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Wednesday, March 03, 2010

At A Quick Look At The New Rudd Health Plan - We Need a Great Deal More Detail.

I have now had enough time to read through the new Health Plan.

All the details on what the Government is saying can be found here:

http://aushealthit.blogspot.com/2010/03/brave-new-health-system-for-australia.html

The major issues I see are (other than that it is clear they have not worked out what to do about e-Health yet) are as follows.

1. The planned public hospital networks, as discussed in the plan, seem to be too small to be really efficient or as clinically effective as one might hope.

2. The GP, Specialist interface does not seem to have been really addressed.

3. Activity Based Costing is quite complex and I doubt it can be implemented in the time-frames mentioned in the document.

However the biggie to me is the notional takeover of all GPs and Primary care. The gap in information on this really worries me. I wonder how the GPs feel about this and what it will mean for them?

This is a huge plan and we surely need a great deal more detail to understand how this is all meant to work.

After watching the 7:30 report this evening on ABC 1, is it also clear that until we see all the plans, it is essentially impossible to know where all the parts fit, and if the whole thing makes any sense. Hold the phone till then!

I have to say that this partially formed rather hospital centric, e-Health sparse plan, does not fill one with a great deal of confidence.

Again I fear the role of e-Health as an enabler of improvement and reform has not been properly incorporated into the plans we see.

David.

9 comments:

Anonymous said...

What is meant by "takeover of all GPs and Primary care"?

I thought all GPs were already funded by the Federal Gov't through Medicare. Can you please explain what is meant by 'takeover"?

Dr David More MB, PhD, FACHI said...

As I read the plan they talk about funding ALL primary care. Presumably that means all the ancillary areas of primary care as well as GPs. Details are still not clear as my headline says - heaps of questions.

David.

Lea Patterson said...

Hi Dr. More,

Just to address one of your concerns. Activity-Based Costing used to be a large complex and burdensome task, but luckily with the proliferation of IT, it is becoming easier and more automated. The models we build now are more driver based, which means we look to the wealth of data inside a range of IT systems already in place and find as many data points, metrics, measures etc. and use these to populate formulas in cost drivers in the model. I've been building ABC models for nearly 15 years now and in the initial stages it was all manual, but luckily the methods and IT have evolved over that time to make it easier for us. Also latest best practice is to build rapid high level models using central business rules in 6-8 weeks and then incrementally improve the model over time, but provide sufficient detail in the high level model to enable initial analysis to be performed.

Cheers,

Mr. Lea Patterson
President / CEO
Pilbara Group

Dr David More MB, PhD, FACHI said...

Hi Lea,

That assumes the feeder systems are in place, and that they are trustworthy and reliable.

There are gaps all over the place in Australia in all these areas - although I do realise you can use surrogate models to get close.

The issue I see will be more a cultural one. We shall all see.

David.

Lea Patterson said...

You are absolutely correct and I have a number of tales of woe of poor data systems. The good thing is that the gaps are less than they were 15 years ago and luckily it's on a case-by-case basis and some organizations have excellent systems in place, although some are still running paper and excel.

Cheers,

Lea

Anonymous said...

One problem will be the availability of Clinical Coders to code the inpatient episodes in the patient record in a TIMELY fashion so that the ICD10 codes can be grouped to DRGs for use in Activity Based Costing.

At present it is predominantly manual task.

Anonymous said...

Indeed! It's already difficult enough to find qualified and experienced clinical coders as it is.

Anonymous said...

PERHAPS THIS ISSUE SHOULD BE ADDRESSED THROUGH THE EDUCATION SYSTEM IE TRAINING THROUGH THE TAFE SYSTEM WOULD SEEM A VIABLE OPTION TO DEVELOP SKILLS REQUIRED.

Anonymous said...

Surely ABF is 'bigger' than hospitals and inpatient episodes? Are we right to think that ABF can be meaningfully achieved by relying on the existing (purpose built) DRG casemix and ICD coding systems and coders? We know that these instruments and practices apply only to hospital inpatient episodes, and are not suited or applicable to primary care (GP), community care, other allied health services, sub-acute care, rehab, disability services or non-inpatient services (such as A&E or outpatients). There are lots of health service activities which might require activity-based funding, especially if we are to 'take the pressure off hospitals' and to transparently fund health services which ARE delivered elsewhere. Instruments, methods and practices which faithfully capture and cost those activities are also needed...along with a workforce to make it happen.