Stay in your own bed when you get sick or old, then share the responsibility for your treatment and care. Thinking back on the last 12 months and our plans to deliver a Transfer of Care form…
I was motivated by Australia's Federal Treasury stating that by 2040, 100% of state revenue will be spent on healthcare alone. Their findings indicated that we have already passed the point where healthcare was affordable by government or private insurance. The next tipping point would be patient outrage as the services start to become rationed.
It was reported that no single party within the health sector anywhere in the world has (to date) demonstrated how to reconcile the two opposing forces of escalating costs and restricted expenditure. Worse still, these calculations had not factored in the emerging trends that would compound the scale of the problem, which includes the escalating prevalence of chronic diseases, where an average population of 33% is drug dependent for life on around six medications which often doubles once in residential care.
The report cited the legally permitted 80,000+ potentially carcinogenic chemicals unleashed into our food chain as a major concern and has raised the obvious questions relating to sustainability, responsibility and most contentiously, liability for the cost of treatment.
The cost of health care is exploding: a new regional hospital can exceed $1.3bn (AUD), but the sting in the tail is the committed life time operational cost of over $220bn or $10,000 per night, per bed. In Australia we have plans, but not a full budget. For new regional hospitals to meet the current demand it will require a new hospital per year for the next decade, which is well beyond the tax payers means.
The introduction of patient centric e-health records is intended to assist this strategy, as well as getting some quick wins for patients and those who need to reference their medications and event summary as part of diagnosis or treatment. eHealth records go a long way in reducing the number of avoidable errors within the health system’s procedures which, in some countries, occurs in around 16% of all patient interactions. The most common error is prescribing a medication that is known to be inappropriate due, in part, to either someone not checking the record, the record being inaccurate or unavailable, or simple errors in forms, like scripts, where for example, in one region over 60% of scripts had clerical errors in them. In 2010 the then Prime Minister stated that during 2007-2008 around 33% of our hospital beds were accounted for by patients who experienced these avoidable errors in chronic disease management alone (ABC news). I spoke with one manager of a leading hospital who confirmed this as conservative, and added that the hospitals then compound this problem by creating an additional 18% of errors on patients who end up in hospital.
According to Sir Muir Gray, the National Health Service Chief Knowledge Officer (UK), if we collected the evidence of what works today from our collective experience, the asset value of this to the health system would be greater than all of the potential medical inventions of the next decade. Whilst facilitating a panel discussion at a health event in Sydney in 2012, I asked a leading care provider what that new evidence might be. The audience was told that most chronic disease conditions could be greatly reduced and in some cases eradicated if some identified life style changes could be prescribed.
But to enable these to become ‘prescribed’ and therefore chargeable Medicare items, they need the evidence to be scientifically collated so that these effective treatments, including healthy diet, exercise and other allied treatments could be included alongside the medications list of chargeable treatments.
However, our GP practices, hospitals or the government itself, do not currently share, report, analyse or collectively collaborate to generate any meaningful clinical evidence that could enable this to occur. The global trends are shifting towards an opening up of these locked databases of information.
But the most interesting and dramatic activity centres around the adoption of mobile devices and the explosion in medical apps that patients and practitioners are adopting for treatment and monitoring. The volume of usable knowledge collected within a scientific framework is likely to exceed what the practitioners receive from the pharmaceutical industry in a very short time frame.
This, in turn, will shift the balance of power to the health consumer and those who can deliver the most verifiable value outcomes to them. Both mainstream, allied and even alternative practitioners will have to come to terms with a new set of consumer expectations. These include total transparency, greater accountability, collaborative interactions, consumer-centric decision making and risk assessment.
The obvious challenge for us is how to leverage the value from these trends and build upon the remarkable community capacity and capital we have built up over the decades, so that our aged, young and vulnerable, along with everyone who is going to become impacted by an ability to pay, does not suffer the full extent of the consequences of our unaffordable and rationed health system.
We tried to Make A Difference
for these people… We will keep trying in 2015 and give the evidence to those who will listen…