The Health Care Home Model Could Have Provided Us Real Opportunity for Quality Health Care in Australia: Politics and Good Social Policy Do Not Mix!

Health Care Homes (HCH) aimed to provide better integrated health care to Australian citizens who suffer from chronic and complex conditions. Some of the targeted beneficiaries of Health Care Homes actually carry private insurance, yet they will benefit from the government funded HCH programme. It was anticipated that should they need help outside what HCH provides, they will see other health care service providers and their insurers will cover the costs (1). But, because of the patient-centred care under HCH, those beneficiaries will be healthier and they will hardly need their insurance to pay for anything. So private health insurance providers, who were recently awarded around 5% increase in health insurance premiums, will make huge savings because of HCH.

Maybe it is time for private health insurance reform and better integrate it into the Medicare system for primary care services. One way is for government to reel them in and ask them to help to fund Health Care Homes related services. That will relieve the burden on taxpayers. Alternatively, maybe the Minister of Health should put an end to most of these substandard health insurance policies that cover very little and cost the members too much. Most primary care costs are covered by Medicare and what Medicare does not cover; private insurance hardly covers and leaves a gap. People basically have policies that really by regulation restrictions are a waste of money in many cases. Hence they become a profit for shareholders. Read more about this?here.

Still, more is required to make Health Care Homes effective. It needs to be flexible and integrated with other health care reforms so that we do not end up with a reformed but fragmented health care system with various stand-alone programmes. However, politics got in the way of good social policy in this instance.

In New South Wales, we have hospital systems that are broken down by demographic regions called Local Health Districts (LHD). We can adopt that system throughout the nation, and cluster GP practices into the LDHs. Those clustered around a particular LHD become part of the preferred provider network for the district. Small GP practices can form consortiums with each other in order to provide the same network service as that delivered by corporate health companies. So, instead of a patient being locked to one health care home, the patient can have a wider choice within a given provider network.

A good investment into digital health and increased use of My Health Record will probably support the roll out and evaluation of HCH. Proper setup of data collection will definitely need to be planned and led by the managing agency with the support of GPs in private practice and the whole public health care system. It would truly be worth having a second go with a redesigned HCH.

Health Care Homes programme definitely had a good sample of privately insured beneficiaries. Data will be required on such beneficiaries to see how much their private insurance contributes to better health outcomes. Private health insurance providers will also want to know how much HCH saves them money. This could drive the long needed Value Based Outcomes models. The managing agency can work closely with insurers who can fund the collection of such data. The information that they gather from that data will inform future decisions on how to improve HCH and the whole health care system.

One can definitely conclude that Health Care Homes could provide a good opportunity for integration of services and patient data collection. It is also a good opportunity to look at possibilities of reforming private health insurance. It just might be the means through which Australia will provide quality health care going forward. Health Care Homes could be a driver to insurance reform in Australia for Medicare and private health insurance. Health Care Homes are sure to deliver outcomes if rolled out correctly and managed accordingly.

We have lessons learned let us use them. What happened to the PDSA cycle we use to use to fix systems that are not working as they should?

References

1. Health Care Home FAQ Booklet 1, version 1.1, 19 December 2016,?https://www.health.gov.au/internet/main/publishing.nsf/Content/AD51EBE397452EF5CA2580F700164BAD/$File/FAQ-booklet-HCH.pdf

2.?The Health Care Home: What It Means For Australian Primary Health Care, North Western Melbourne PHN, August 2016,?https://nwmphn.org.au/_uploads/_ckpg/files/About/NWMPHN_DiscussionPaper_Health_Care_Home.pdf