For a long time I’ve argued that a significant barrier to substantial reform in healthcare in Australia is that the main players are too captive to their membership bases or special interests to be willing to leave their corners and engage in meaningful discussion.
I sometimes toss around the idea of getting Australia’s healthcare leaders in a room and asking them to nominate one major policy development they are willing to embrace that specifically goes against their self-interest.
As the CEO of one of Australia’s leading providers of public and private hospitals, something my organisation has been doing for close to 180 years, I’m happy to get the ball rolling.
If Australia is to make the most of its healthcare future, it will likely need fewer hospitals, not more.
There I said it.
I half expect to be reminded of that admission every time I approach a state health minister, cap in hand, for help funding a new ward or hospital wing.
But it’s the truth.
Partly reflecting the benefits of technology and the preferences of patients, and partly reflecting the need to grapple with increasing demand and the costs associated with hospital-based care, in the future, more and more healthcare will be delivered in the home.
Fewer hospitals will exist along traditional lines. The emphasis of our healthcare system will be providing primary and ambulatory care in localised clinics and in the comfort of people’s homes.
Hospitals will become different places, only housing emergency and critical cases and offering highly specialised care.
Hospital stays will also be shorter. Day procedures will be more common place. Admissions will only occur for the most serious of cases.
We can already see that shift occurring in the provision of greater amounts of dialysis and chemotherapy in the home.
Denmark shows the way
Some countries are already well ahead of us in this process. In 1999, Denmark had 98 hospitals — today it has 32.
So why and how has Denmark gone down this road?
Quite simply, it saw the writing on the wall. Denmark recognised its traditional healthcare model would become unsustainable in the long-term, given the demographic and technological forces it was facing.
To quote Hans Erik Henriksen, who is CEO of Healthcare Denmark, a non-profit organisation tasked with proselytising to the rest of the world about the nation’s healthcare achievements:
“About 15 years ago, we realised the solution to these problems is not more hospitals but to think about how we can deliver healthcare in a different way.
“We aim to deliver as many services as possible through primary healthcare, municipalities, health centres and outpatient clinics and as little healthcare as possible from our hospitals.”
Contrast this to Australia, where every state election our major political parties fall over themselves in a bidding war over who can promise to build the most hospitals.
Somehow we need to reach our policymakers with the message that building a better health system and responding to increased demand shouldn’t necessarily equate to more bricks and mortar.
In Australia, the path to transforming our public hospitals can begin with the creation of same-day ambulatory care clinics which have the potential to improve both efficiency and patient outcomes.
Many public hospitals already provide a large number of “out of hospital” services, but there are often delays for access.
This can see initially non-urgent health issues deteriorate to the point of requiring a more expensive health intervention, including in-patient care; or they are predominately providing follow-up appointments for patients who have already been discharged and should be managed in a primary care setting. This can be at the expense of new patients who could be diverted from in-patient care.
Emergency Departments are under great pressure.
Australian emergency departments currently see very large numbers of patients classified as non-urgent or semi-urgent — 8.8 per cent and 39.9 per cent of all presentations respectively.
Public hospital EDs have been doing a tremendous job over many years becoming more efficient and seeing greater numbers of patients in quicker times, but they can’t do that forever.
Take for example new data released by the NSW Bureau of Health Information, which shows the state’s EDs are under enormous stress and close to breaking point.
More than 760,000 people presented at NSW’s EDs between July and September — 47,000 more than in the same quarter last year and more than any other previous quarter.
Many of these patients would be more appropriately treated in either primary care or through an ambulatory care clinic.
It’s time to prepare
In an Australia where we no longer seem to have an appetite for big reforms, our health system is drifting.
For the past decade governments and policymakers have failed to comprehensively grapple with the system’s mounting problems.
This is a reform that demands attention before our EDs completely break down.
Is private health insurance worth it for older Australians?
I’m hopeful that we’re starting to see the penny drop.
For example, it was heartening to see Greg Hunt announce his plans to encourage greater “healthcare in the home”, allowing health funds to cover specialist treatment outside hospitals at a lower cost.
NSW’s Health Minister Brad Hazzard also appears to have had his lightbulb moment, declaring at a recent event: “Why do we need to keep building new facilities on all occasions … when there are often private facilities nearby who can provide those services through contractual arrangements?”
It’s a start, but it’s only the tip of the tip of a very large iceberg.
We need to find a way to encourage politicians not to reinforce these old models of care — such as more hospitals and bigger emergency departments — and instead invest in the redevelopment of health infrastructure, supporting hybrid models that offer a mix of primary, ambulatory and acute care.
The challenge is, of course, name a politician who doesn’t like standing in front of a brand new hospital, red ribbon and scissors in hand?
Equally, our leaders have a responsibility to start a conversation with the Australian public about the inevitability of the coming changes and why our health system will need to transform.
These changes are coming whether we like it or not.
We can prepare for them, like Denmark, or have them forced upon us through shrinking healthcare budgets and unavoidable demographic change.
I know which I’d choose.
Toby Hall is the chief executive of Vincent’s Health Australia.