Catholic Health Australia National Conference Jennifer Doggett August 2014

Transcription

1 Catholic Health Australia National Conference 2014 Jennifer Doggett August 2014

2 Stinging rain fall down afternoon time Rosella Namok

3 Our Medicare system is unsustainable. Australia's health spending is heading to a point where it will become unmanageable." If our health and welfare and education systems stay exactly the same, Australia is going to run out of money to pay for them.

4 International health spending Source: OECD Health Data 2012

5 Rise in health funding

6 % Change in health expenditure against % change in GDP - Australia Source: Commonwealth Fund

7 Projected demand Source: NCOA

8 Growth in Medicare - PBO the growth in spending on ten programs that grew rapidly over the past decade will be constrained to less than real GDP growth over the next decade. These programs are Family Tax Benefit, higher education, Medicare, public hospitals, Age Pension, Private Health Insurance Rebate, Disability Support Pension, government superannuation, public debt interest and Official Development Assistance.

9 Why are we spending more on health? 1984 Patched up and sent home Dies 2 months later of a heart attack 2014 Falls reduction clinic Pre-diabetic Dietician Exercise physiologist Mental health plan Statins, low-dose aspirin..etc Prostate cancer screening Goes back to work for 4 years, retires, joins the local Rotary, looks after his grandchildren 1 day a week, takes that world cruise and lives for 12 more years

10 Challenges and choices Ageing population Increase in chronic disease and multimorbidity Multi-disciplinary, long-term care Greater availability of data More health care options Knowledgeable consumers Role of technology Health funding as a tool

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12 Health funding basics Two major ways to fund health care Most countries have a balance of both All systems have advantages/disadvantages Often trade-offs have to be made Best system is the one which reflects community/consumer values Best cost control AND best health outcomes are in countries with strong public sectors Private health services and private health insurance are NOT co-dependent

13 Reform aims Reflect consumer/community views Resolve fault lines in current system Address vested interests Support greater choice Reduce inequities Based on a SDOH perspective Embrace diversity and flexibility Grounded in evidence and backed by data

14 First.address waste Workforce substitution ($390 million) Breadon Poor value procedures ($500 million/26) Elshaug Generic pharmaceuticals ($1.3 billion) Duckett Hospital funding ($1 billion) Duckett MBS/PBS reform ($2-3 billion) Webber Compare: $7 GP co-pay $700m/4 years

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16 Aboriginal and Torres Strait Islander men, on average, live 10.6 years less than non- Indigenous men, while Aboriginal and Torres Strait Islander women, on average, live 9.5 years less than non- Indigenous women Source ABS

17 We already have a problem Source: Commonwealth Fund

18 I have had to wait until I was unable to move around, putting up with excruciating pain on a daily basis for many weeks, because having joint injections is so expensive. Consumer, WA I m a middle class mother yet I now find I can no longer manage my financial medical situation. This is a new experience for me. I frequently have no money at all and live pay to pay so a $6.00 co-payment would mean I either didn t go to the doctor or I'd have to go to the emergency department of a public hospital. Consumer, Vic I currently owe my psychiatrist $3,500 in gaps. I am fortunate that charges a very small gap and he is happy for me to drip feed the money over the years but most doctors don t do this. I don t qualify for a healthcare card so have to pay full price for everything. Consumer, Vic I have private medical insurance which I can t afford but it s essentially compulsory. I can t use the private system any more as I can t pay the excess and gaps required by doctors and hospitals. Consumer, Vic There was a time that we couldn t afford injections for both children and had to choose who had them. And the other one would need to wait till we got the money. Consumer, NSW

19 Co-payment research Decreased access to health care (strong evidence) Decrease in access is proportional to the size of the copayment (strong evidence) Greater impact on the elderly (strong evidence), people on low incomes (strong evidence) and people with chronic illnesses (medium level evidence) NO evidence of a decrease in just unnecessary or low-value services. Limited evidence of a decrease in both high and low value services. NO evidence for overall cost savings Limited evidence for increased downstream health care costs.

20 Impact of higher co-payments Reduced access to preventive and cost-effective health care Impact on people with chronic conditions, Indigenous Australians and those in rural/remote areas Health problems become more serious People forgo other expenses to afford medical care Increase in stress and anxiety about health care costs Consumers seek less cost-effective forms of care resulting in higher overall health care costs Compound existing disadvantage resulting in a less equal society.

21 Out-of-pocket costs: where to from here? Consumer payments part of Australian health system and worldwide Wealthier community capacity to contribute Need policy extreme makeover Data who pays for what? Safety-net targeting chronic and complex conditions Allow flexibility and choice Not create barriers to preventive/cost-effective care Work for the most disadvantaged not increase inequity

22 Option 1: Health credit card Consumers pay for all health with personal health credit card G ment pays providers directly G ment bills consumers monthly for net outof-pocket costs Repayments over time, linked to income

23 Option 2: PHI opt out Consumers choose to opt out of PHI and receive a payout equivalent to their rebate This $ can be used to cover OOP costs for private health goods and services Consumers can opt in at any time, subject to normal health fund restrictions

24 Option 3: Public Hospital Excess Consumers can choose an excess for public hospital admissions In return, they receive a set amount for use in paying for non-hospital services Excess would be billed retrospectively ED or other types of admissions could be excluded

25 The Catholic Health Sector Advantage Understanding of both public and private health sectors Linkages across health/community/aged care SDOH perspective Presence across Australia, urban and regional areas Culture of values-based health care History of successful collaboration across political boundaries

26 Thank-you Jennifer