24 April 2019

‘Move funding upstream to modernise health’

Policy TheHill

The Consumers Health Forum of Australia (CHF) has urged political parties to get in front of an imminent health crisis by tackling childhood obesity, reforming primary care and boosting prevention.

In a report released yesterday, “Priorities for the 2019 Federal Election: Making Health Better”, the CHF calls for a modernised health system that is equipped to meet increasing demand and keep people out of hospital.

It challenges political parties to commit to blended primary care payments to encourage teams and telehealth, while building on the Health Care Homes model and strengthening Primary Health Networks.

On prevention, the forum calls on whoever wins the May 18 election to implement the eight recommendations of the Obesity Policy Coalition’s 2017 “Tipping the Scales” report, which include restricting children’s exposure to junk food marketing; setting nutrient targets for food manufacturers; making the Health Star Rating system mandatory; putting a 20% price levy on sugary drinks; and establishing national weight management guidelines.

The CHF wants the proportion of the health budget spent on prevention to increase to 5%. Currently it’s about 1.34%, according to the 2017 report “Preventive health: How much does Australia spend and is it enough?” from La Trobe University’s public health department and the Australian Prevention Partnership Centre.

“Hospitals get the headlines,” CEO Leanne Wells told The Medical Republic. “Where it resonates with the community is that when you need acute care or surgery you want to know you have high-quality hospitals without a big waiting list.

“But it’s short-termism, and it’s more visible to build hospital and infrastructure. The kind of investment we’re advocating for in primary care and prevention, the yields from those are more long-term.”

She said the CHF was hoping to see a shift in the debate and the investment towards evidence-based prevention and modernising Medicare.

“We can’t have everything, we need to get the best bang for the buck in our health spending, and I think people are well aware of that. We’re certainly hearing that people want to see more investment in prevention.

“So there’s a disconnect between what the community wants and what the parties are talking about.”

Ms Wells said Health Care Homes was a move in the right direction towards coordinated care for chronic conditions.

“I think we’re playing catch-up. It’s a better model because there’s so many comorbidities to manage now. The activity-based funding model is good for some things, but when you have a mix of complex needs a single GP is not going to manage that as well as they would if they were leading a primary healthcare team coordinated around a shared care plan.

“We’ve got constraints that mean Skype and case conferencing and non-face-to-face activities, which really are part of good care coordination, can’t be funded because the patient’s got to be sitting in the room.”

She said the CHF wanted Labor to match the Coalition’s budget commitment to per-patient payments for older chronic disease sufferers.

“We would want to see at least a matching commitment or a recognition from Labor of the adjustments to the funding model that are needed, and we haven’t heard any definitive statements from them.

“We welcomed the downpayment by the current government in the over-70s initiative, but we’d like to see that rapidly extended to everyone with a chronic illness and to families with children under five – there’s a lot of avoidable ED presentations by worried parents. If their family general practice was incentivised and organised so that after-hours and reach-out care could be provided that would be a far better experience and less costly.”

Ms Wells said Primary Health Networks should be given a stronger mandate to coordinate care in the community, but that they also should be more transparent around performance and accountability for how they spent taxpayers’ money.

To address rising rates of chronic disease, the CHF charter calls for family and early childhood programs to foster healthy behaviours early on, and support for health providers to help patients actively manage their health. “This should include the ability to write ‘social prescriptions’ to encourage people to reach out to support like health coaches or community groups,” it says.

The CHF also wants professional service delivery funding in the Community Pharmacy Agreement spread out to also cover pharmacists in general practice and hospitals.

“We think that funding could be leveraged to much greater benefit to the community,” Ms Wells said. “It could be equally well spent if it was unlocked and could fund pharmacists in general practice teams as well, so it’s not the exclusive province of the community pharmacy.”

Meanwhile, the Obesity Policy Coalition and the Public Health Association of Australia welcomed Queensland’s decision over the Easter weekend to drop all junk food and alcohol advertising from government sites, including public transport and on roadsides.

“The Queensland ban will make a difference by protecting children from exposure to harmful marketing that we know drives consumption,” said PHAA CEO Terry Slevin.

The OPC’s executive manager Jane Martin said the move was ” exactly the sort of action that’s recommended by agencies around the world, like the World Health Organisation, to protect children from the influence of junk food marketing”.

“These brands spend millions of dollars plastering their unhealthy products all over these settings because they know it works,” she said. “It’s great to see the Queensland government acknowledging the pervasive influence this type of marketing has on children and putting a stop to it.”