

Given our knowledge of the system, my brother and I guided her and her parents through the maze of opinions, systems (public or private or a combination?) and treatments.  We acted as her advocates, optimising her access and minimising side effects of toxic life extending treatments.  Support to all involved was vital, co-ordinating, re-assuring, counselling, including suggesting options like psychological care when nearing the end of life. 

Costs were significant, including gaps in specialist fees, private hospital admissions, medications, not to mention loss of income for her and her support team. Even the cost of hospital car parking alludes to a system near skint.

The empathy and care provided by staff working in our hospital systems was then and is now, superb, although the strains are there to see.  The health advocate role is undervalued, especially for the ageing or those new to needing care.  The success of the McGrath Foundation breast care nurses reflects the needs of those undergoing care; not just nursing, but support, advice, guidance and advocacy.  While similarly funded services are available within the system, it’s not universal and not easily accessed within non-cancer services. 

As someone working in the system, I know it is fragmented: so many different sectors, services and funding structures to engage through a course of treatment.

From a clinician’s perspective, any hospital service development requires a business case; where will the money come from, what will be the benefit?  It’s a difficult sell if income, including from the federal Medicare system or grants doesn’t cover the local state-based costs, particularly if the benefits are then seen in another part of the sector.  In an activity-based funding system there is little financial incentive to prevent or reduce health interventions by keeping people healthy and out of the system.

The concerns of poor integration within Australia’s health sector extends further than just its funding models.  Currently many services are provided in silos, like cancer, cardiac, orthopaedics, aged care, etc, yet they interact and overlap with other sections, meaning duplications and endless cross referencing.  Communication easily breaks down, leading to delays, confusion and potential for error.

It all leads to one critical question: will pouring more money into the current structures lead to better access and/or quality of care?

In recent times, multidisciplinary teams have developed to offer more co-ordinated, holistic care, yet the funding systems to support often lag behind or don’t extend well out into the community where much of the care and support takes place. 

In my area of work, pain management, a different approach has been advocated.  Painaustralia’s The Cost of Pain report, demonstrated the enormous cost to the community of chronic pain ( estimated at $139.3 billion and rising).  An integrated National Action Plan has been developed.  Themes include educating and empowering consumers and primary care clinicians regarding optimal pain management. 

One example, on which I’m keen, is the development of ‘pain educators’. This is a model most notably implemented by Pain Revolution, which uses specialist trained allied health clinicians to act as knowledge disseminators, coaches and advocates for better pain management to both consumers and other health clinicians. 

Investments in such strategies gives excellent financial return to society as a whole, such as reductions in health care costs, welfare payments, improved workforce participation (and taxation) and better quality of life for those living with chronic pain.  It would also reduce prescription medication dependence and suicide - a win in anyone’s language.

With a total health spend of $180 billion, efforts to break down the barriers put up by the different funding and care models will provide a better return on this investment. 

An independent health reform commission, as proposed by the ALP, is a demonstration that a potential incoming government has been listening to concerns about the failures inherent in our health system. 

For the patients I work with, getting the treatment they need is challenging at best.  There is no clear path to good multi-disciplinary care that treats the individual as a whole person.  Surely we can do better by redesign rather than endless funding growth.

 

Associate Professor Malcolm Hogg

Malcolm is full-time specialist in Anaesthesia and Pain Medicine and Head of Pain Services, Melbourne Health. He is a past president of the Australian Pain Society (APS) and fellow of Faculty of Pain Medicine, ANZCA, and member of the International Association for the Study of Pain (IASP).

Malcolm's leadership roles include membership of external advisory groups to Victorian Dept of Health and Human Services safescript (medication monitoring system) external advisory group, Drugs of Dependence committee and Pain services clinical advisory committee.  Research interests include pain outcomes following trauma and models of care for pain service delivery.