Moving our healthcare system from a fee-for-service model to one based on patient health outcomes remains the nirvana of one of Australia’s leading health policy experts.
“The way to transform the health industry is to realign competition so it’s based on value for patients, not just cost,” said Dr Stephen Duckett, Health Program Director at the Grattan Institute at a recent CEDA event in Sydney. Value for patients was equal to outcomes, divided to cost, he added.
The need for this move is well-established. The current system, while it has served us well to a point, is unsustainable financially and tends to reward volume rather than quality. The system, as it stands, does not promote or allow for the promotion of the best value practices.
Dr Duckett cited the example of an audit of hip prostheses and the rate of revision procedures that had been done with each different brand of prostheses. The audit found that the revision rate between the various prostheses ranged from between 2 and 8 percent. In an ideal world, all orthopaedic surgeons would be using the prosthesis associated with the lowest rate of revision. But this is not the case.
“Three quarters or so of all hip prostheses that are used in this country are not the best performing,” Dr Duckett said. This information is out there and yet no one is addressing this problem.
And while some outcomes, such as revision of hip prostheses are straightforward and data relatively easy to access, there are many areas in the health system where the data needed to analyse outcomes has either not been collected or is not readily accessible. For example, there was no information in the public arena for outcomes of cancer surgeons, Dr Duckett said.
He recalled trying to obtain information on readmission rates over a 10-year period at a single Australian hospital. The difficulties, delays and ultimately expense he encountered in attempting to get this data made him “weep” with frustration.
The whole premise of value-based healthcare relies on knowing outcomes.
“Outcome measurement is the single most important tool to drive innovation in healthcare delivery,” he said.
Measurement and collection of data, integrating technology better into traditional systems and giving better information to consumers would assist in driving better patient-oriented outcomes.
And it is important when discussing patient-oriented outcomes that this includes outcomes that the patient values, which may not always be the same as the expectation of the clinician or indeed the taxpayer. Patient-reported outcome measures are therefore fundamentally important when assessing value.
A value-based healthcare system needs to have in place the feedback mechanisms in place to ensure delivery of the highest quality, most efficient and most appropriate service, therapy or surgery at every patient encounter.
And for Australia, any healthcare system will also need to take into consideration concepts such as the patient experience, equity and societal outcomes.
“Healthcare is not only about individual treatment, healthcare has issues about creating social solidarity, teaching and all sorts of other things that aren’t actually in the value equation,” Dr Duckett concluded.