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Consumer-Centred Health Care
Building a Consumer-Centred Health System in Australia
NATIONAL CAMPAIGN
Join the health reform campaign
Our Aims
Our Principles
Our Steering Group
Our Five Point Campaign
How to become involved
This federal election and the next
The background
Your feedback
The health policy and health reform debate in Australia is thoroughly dominated by provider and practitioner peak bodies in both private and public sectors. Politicians take their policy cues from these peak bodies. Consumer voices are
poorly-developed, under-resourced, and almost entirely ignored in public debate. There is no national health consumer body in Australia that has a strategic commitment to consumer-centred health care. Illness-specific and institution-specific consumer representation and advisory bodies have emerged in the last thirty years but are usually restricted in their role to the facilitation of consumer voice within provider and practitioner-centred systems, often in response to government requirements that institutions demonstrate accountability to their various ‘stakeholders’ – with consumers usually classified as but one 'stakeholder group' amongst many.
The National Campaign for Consumer-Centred Health Care is a
response to this imbalance in the Australian health reform debate. It aims to generate a broad movement for transformational change in health policy towards consumer-centred health care.
Our Aims
The aims of the Campaign are:
To develop a movement of citizens and consumers for change in the Australian health system towards consumer-centred health care.
To participate in the health reform debate in Australia and influence its direction; and
To influence the thinking of politicians, policy makers, journalists, practitioners and consumers about health care and health reform.
Our Principles
Our four principles are:
My Life. My History
Information about a person’s health history and care strategies belongs to that person, and authority in management of and access to this information resides with each person.
My Life. My Care
A person requiring health care interventions should be resourced with the means to acquire independent personalised information and support in making decisions about care options and coordination.
Self-Care and Self-Management
A person with chronic or complex health conditions has a right to expect support from providers and practitioners in developing their capacity for self-care and self-management in their journey towards better health.
My Life. My Money
A person requiring health care interventions has a right to know the price,
quality and safety credentials of these interventions.
Our Steering Group
The members of the Steering Group are:
Professor Debbie Kralik, Royal District Nursing Service SA
Samantha Thomas, Consumer Health Research Group, Monash University VIC
John Stubbs, Cancer Voices Australia NSW
Maxine Drake, Health Consumers Council WA
Professor Enrico Coiera, Centre for Health Informatics, Australian Institute of Health Innovation UNSW
Ronald Hicks, Hunter New England Area Health Service NSW
Colin Frick, Improvement Foundation Australia, SA
Jose Simsa, Community Participation Committee Inner South Community Health Service VIC
Yvonne Orley, Self-Care Advocate QLD
Professor Kerry Bennett, Diabetes and Diversity in Western Melbourne, Australian Community Centre for Diabetes VIC
Jacqui Gibson, Prahran Mission VIC
Vern Hughes, Social Enterprise Partnerships VIC (Convenor)
On 20th January 2010, the West Belconnen Health Co-op opened its doors in a Canberra
suburb as a health service owned by consumers and community organisations, with a philosophy of integrated, holistic person-centred care. A century ago, most of Australia's health organisations were consumer-initiated, consumer-centred and consumer-managed. Most general practitioners were
contracted to collectives of consumers (friendly societies)
for primary care services on a capitation basis (payment by
person rather than episode of care). Bush nursing
associations ran small hospitals and clinics on a capitation
basis (payment by subscription). Hundreds of pharmacies
were run as community services by friendly society
dispensaries. Charities and membership-based organisations ran most of our larger hospitals. A century later, politicians, bureaucrats and provider peak bodies act as if health care belongs to politicians, bureaucrats and provider peak bodies. It doesn't. It belongs to consumers.
Our 5 Point Campaign
A Person-Controlled Electronic Health Record
A Care Coordination and Brokerage Payment of $2000 for every consumer with a diagnosed chronic and mental illness
A Person-Controlled Health Management Tool
A Health Care Price and Safety Information Service
110 Divisions of Consumers as Incubators of Innovation
A Person-Controlled Electronic Health Record
The Final Report of the National Health and Hospital Reform Commission in June 2009 recommended that by 2012 every Australian consumer should have an electronic health record which will be used by providers and practitioners across service and disciplinary boundaries. Each person should be able to authorise access to the record to the providers and practitioners of their choice. In May 2010, the Rudd Government committed itself to introduce this system from 2012 on an opt-in basis for those consumers who want it.
However, this Commonwealth commitment is not strong. In the face of pressure from hospitals and other practitioners, the Commonwealth may introduce a watered-down version of the record without consumer-control over access. Or it may drop plans to mandate use of the record by hospitals and other providers. Strong political pressure is needed to get the Commonwealth to honour its commitment to introduce a person-controlled record. Additional pressure is needed to get the Commonwealth to make it mandatory for aged care, disability and mental health providers to use the record. The first step to a consumer-centred health system is the introduction of consumer-controlled electronic health record by 2012.
A Care Coordination and Brokerage Payment of $2000 for every consumer with a diagnosed chronic and mental illness
Every consumer with a diagnosed chronic and mental illness should receive an allocation of $2000 as a Care Coordination and Brokerage Payment. The initial set-up payment of $2000 would be followed by an annual $1000 payment thereafter.
This payment would be for the purpose of purchasing the services of a care coordinator/ care broker /health coach as required by the consumer to guide them through the maze of services, costs, waiting lists and information overload. Payments may be made for coordination, advocacy, health literacy training, self-management training, individual or collective purchasing and tendering, contractual arrangements, and personal health and fitness coaching.
An eligible consumer would nominate a Care Coordinator and Broker to receive and the manage the Payment on their behalf. The Care Coordinator and Broker may be a community health organization, an illness-specific association, a health fund, a GP or nurse or allied health practitioner, or a consumer organisation. It would be the consumer's prerogative to choose a Care Coordinator and Broker who has the capacity to manage the financial allocation, enter contractual arrangements on their behalf, and manage their support and care relationships to their satisfaction.A consumer must be free to select their Care Coordinator and Broker, and free to transfer from one to another annually. Every consumer with a chronic or mental illness should be resourced to find a pathway through the complexity and fragmentation of the health system. A system that does not resource and empower consumers to do this in a personalised way effectively denies access.
A Person-Controlled Health Management Tool
Every consumer with a diagnosed chronic and mental illness, disability and aged frailty, should receive a payment for, and a legislated entitlement to, a person-controlled health management tool. Every eligible consumer would receive an initial set-up payment of $2,000 for acquisition of a person-controlled health management tool, and training in its use. Thereafter, an annual payment of $500 would be received for maintenance and training, paid to their Care Coordinator and Broker or nominated agent. All providers and practitioners supplying services to eligible consumers with chronic and mental illnesses, disabilities and aged frailty, would be required by legislation to enter information on the service supplied into the person-controlled health management tool. The tool would enable the consumer, or their family or Care Coordinator and Broker, to coordinate information and support tools in accordance with their care plan.New technologies make it feasible and affordable for consumers, and their agents, to manage their health care through a person-controlled management tool. Commonwealth legislation will be required to make it mandatory for providers and practitioners to use this tool in partnership with the consumers who seek their services.
A Health Care Price and Safety Information Service
The Commonwealth should establish an independent Health Care Price and Safety Information Service to make available to consumers comparative price and service quality data on hospitals, providers and practitioners so that consumers can know what they are using and purchasing.
This entity would be a statutory authority, independent of providers and practitioners, with authority to require information from providers, insurers and practitioners for public disclosure online, including:
- Hospital payments for the services of medical specialists
- Health fund payments for medical specialist charges
- Hospital errors and deaths
- Hospital-based infection rates
- Specialist fees in private practice
In a consumer-centred health system, consumers and their Care Coordinators and Brokers, must be able to access information about the price and quality of the services they use and purchase.
110 Divisions of Consumers as Incubators of Innovation
Successive Commonwealth governments have established and funded Divisions of General Practice in 110 regional areas across Australia to strengthen the place of general practitioners in the health system.
The Commonwealth should also establish and fund 110 Divisions of Consumers to facilitate, incubate and resource consumer-centred innovations in health care.
These Divisions should receive the same resources as are allocated to Divisions of General Practice (infrastructure and 12 - 25 staff in 110 regional locations) with consumer-based governance.
The purpose of the Divisions is to facilitate, incubate and resource consumer-based innovations in health care on a local and regional basis.
HOW TO BECOME INVOLVED
There are many ways you may become involved in our National Campaign for Consumer-Centred Health Care.
Join up (there is no cost)
Invite a speaker from the Campaign to visit your group or organisation
Express your interest in joining our Steering Group
Convene a regional initiative/forum in your area
THIS FEDERAL ELECTION AND THE NEXT
Our aim is to influence governments to implement this 5 point agenda. To this end, we will work to gather political support for the agenda from politicians, political parties, policy makers, and the community. The Campaign will take this 5 point agenda to candidates and parties in this year's federal election. The hospital financing and health workforce measures announced by the Rudd Government in April 2010 will have little impact on the imperative for transformational system change in health care. This will become increasingly apparent after the 2010 election. The federal election in 2013 will have greater significance for health reform than the 2010 election, and our Campaign will aim to maximise its impact in 2013.
THE BACKGROUND
The ideas in this Campaign were generated at the
Consumer-Centred Health Care: Policy Innovation and Empowerment conference held in Melbourne on 22-23 March 2010.
These 5 points are not the last word in health reform. They are simply starting points for the re-direction of reform efforts away from a narrow pre-occupation with hospitals to a focus on the total consumer experience of health and health care. As starting points in this process, our Campaign has a focus on the funding and structuring of consumer decision-making, empowerment, self-care and self-management.
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