Sunday, December 9, 2007

Capital Health (NZ) to reduce medical staff

As reported online on the Scoop website recently, Capital and Coast District Health Board in New Zealand is planning to reduce the number of employed doctors so as to limit future deficits. It is certainly one means of achieving that outcome, on the surface at least, considering staff costs to be the single largest cost component for a hospital, however any hospital considering such measures would need to consider the long term implications.

Medical staff perform a vital role within any hospital. One has to assume that government funded hospitals simply do not receive sufficient funding to enable them to employ a surplus of trained medical staff. Therefore it is highly possible that a cut in the number of medical professionals may lead to a reduction in the level of service available to patients, which in turn may increase waiting lists for surgery.

At the same time consideration needs to be given to the message such action might send out to those considering a career in medicine. It takes almost a decade of training to get a doctor to proficiency and full productivity within the hospital system, not to mention the time invested in ongoing professional development. Should the demand for medical professionals fall the it is likely less people will consider entering the profession or those that do may elect not to work within the hospital system. On the surface this may appear a good short term solution for reducing any excess numbers of medical professionals (if there is such an excess), however the time lag between entering the system as a trainee and becoming fully productive means it is necessary to have a full compliment of medical professionals available at all times.

Friday, December 7, 2007

Warley Hospital reflects private health issues

During the 2003-04 year Warley Hospital discharged 602 medical patients and treated a further 2200 in A & E. Assumably those numbers have increased over the past three years, yet the hospital Board reports that Warley is no longer financially viable.

This situation has not occured overnight. Records from the Victorian Department of Human Services show consistent financial assistance to Warley Hospital over the past 5-7 years. In 2001 the Bracks Government provided additional funding of $22,000 to help maintain emergency services, $68,000 towards capital improvements and almost $200,000 towards the cost of developing an improved primary care facility. Again in 2005 the Bracks Government provided Warley with a one-off funding grant of $300,000 to enable the hospital to provide emergency services through to the end of 2006. A condition of the funding was that
Warley Hospital undertake business planning. In addition there has been significant private fundraising over the same period. This would suggest the issue is not necessarily one of poor management; rather an issue of ongoing cost escalation against declining revenues. That is assuming the Board and management have taken all the strategic cost cutting measures available to them!

Being a private hospital there are no publicly available records such as annual reports. This means we have to assume appropriate management of the hospital. If a private hospital is continuing to seek financial support from public funds then it needs to make its accounts and reports available for examination. Transparency is critical to ensure effective decision making.

Warley Hospital is a small, private, not-for-profit, hospital on Phillip Island in Victoria, Australia. According to the hospital profile, containing information that is three years old, the hospital has 13 acute beds, some of which are 'temporarily' closed and 30 residential aged care beds. The fact that Warley Hospital has been providing services to residents on Phillip Island for the past 80 years is off little consequence; the reality is that a combination of low levels of acute beds plus a low number of residential beds equates a low revenue base with few opportunities to increase revenues; at the same time costs continue to increase. Unlike public hospitals, private hospitals do not receive operational funding from the Federal Government. Private hospitals are funded from a mixture of benefits paid by health insurance providers and charges levied on services provided. Clearly a hospital that is not fully utilising an already low number of acute beds is limited in its ability to impose service charges, similarly its ability to attract benefit payments from health insurers is also restricted.

Should either the Federal Government or the State Government step into rescue Warley Hospital? Both the new incoming Rudd Government, through Health Minister, Nicola Roxon and the Victorian State Premier John Brumby appear to be distancing themselves from Warley Hospital. Perhaps they are viewing the long history of additional support funding and saying its time to draw a line in the sand!

Obviously the Phillip Island community would like to see all possible support for their hospital continued. Yet is a 45 minute drive on a good road, albeit the only road, to the next hospital that big an obstacle? Is it even necessary to have a full acute hospital service within the Port Phillip community? Could a smaller, satellite campus, serve the basic emergency needs of the community, before transfer to a regional hospital by ambulance? These are the sort of question that will be asked and need to be answered before the ongoing future of the facility can be assured. If it has a future.

A total of 80 people are employed by Warley Hospital, representing about four million dollars of salaries and wages being injected into the Port Phillip community. The hospital serves a permanent population of 8000. This swells to around 50,000 during the holiday periods and at the time of the Grand Prix. The reality is that a small acute hospital with restricted bed use is only going to be able to cope with minor emergencies; in the event of a major accident at the Grand Prix for example, emergency helicopter services would deliver patients to other larger providers.

It would be fair to suggest that in there rests the problem. Warley is private hospital based amongst a permanent population of only 8000, not all of whom have private health insurance. Despite the best intentions of the community and their desires for their own hospital, it is possible the community simply does not have the population base to sustain Warley. Furthermore the patient output figures would suggest, that within the current health environment, Warley Hospital is operating close to its capacity. If there is to be a future for Warley Hospital it would appear to be a future that requires increasing, ongoing, financial support. Should that be the case then the question becomes one of where will the money come from? Or maybe more importantly what value is Warley Hospital to either the Victorian State Government or the Australian Commonwealth?

Saturday, August 11, 2007

Aged care trends in Australia

According to projections made by the Australian Bureau of Statistics, half of the population of Australia will be 50 years old or more by the year 2051. In that time the population of Australia is expected to increase to between 25 and 33 million people, an increase of between 5 million and 13 million on current day population figures. Consider the projected population growth in these terms. It has taken almost 250 years for the population of Australia to reach 20 million yet over the next 40 years the population will grown by a possible 5-13 million. This is somewhere between a 25% and 65% growth in population in less than 20% of the time it took to reach the current figures.

The implications of this growth are staggering. The impact upon Australia's infrastructure will be enormous, especially when the projections are that 66% of the population will live in a capital city, with Sydney and Melbourne predicted to be the most populated cities. It is notable that Queensland is predicted to replace Victoria as Australia's second largest State during that time. Perhaps reflecting a move by both the young and the elderly to a warmer climate.

What are the implications for the health sector and for the aged care sector in particular with this growth in percentage of elderly? For a start elderly people require either residential services or they require services delivered to their homes. Currently around 33% of Australia's population is aged over 50 years. Over the next forty years this percentage will double. The need for residential services and community services will grow faster than in the past. Effectively the development of appropriate services will need to be put into place at a much faster rate. Potential developers of residential services will need to be looking a decade or two into the future and identifying now the need and available land for such services.

Government investment, for aged care, at all three levels of government will likely need to increase substantially. The increase in number of aged will create difficulties for Government when prioritising health funding. Governments will need to start identifying ways and means to encourage those that are not yet elderly to commence saving for the services they will require later in life. The family inheritance will go the way of the dodo for the average family as that capital base will be needed to pay for care. Those family members caring for an elderly parent in their own home should be eligible for carer funding support. It is much less expensive that having to provide Government funded residential or community support!

Technology will play an increasingly important role in aged care in the future. The generation of people requiring aged care services over the next forty years are computer literate, they are familiar will locating and identifying information related to their own health concerns and during that time it is likely systems will be developed that enable medical practitioners and patients to interact online in numerous different ways. Technology will also enable greater involvement in aged care by the extended family. Video conferencing technology via the internet will enable extended family members to maintain a watch on elderly parents from remote locations. Such technology will also enable the aged living in the community to communicate with their health providers and professionals. The ability to link the home refrigerator to the internet would be a boon for many elderly unable to undertake their own shopping. The baby boomers moving into elderly status will be familiar with and able to use online shopping, banking, bill payments, email, chat and so on. Governments need to invest funding into technology that will help the aged live more fulfilling lives at home and in the community rather than investing in support systems in the hospital.

Technology alone may drive many of the changes to how we deliver aged care services. Should the trend be towards more community living, aided by technology, then the role of those operating residential facilities will change dramatically; they will likely need to change from investing in infrastructure to investing in the delivery of services to a variety of locations. Those that already delivery community services will have a distinct advantage.

The increasing number of elderly people and the transient nature of young people, especially those within the workplace, means a premuim will be placed on those with experience and knowledge. Increasingly employers will understand the value of hiring and retaining mature workers, many of them will continue to work into their seventies. This group of people are in the workplace at present. They are learning to adapt to changing circumstances and they will continue to improve in their efforts to reinvent themselves. The emerging knowledge economy within Australia suggests also that many elderly will continue to work longer but may choose to work from home or from other remote locations. We will be less inclined to assume elderly means enforced retirement. It is feasible an increasing number of elderly will be partly retired while continuing to work from either home, or interestingly enough, from so-called retirement villages!

Interestingly the ABS forecasts predict the number of elderly aged 85 plus will increased during this period from around current levels of 350,000 to somewhere between 1.6 million and 2.7 million, to make up around 7% of Australia's population. These people will be those likely to require medical assistance, yet at the same time they will be fitter and healthier than their counterparts in 2007. The services they will require will change also. As with the elderly today they will continue to require meals to be provided - the growth in meals being delivered into the community will spiral. Those that provide meals into the community will need to provide 506X that currently being supplied. This will require improved facilities, greater nutritional advice and an increasing number of volunteer drivers. The tastes of the future elderly will be different, more cosmopolitan, they will demand variety and diversity of meals in line with their previous experiences as global travelers.

Kathryn Roberts, CEO of United States-based Ecumen when conducting research into future aged care needs in Minnasota wrote that the future represents an opportunity for Governments and providers to listen and to act and importantly, to work together to shape solutions that help the aged live where they want and how they want.

The implications for the retail sector, and its associated industries, such as advertising are enormous, and already these sectors are beginning to understand that their environment will be changing constantly over the next 40 years. There will still be a need for branded items, just less of a need, as the population ages. Older consumers use a different criteria when making purchasing decisions. In the past the aged have been patronised by almost every sector of the community - continue with those practices in the future at your own peril.

The acute care hospital sector will always be needed to provide medical assistance to the elderly, it is a fact of life that the elderly are more susceptible to illness than those much younger. Future governments need to streamline the funding of health so as to make the transition from aged care to acute care and back again seamless for the patient. This is difficult to achieve when different funding models apply to acute and the aged care sector ensuring each sector jealously guards its funding allocation by trying to transfer the patient and the cost to the other.

Sunday, March 18, 2007

No cost, no consequence

Consumers are often berated by all and sundry for not taking personal responsibility for their own health. The assumption being that were consumers to be more responsible then they would choose to remain healthier and thus require lower levels of primary care.

There is a thread of logic in the above argument. Afterall, why would someone choose to be unhealthy rather than healthy? A question that is difficult to answer. The reality is that the population globally make choices daily that are likely to lead to reduced healthiness. For example, many choose to smoke cigarettes, consume chemical cocktails of drugs or drink excessive amounts of alcohol. Others elect to involve themselves in sporting activities that often lead to ongoing health issues, others choose to drive motor vehicles in a dangerous manner or without the use of safety equipment. Is it possible they continue to make these choices due to their being no consequence? Some would argue that the potential for losing a limb or being institutionalised in itself should be sufficient consequence, but it often isn't. Again the reality is that even with instances of extreme disability, at least within the developed world, one can continue to live a life. Therein lies the possible answer to the issue of accountability. As individuals we often have little concept of the actual cost of healthcare.

We understand that should an event occur that results in some form of incapacity then our options will become limited, however do we fully understand the costs of the system and the processes that are then utilised to enable us to enjoy even a limited level of life? More to the point, are we, as consumers, able to make an informed decision with regards to our health care?

Public education campaigns have proven to be successful at reducing the level of illness caused by smoking and motor vehicle accidents. While we may appear as a population to be gamblers by choice, our reaction to such advertising campaigns indicate that when presented with the right information we often can change our actions. It is possible that our lack of understanding of the true cost of poor health decisions lead us to believe the cost is low - maybe even to the point where we believe healthcare is effectively free! Could it be that a part of the strategy to help consumer take personal responsibility for their health lies with them having easy access to a greater level of information as to the real costs?