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What will it take to overcome the barriers to wider use of “hospital in the home” care?

As previously reported at Croakey, there is considerable evidence that caring for patients at home rather than in hospitals (whether through avoiding admissions or early discharge) saves both money and lives.

But many barriers remain to a greater uptake of Hospital in the Home programs, and Medicare Locals have an important role in helping to overcome these, according to Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association.

****

Alison Verhoeven writes:

With healthcare costs continuing to rise and hospitals struggling to meet increasing demand, there have been calls for radical overalls of the funding and governance structures in the Australian health system.

Before launching into another round of major, yet inevitably watered-down reform, governments and service providers would do well to consider the existing models of care that have steadily been gaining support and credibility over recent years.

The National Health Performance Authority (NHPA) has today released a new report identifying the variation between hospitals in the length of stay for patients with same condition.

In a second report NHPA has highlighted the large number of potentially avoidable admissions to hospitals in 2011-12.  Unnecessarily long stays in hospital and avoidable admissions are an obvious area of waste in the health system and an opportunity for significant improvement in efficiency.

The availability of appropriate primary care services and community based care options is a key factor that influences the need for hospital admission and delays to discharge.

Hospital in the Home programs (HITH) that provide acute and post-acute care in the patient’s home are an efficient, cost effective and safe substitute for being in hospital.

Historically, the financial incentives for avoiding admissions or reducing length of stay were minimal as there were always other patients that would fill the beds and no realisable savings would be made. The incentives that did exist related to freeing up hospital beds to allow elective surgery patients to be admitted. This group was a priority as there was often additional funding available for efforts to tackle the highly public and political issue of waiting times.

Additionally with the fragmented funding system, the responsibility for funding HITH services was often complicated and debated between the Commonwealth funded primary care sector and the state funded hospital sector. The result of this was a lack of collaboration, service duplication and accusations of cost shifting between Commonwealth and states.

While a Deloitte Access Economics review in 2011 confirmed the cost-benefits associated with HITH, Professor Debora Picone, Chief Executive Officer, Australian Commission on Safety and Quality in Health Care, speaking at the HITH Society Conference last week, alluded to the out-dated attitudes and beliefs of senior clinicians and managers, particularly in relation to cost, as a major barrier to greater use of the HITH model.

With the introduction of activity-based funding model, where hospitals are paid for the actual number and type of service they provide, there is greater incentive to implement HITH models.

While the incentive to drive elective surgery throughput remains, the activity driven funding model provides the capacity to access funding for both the HITH program and the additional hospital activity that the HITH programs allow.

HITH programs rely on effective collaboration between the acute hospital sector and primary and community care services.  Medicare Locals have played an important role in facilitating cooperation between existing services and supporting the development of new services where gaps existed.

Following comments by the then Opposition Health Spokesperson which suggested that Medicare Locals would be disbanded by a Coalition Government, the Prime Minister stated, during the election campaign, that no Medicare Local would be closed.

The Health Minister Peter Dutton appears to be backing away from this commitment and is deferring any decisions pending the outcome of a review of the Medicare Local structure.

For many patients, Hospital in the Home programs provide a safe and effective alternative to a hospital stay.  Increased use of HITH programs will free up hospital resources to treat those for whom hospital admission is the only option.

The national health reform process has delivered a funding model that better supports the HITH approach.

The missing components are the broad support of health service administrators and possibly the capacity to integrate care across sectors if the axe falls on Medicare Locals.

• Alison Verhoeven is Chief Executive of the Australian Healthcare and Hospitals Association

 

 

 

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