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Empowering Consumers
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Consumer-Centred Health Care

NATIONAL CAMPAIGN

RECLAIMING OUR HEALTH SYSTEM


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.

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.

CLICK HERE to become involved.
 

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, citizens and taxpayers.

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 personís 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 5 Point Campaign

  • 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.

    This has yet to happen. In May 2010, the Rudd Government committed itself to introduce this system from 2012 on an opt-in basis for those consumers who wanted it. A vast amount of public money was wasted in trying to implement this Record with little consumer input into the process. With a lack of strategic vision for effecting change in health systems, the Commonwealth's version of a Patient-Controlled Electronic Health Record died a sorry death.

    In 2015, the Turnbull Government has re-instated a commitment to introduce a Patient-Controlled Electronic Health Record, this time on an opt-out basis, rebranding it as My Health Record. Two trials will be undertaken in 2016 involving one million consumers in Far North Queensland and the NSW Nepean Blue Mountains region.

    We believe a PCEHR is best developed as an initiative of collaborating associations of consumers and health care organisations with government support. It must be independent of provider and practitioner control, and designed to enable consumer self-care and self-management, and consumer-generated innovation

    The critical step to a consumer-centred health system is the development of a consumer-controlled electronic health record by collaborating associations of consumers and health care organisations.
     
  • A Care Coordination and Brokerage Package for Every Consumer with a Diagnosed Chronic and Mental Illness
     
    Every consumer with a diagnosed chronic and mental illness should receive a Care Coordination and Brokerage Package. We propose that this Package should comprise an initial amount of $2000 would be followed by an annual $1000 payment thereafter.
     
    This Package 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 then manage the Package 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.
     

  • Funding for Regional Pools of Consumers with Chronic and Mental Illnesses to Purchase Localised and Personalised Care

    Fee-for-service models of health funding are suited to acute and episodic care. They are not suited to funding care for consumers with chronic and mental illnesses. Fee-for-service systems provide no incentive for practitioners and providers to develop the self-care and self-management capacity of consumers. On the contrary, they incentivise multiple, disconnected interventions and drive over-servicing.

    The Commonwealth should redirect Medicare funding for single episodes of care for chronic and mental illnesses, to regional pools of consumers with these conditions who opt to collectively purchase localised and personalised care through a Regional Pool of Consumers. Where consumers in any of the 31 Primary Health Network regions establish a pool of consumers, with consumer-based governance, we propose that this enrolment pool of consumers be recognised and funded by the Commonwealth, on an opt-in basis, to purchase localised and personalised care. State governments should redirect funding similarly.

    We also propose that an independent third party to commissioned to monitor expenditure by regional pools of consumers, and measure movements in productivity in each enrolment pool.

    Over time, we propose that additional funding and management functions be transferred from providers and practitioners to these enrolment pools of consumers.

    Where consumers in any of the 31 Primary Health Network regions establish a pool of enrolled consumers to purchase localised and personalised care in chronic and mental illness, these regional pools of consumers should be recognised and funded by governments.
     

  • A Health Care Price and Safety Information Service

    The Commonwealth and State Governments 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.
     
  • Consumer-Elected Consumer Participation in Health Service Governance

    Public and community health services and networks should enable one third of their governing board positions to be filled by consumers elected by registered users of these services.

    Our preferred composition for governing boards of public and community health services is one third funders (government), one third practitioners/providers, and one third consumers.


    It is a very simple exercise for complex organizations to establish a system of opt-in registered users of their service and allow a periodic election in which these registered users vote.

    One third of governing board positions in public and community health services and networks should be filled by consumers elected by registered users of these services, as a condition of eligibility for public funding.

Local Incubators of Innovation

Successive Commonwealth governments established and funded Divisions of General Practice, later renamed Medicare Locals, and subsequently renamed Primary Health Networks, in regions areas across Australia to strengthen the place of general practitioners in the health system.

The Commonwealth could have established and funded Divisions of Consumers to facilitate, incubate and resource consumer-centred innovations in health care. It didn't.

The Commonwealth has given the 31current Primary Health Networks (PHNs) a brief to integrate primary health care and facilitate a more streamlined patient journey through the health system. This was the role Divisions had too.

PHNs are by governed by health providers and practitioners, with nominal consumer input. Despite their provider and practitioner-centred governance, some PHNs are amenable to supporting innovations to the consumer pathway through the health system. We plan to work with these bodies to incubate local innovations in health care.

A map of the 31 PHNs and their boundaries is available here.

Local bodies are needed 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

CLICK HERE to become involved in any of these ways.
 

The Background


The ideas in this Campaign were generated at the
Consumer-Centred Health Care: Policy Innovation and Empowerment conference held in Melbourne in March 2010.

The 4 points in our Campaign 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.

Our aim is to influence governments to implement this 4 point agenda. To this end, we will work to gather political support for the agenda from politicians, political parties, policy makers, and the community.
 

Your Feedback     

Tell us what you think. We would be pleased to receive your comments or suggestions.

CLICK HERE to open a feedback form.


Further information

Vern Hughes
03 5629 8400 
0425 722 890
vern@partnerships.org.au

 
    

 

  OUR KEY AREASO

DISABILITY, AGED CARE , MENTAL HEALTH
Self-Directed Services and Personal Budgets
EDUCATION
Student-Centred Learning and Personal Budgets
HEALTH
Consumer-Centred Health Care and Personal Budgets
CONSUMER
MARKET POWER

Brokering Consumer Power in Utilities, Telecommunications

  DIARY

May 2015
Formation Meeting - Good Life Cooperative.

CLICK HERE for details.

NEWS
Making It Personal
This Demos Report from the UK on Persona Budgets and Self-Directed Supports provides an excellent overview of the this agenda CLICK HERE.
PROJECTS
A Personal Information Record for Every
Australian

Every person who has used services in social support, education and health care knows we need a consolidated personal information record.
CLICK HERE for more information.

Individual Learning Plans
Individualised learning should be a right for all children. CLICK HERE for more information.

Family Income Management Plans
Indigenous communities are not the only ones where Family Income Management Plans can make a difference. CLICK HERE for more information.

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© Social Enterprise Partnerships 2015