Originally published in Croakey Health Media, Editor: Melissa Sweet, Author: Bruce Levett.
Published Wednesday, March 8, 2023
Introduction by Croakey: In a fair and rational world, those with the greatest need for improved access to quality healthcare would be given centre stage at the various tables where health reform decisions are made.
On that basis, people with experience of healthcare inequities in lutruwita/Tasmania – a state with both poorer overall population health and worse access to healthcare – should be helping to drive national health reform conversations and decisions.
Consultations with health consumers in Tasmania offer plenty of useful insights for health policy making at national, state and local levels, writes Bruce Levett, CEO Health Consumers Tasmania.
Bruce Levett writes:
The number of Tasmanians who cannot access healthcare is growing, particularly in rural and remote areas.
Most Tasmanian’s do not have access to affordable healthcare. Tasmania has the second lowest bulk-billing rate in Australia (6.9%), well below the national average (42.7%) and the out-of-pocket charge in Tasmania is the second highest of any state (after ACT).
Tasmanians are telling Health Consumers Tasmania that they no longer want a piecemeal approach to ‘fixing’ health and they understand that more of the same no longer works.
They believe we have lost sight of some key fundamentals of what the health system was designed to achieve, which in turn is impacting on peoples trust in it.
Tasmanians want continuity of care rather than the increased use of locums. Hence, the corporatisation of primary care and the systems driven approach is not popular and it is occurring at the expense of consumer centred care.
Keeping people well – preventative health – is important to communities but it is often not seen as a priority by funders. Health Consumers Tasmania believe preventative health should be incorporated into primary healthcare reform process and not be treated separately.
Tasmanians have a broad view of health and wellbeing, and it extends well beyond the health sector – for example, hospitals and GPs. It extends beyond their own physical and mental health and it factors in the health and wellbeing of their families, parents and their local communities; things like transport and jobs; housing and food and an ability to participate in life and activities that are important to them.
So as Australian governments progress primary healthcare reform, Health Consumers Tasmania would urge them to take a deeper and longer term approach to fixing the health system and to respect that Tasmanians have some solutions that they believe could make a difference.
Firstly, much of the focus of the Strengthening Medicare Taskforce is on improving patient access to general practice, including after hours. In Tasmania, the reach of general practice no longer suits our state’s decentralised population, and therefore we argue that innovative solutions beyond GPs are required to fill this gap. This could include expanding the frontline primary care workforce to include pharmacies, nurse practitioners, community nurses, peer workers, allied health, and an expanded telehealth service that are funded under a new, streamlined funding model.
Our evidence suggests some in our communities are already desperately seeking healthcare support through these mechanisms because of high GP costs, lack of access or because they feel these services better meet their needs.
Secondly, a fundamental rethink of how we deliver primary care is required for Tasmania including new multidisciplinary care support that includes nursing and allied health.
Whatever new approach is developed; it is important that it be patient-centred rather than GP-centred or led.
It would incorporate continuity of care or support for the patient between health care visits, whether this is between GP visits or between acute care -primary care – allied health care visits. The gap between different service providers, and the ability of consumers to navigate the health system across these gaps is becoming, for many, overwhelming. This will require new thinking and the establishment of new roles or functions within healthcare.
It is also important that patient information stays with the patient, not just with the premise or practice, and that reform supports funding models that move away from transactional primary care to chronic condition management and coordinated care is also important.
What is also missing and desperately needed is building more entry points for consumers into the health system depending on their situation or location.
Unfortunately, and not blaming GPs, but they can no longer cope with the bottleneck that is occurring at their front door. For example, a consumer should be able to seek mental health support through a mental health practitioner or seek an appointment with a skin specialist directly rather than be forced to wait for a referral through a GP. This adds an unnecessary burden of waiting times, delays and cost onto consumers.
Tasmanians continually tell us that they don’t want to become ill if they can help it. Therefore, improving prevention and management of ongoing and chronic conditions is important.
To prioritise prevention, it would be ideal if all Tasmanians (or Australians for that matter) could have access to a free annual health and wellbeing check as a central component of the national health reform agenda.
Communities want access to opportunities for affordable healthy food as well as recreation and social activity and see the lack of these as a barrier to maintaining good health.
Health literacy plays a central role in prevention and given Tasmanians poor literacy levels (relative to other States), there is an opportunity to base Australia’s health literacy expertise and focus within Tasmania, a place that could develop and trial new innovative strategies to lift health literacy levels across the State and nationally.
Tasmanians continually tell Health Consumers Tasmania that they want to be treated within their communities when it is safe to do so.
Health Consumers Tasmania’s experience working in regional centres including Scottsdale, Ulverstone and the Huon through the Tasmanian Governments Health and Wellbeing Network initiative, together with our involvement in the Tasman Peninsula, Central Highlands, Dover and Geeveston communities demonstrates that local communities can meaningfully influence the health service delivery models of their locality if they are empowered to do so.
Telehealth provides a wonderful innovation for both service providers and consumers and has additional significant benefits for those living in rural or remote areas across Tasmania.
While it should not replace face-to-face care, continued refinement and expansion of telehealth is required, both to expand its reach to those without technology or knowhow, and in a way that doesn’t penalise consumers because of the predatory actions of some service providers.
Health reform cannot be limited to primary care, it needs to incorporate deep reform of acute care, sub-acute care, dental care, aged care and disability care through the NDIS and associated funding models.
It is important to acknowledge that some work is already happening. Health Consumers Tasmania supports the Federal Government’s commitment to establish three urgent care centres in Tasmania and the Tasmanian Government’s announcement to pilot a new single-employer GP training model in Tasmania and to also fund seven GP after hour clinics is welcome news.
A good first step but much more is required and without it, the pressure on our hospitals and emergency departments will only continue to grow.
• This article is based upon a letter recently sent to the Tasmanian Premier, Jeremy Rockliff, who is also the state’s Minister for Health, Minister for Mental Health and Wellbeing