Consumer-Centred Health Care
NATIONAL CAMPAIGN


Join the health reform campaign

• Our Aims
• Our Principles
• Our Five Point Campaign
• Our Steering Group
• How to become involved
• The background
• Your feedback

Your comments are invited on our draft Strategy Paper for the National Campaign for Consumer-Centred Health Care.

Please forward your comments by 31st March 2001 to info@partnerships.org.au

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.

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 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 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 Package for every consumer with a diagnosed chronic and mental illness
   
  Every consumer with a diagnosed chronic and mental illness should receive a Package for Care Coordination and Brokerage Payment. 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.
   

• 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 for acquisition of a person-controlled health management tool, and training in its use. Thereafter, an annual payment 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, should 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.
   

•  Local 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 over this time could have established and funded 110 Divisions of Consumers to facilitate, incubate and resource consumer-centred innovations in health care. It didn't.
  
  Now the Commonwealth has said it will turn this Divisions into 38 Medicare Locals, to improve service coordination and facilitate a more streamlined patient journey through the health system. This was the role Divisions had too.
  
  Medicare Locals will by governed by health providers and practitioners, with a consumer representative at the end of the table. How these Medicare Locals will improve service coordination on behalf of the consumer is yet to be seen.
  
  Local bodies are needed to facilitate, incubate and resource consumer-based innovations in health care on a local and regional basis. 

Our Steering Group

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 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.

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 the 2013 federal election.
 

  OUR KEY AREASO