The Alliance, in partnership with HESTA, recently hosted a webinar on alternative funding arrangements for primary health care, which provided more than 140 participants with the very latest in research and thought leadership in Australia.
The opening speaker is one of the country’s most prominent health economists, Distinguished Professor Jane Hall from the Centre for Health Economics Research and Evaluation at the University of Technology. Professor Hall discussed the experiences and learnings from different, ‘traditional’ models of funding health care, saying there has been a lot of reform in Australia to try to increase universal access to health care services.
“But it hasn’t actually changed the fundamental funding flows that form our system. We have PBS, we have the MBS and we have hospital payments. And although they have changed over time those different silos that fund institutions or services, rather than people, haven’t changed.”
Jane segued to the current motivation for reform, which involves a shift to a value-based payment approaches, focussing on ‘patient empowerment’ rather than a focus on the institution.
She said there is an increasing emphasis on joint planning and funding at local levels across primary, secondary, disability and aged care, and a move to new and flexible payment methods. She said this should improve equity and better evidence-based care, enabling better outcomes for our health dollar – outcomes that matter to patients.
Richard Colbran, CEO of the NSW Rural Doctors Network, spoke about the role of workforce in the health system and the need to not only attract, recruit and retain staff, but preserve the workforce, especially in times of disaster such as the current flood emergency on the East Coast.
“The mental health and the self-care of our health workforce is a ‘must’ issue right now… and RDN in partnership with about 25 different agencies have established a service called #RuralHealthTogether, which is an aggregation of all the existing self-care and wellbeing programs that are funded across the country to support our clinical people.”
Richard discussed the patchwork funding and competition across different towns and communities for health care resources and recommended a focus on strengthening leadership across all health-related organisations in the broader rural health system. He highlighted examples of team-based care and the spirit of cooperation that is driving care models in some towns such as Canowindra. And in summarising local success stories, Richard also mentioned the accidental innovation and learnings coming through from Commonwealth funded clinical outreach programs providing rural service solutions in specialist care.
The third speaker was CEO of Alpine Health Nick Shaw who provided a case-study of their organisation’s experience of the Multi-Purpose Services, or integrated, model. He said the MPS model provided “deep reach” across the community and has three defining features that foster innovation.
He said the most prominent feature of the MPS model which drives a level of innovation in care and sustainability in smaller communities was ‘block’ funding, which is pooled state/Commonwealth funding, supplemented by the health service.
The second feature is the flexibility principle which has shifted their health service out of institutionalised settings, and into integrated models of health, and largely into a primary health setting.
“This allows us to direct funding and resources in a flexible way to respond to and meet the needs of people in a community-based setting that hones-in on person-centred care, rather than acute settings.
“The greatest thing around flexibility is that it liberates an organisation’s, and for that matter a community’s, thinking. Staff are less constrained by the some of the narrow structures that can characterise health at different points in time.”
Nick said it allows Alpine Health to think more expansively around health need and the response we arrive at and the way we work with other institutions and organisations.
Nick explained that the third foundation of the MPS model is community involvement and consumer-led health planning and response, which generates relationships with the community; drives a level of community investment in their own health; and brings people together to think innovatively about health.