There Is Little Doubt We Can Now Deliver A Lot Of Care Outside Expensive Hospital Environments!

This appeared late last year.
Why home is better than hospital

Patients can often be treated at home just as well as in expensive hospitals. But private health insurers have too little incentive to fund it. 

Jason Kara is chief executive of Catholic Health Australia

Jan 1, 2024 – 2.47pm

Modern hospital-in-the-home care is a generational game changer for the health system, offering huge cost savings and superior patient care.

So why is Australia missing out while the rest of the world roars ahead?

The answer is our private health insurance system. This isn’t to say that the private health insurance sector does not recognise the advantages of hospital in the home (HITH).

But the system as it stands allows individual insurance providers to try to manipulate the system to suit their respective individual corporate interests. This messy, piecemeal approach is stymying Australia’s progress.

On current projections, by 2025, when the UK expects to be treating 20 per cent of its patients at home, Australia will be lucky to hit 5 per cent. What we need is system-wide reform.

But before we consider how that can be done, it’s worth noting the true scope of the benefits we’re talking about.

HITH today uses modern technology, meaning there need not be any compromise in the standard of clinical care.

Hospitals can impose strict infection control standards and policies. They have rigorous incident reporting and management protocols.

HITH is not suitable for all types of care. But for a significant portion of the current hospital patient load – think chemotherapy, dialysis, wound care, and post-surgical rehab – it can offer superior health outcomes, often at a fraction of the cost.

If we take cellulitis as an example, the savings are about $970 per patient, per day.

Unfortunately access to home treatment for that patient is dictated by their insurer, not their doctor.

HITH also offers substantial advances in palliative care. Though the range of care treatment scenarios makes it difficult to carve out a specific dollar value, the Productivity Commission found the cost of avoiding a single hospital admission was enough to cover the cost of community-based palliative care for several months.

Yet, in Australia, the overwhelming majority of palliative care and cellulitis treatment still happens in bricks-and-mortar hospitals. Why?

The problem is that private health insurers do not have to offer HITH as a default benefit, as they do in-hospital care.

Often, a patient wants to be treated at home and their doctor believes HITH is appropriate. Unfortunately access for that patient is dictated by their insurer, not their doctor, and depends on the individual contracts their insurer chooses to sign with hospitals and other providers.

Many insurers do not support HITH services outside of those they are able to provide themselves, either directly or via a subcontractor.

Some insurers may cover more of the costs associated with HITH services if the services are provided by a preferred provider.

But if a patient chooses to receive HITH services from a non-preferred provider, their insurer may cover less of the cost or may not cover it at all.

The lack of default benefits for HITH is a severe barrier to its wider adoption. As things stand, there’s no real incentive for insurers to cover HITH services if those services are provided by non-preferred providers.

Healthcare providers, meanwhile, are obviously less likely to invest the time and resources required to develop and offer HITH services if they know most insurers won’t cover these services.

Two things need to happen to break the impasse.

The private health insurance lobby needs to recognise that the short-term desires of its individual members are at odds with the long-term health of the system. And the Department of Health and Aged Care needs to step up and bite the bullet on reform.

The health portfolio is not generally considered simple and reform is often devilishly tricky. But in this area, the path forward could not be clearer.

Private health insurers currently have to provide a range of default benefits, notedly for all care delivered to eligible members in hospital; HITH simply needs to be listed as a logical extension of this.

The new system should mean that if any insured patient is being treated for an eligible condition at any hospital where HITH is an option, if they and their clinicians decide HITH is right for them their health insurance would automatically cover it.

Catholic Health Australia commissioned independent economic modelling to identify the default benefit necessary. It found a default benefit of $330 per day would be sufficient to provide an incentive for hospitals and insurers to significantly expand clinically effective HITH programs for a range of conditions and episode types.

More here:

https://www.afr.com/companies/healthcare-and-fitness/why-home-is-better-than-hospital-20240101-p5euhr

Funny that this article does not mention the big driver in my opinion, patient preference. Given the chance many would far prefer their care to come to them and for their monitoring to be increasingly remotely enables, once over the acute issue. I know I sure would!

The problem is, of course, that delivery of this type of care is not as convenient for clinical care providers and so is typically less favoured by the powers that be! Changing this bias will require attitudinal change and improved technology that better links patients and their carers. Structured investigation into what remote technologies would be most useful would be very worthwhile!

I wonder what changes we will see over the next few years?

David.