Australia-wide search finds innovation in chronic health care

Innovation is key to improving health care, particularly in rural and regional communities. So how do we get more of it?

To answer this question, the Productivity Commission recently investigated health innovation across Australia. In particular, we looked at examples of best practice care provided to people with chronic physical health conditions, such as heart disease, cancer, respiratory disease, diabetes and arthritis, to name just a few. These conditions involve long-term management and ongoing care rather than a one-off treatment. There are 9.2 million Australians who have at least one chronic health condition. In total, we spend around $38 billion managing these conditions each year. And these numbers are growing as our population ages.

The Productivity Commission found many great examples of innovation in chronic health care.

For example, Virtual Clinical Care, operated by Country Health South Australia, uses technology to help people who live in remote locations to monitor their symptoms and self-manage care. In Queensland, some hospitals have dedicated roles for GPs with special interests. These GPs work with specialists to perform clinical assessments and coordinate ongoing management of care. Consumers benefit from shorter waiting times without sacrificing health outcomes. And in the Northern Territory, health clinic data is linked and analysed to improve prevention, early detection and management of chronic conditions.

However, these innovations were the exception, not the rule. They were often isolated, operating in only one or a few hospital districts. They often depended on dedicated individuals who were able to work around unhelpful funding rules. They often ran against the incentives that are built into our health system. Put simply, they succeeded despite the system, not because of the system.

The Productivity Commission has just released a report that considers how to change our approach to health so that these types of innovation become the norm rather than the exception. We provide four recommendations to governments.

First, there needs to be increased funding flexibility so that more innovations can be trialled. This does not necessarily mean more funding. Rather it means listening to ideas, funding the best of those ideas, and critically measuring the results. It also means rewarding success. If a health body, such a Primary Health Network, shows success in innovation it should be rewarded and encouraged to innovate further.

Second, we need to rethink how we fund hospitals and other health professionals. Currently, hospitals are paid when people use their services. A better outcome is to manage health conditions, to avoid hospital admissions. But the incentives in funding and reporting drive behaviour, so if we want a pro-active health system that focuses on prevention and in-community support, we need to trial alternative models of funding and performance management.

Health data is a key input to improve health service delivery. ‘What medicines are you taking?’ is the first question when being admitted to hospital. Hospitals cannot access your medical and medicine history even though this is critical for your care. And your GP may not know you have been in hospital, far less know the outcome. Linking and communicating patient data across the health system and allowing for anonymised aggregation to track health trends is best practice health care. So our third recommendation is that governments carefully expand the flow of data across the health system.

Finally, we need to spread best practice through the health system. Successful innovations should be actively disseminated with health service providers encouraged to take up proven innovations that match their community need.

Some of the innovations discussed in the Productivity Commission’s report could be quickly rolled out to many more Australians. Others are best used in specific contexts, such as The One Stop Liver Shop, which is a mobile care delivery model for people with chronic hepatitis B living in remote Northern Territory communities.

However, the big message from the Productivity Commission’s report is that, with some modest reforms, more Australians can benefit from healthcare innovations.