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Healthcare package trial a welcome first step in relieving demand on public hospitals

March 2016

The Federal Government’s announcement of a trial of tailored healthcare packages for 65,000 chronically ill patients has the potential to deliver improved health outcomes while relieving demand on public hospitals, according to St Vincent’s Health Australia (SVHA).

The organisation – Australia’s largest non-government provider of public hospitals – said it hoped the trial was the start of a broader move among governments to improve efficiencies in the acute care sector.

SVHA’s CEO, Toby Hall, said while the organisation was positive about the Health Care Homes trial – along with the other measures announced – it hadn’t escaped its notice that it would be financed by the Commonwealth holding on to $70 million in health funding destined for public hospitals.

“For a very long time we’ve been calling on governments to pursue a range of initiatives – real structural reforms – to make healthcare more efficient and relieve demand on public hospitals. This is a very good first step,” said Mr Hall.

“While recognising it appears the trial will be paid for by the Commonwealth holding on to $70 million in health funding earmarked for the states, on balance, we support the proposal. However, we expect the trial’s progress to be monitored and reported on regularly so we can be sure it – and its funding – is reducing hospital demand.

“From a public hospital provider’s perspective, we’re positive about today’s announcement because around 8% of all public hospital admissions (3% of private hospitals) nationally are classified as ‘potentially preventable’, in that they could have been managed effectively through community and primary care.

“Around half of these are people with chronic conditions such as chronic obstructive pulmonary disease or diabetes complications.

“So there’s great potential for measures like this to genuinely reduce demand our hospitals.

“We encourage governments to go further and deeper by pursuing other trials and reforms that will both deliver better care for patients and greater efficiencies.

“For example, more and better use of same-day ambulatory care clinics in public hospitals have the potential to improve both efficiency and patient outcomes.

“Public hospitals currently provide specialist outpatient clinics but there are extensive delays for access, which can see non-urgent health issues deteriorate to the point of requiring a more expensive health intervention, often involving in-patient care.

“Our modelling indicates that new Rapid Diagnosis and Treatment Centres at public hospitals would reduce the cost of treating overnight and some short-stay inpatients. By treating them as ambulatory inpatients it could deliver a 10% cost saving for this group and a three-fold increase in the number of newly referred patients, now seen as outpatients, at the current cost.

“It would also reduce waiting times and create extra capacity in our hospitals.

“We must also reduce demand on hospital emergency departments. Public hospital EDs see very large numbers of patients classified as non-urgent or semi-urgent – 9% and 43% of all ED presentations.

“People generally go to an ED rather than primary care because of lack of after-hours access to GPs, and concerns around cost of primary care, including pathology and diagnostic tests.

“We need to expand trials of more assertive triage models and improve access to after-hours GP care – including co-location of GP services with hospitals – to divert non-emergency cases to more appropriate care.

“Another area where there’s much work to do is the cost-shifting that goes on between the residential aged care system and the public hospital system.

“Around 10% of the 1.1 million hospitalisations each year among older Australians are from people living in residential aged care, many for conditions that could be prevented or managed by the aged care facilities.

“We regularly see elderly patients in our hospitals with viruses and infections that could easily be treated in the facility at a lower cost.

“We think a model needs to be urgently developed that allows for aged care residents to receive health care on site rather than being transferred to a hospital in most cases,” said Mr Hall.