More vision on healthcare needed

June 08 01:00 2014 by ushadmin

Let’s have a more visionary approach to reducing health costs. While most see the need to reduce health costs, wouldn’t it be refreshing if our politicians and their advisers looked at more visionary ways of cost reduction instead of a $7 co-payment, a scheme which will become a cost-shifting exercise as patients reluctant or unable to pay this amount will just turn up at already overburdened emergency departments?

While it’s true that health costs are rising as the population ages, we aren’t all that different from other developed countries. At 9.5 per cent of GDP our health expenditure is a little above the OECD average of 9.3 per cent and well below the US at 17.9 per cent, the only OECD country without universal health coverage and with a strong focus on privatisation.

Tom Delbanco, a Harvard professor, has helped to reduce costs. He had the audacity to suggest patients have access to their medical notes. His colleagues were aghast, saying this would be time consuming for doctors and cause anxiety in patients. Delbanco persisted.

In 2011 he persuaded over 100 doctors to participate in the Open Notes project. Despite initial anxiety, by the end of the trial there was overwhelming support by participating doctors. They found it made doctor-patient communication more effective and actually saved time as better-informed patients did not make unnecessary visits.
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Patients liked it too. Sometimes they were able to point out that their notes did not accurately reflect what they’d told the doctor, resulting in better treatment and often fewer tests. Most felt empowered by the trust and respect that came with having access to their personal information.

The recent Australian patient controlled electronic health record is an important step in this direction, giving people a summary of their health records, but the Open Notes concept shows patients exactly what the doctor has written. This makes doctors write better notes, avoids confusing abbreviations, makes patients partners in their own care and according to Delbanco, reduces the cost of care.

Another opportunity to reduce health costs is in the last year of a person’s life. A Canadian study showed 33 per cent of healthcare expenditure occurred during the last year of life, particularly the last few weeks. In the US the figure is 22 per cent. Research from Victoria found average hospital costs increase almost ten-fold in the last month of life.
At 81, David Munro* had a large brain haemorrhage, leaving him in a coma, able to breathe only with mechanical help. On medical advice his two daughters felt he should be allowed to die peacefully. His son, who’d had little contact with his father, disagreed. He insisted “everything” be done, every investigation and every possible treatment. So they persisted. David slowly deteriorated and died seven weeks later. By then the extra costs had reached $270,000.