What is value-based
rural and remote healthcare?
The cost of delivering safe and high quality hospital care is growing as rural and remote populations age, levels of chronic disease increases and more people are hospitalised for conditions that could have been prevented.
The increasing cost of healthcare, which is growing at a rate faster than inflation, is placing a strain on government health budgets.
Governments are looking for a stronger focus on health services that deliver improved health outcomes for the amount of money that they spend so that they can continue to deliver services that the community expects, regardless of where you live in the country. So are rural and remote people!
Over the last 20 years, governments have given priority to addressing the geographic maldistribution of the rural and remote workforce in Australia.
These programs have largely failed to increase the number of doctors and health workers in rural and remote areas. Recent changes to more strongly support rural based health and medical education are unlikely to deliver workforce improvements for another 20 years.
A new model of care is needed for rural and remote communities.
Our traditional fee for service approach to Medicare and hospital funding rewards increases in the number of rural and remote people being admitted to hospital regardless of cost, rather than improvements in health outcomes.
A value-based approach to healthcare delivers funding to patients based on health needs. It focusses holistically on the patient enabling GP-led primary care teams to deliver the right interventions, and rewards care based on improvements in outcomes.
Value-based care enables health professionals to support patients to improve health, not just treat patients when they become chronically unwell. GP-led teams would be able to prescribe weight loss programs, exercise classes, quit smoking and other interventions to reduce the burden of disease. This will lead to reduced hospitalisation for preventable conditions lowering the cost of healthcare in the longer term and delivering better outcomes.
Value-based care enables a shift in our focus away from hospital-centric and disease-centric care to patient-centric care, ensuring that health expenditure goes to the interventions that generate the greatest returns at the lowest cost.
Why is value based care better for rural and remote communities?
Rural and remote residents have multiple social determinants of health that contribute to higher rates of chronic disease, earlier death and higher levels of avoidable hospitalisation. The rate of mortality and morbidity, and the consequent cost to government, will only increase if we don't shift our focus to improving patient health outcomes through coordinated team-based primary care.
Rural and remote residents are more likely to be unemployed, have lower educational attainment, crowded housing and live in locations in the bottom socioeconomic quintiles compared to cities leading to higher rates of chronic disease and poor health.
Rural and remote residents are older compared to people living in major cities which increases the need for primary, acute and emergency care and the rate of chronic disease.
Aboriginal and Torres Strait Islanders make up a substantial part of the population of rural and remote communities which contributes to higher rates of mortality, chronic disease and demand for medical care.
People with disabilities are more likely to live in rural and remote areas because it is cheaper, but have higher needs for health and medical care that is often not available due to a shortage of health and medical professionals.
The burden of disease in rural and remote communities is 1.4 times higher than major cities which requires higher numbers of doctors and health workers to ensure population health.
Rural and remote people are more likely to engage in unhealthy behaviours such as smoking, which reflects levels of poverty and educational attainment.
Rural and remote people have access to significantly fewer doctors, nurses and health professionals per person despite having significantly higher need for health and medical care.
How can we deliver value in rural and remote healthcare?
RARMS Quadruple aim for healthcare
The healthcare system uses the “Triple Aim” to drive value in healthcare incorporating the following objectives:
Improving the patient experience of care (including quality and satisfaction);
Improving the health of populations; and
Reducing the per capita cost of health care.
RARMS does not believe this model properly account for the role that primary and hospital care systems in supporting local jobs, economic activity and social cohesion in rural and remote communities, or the whole-of-goverment savings generated by rural and remote healthcare.
RARMS has adopted a Quadruple Aim for Healthcare which acknowledges the social, economic, environmental and health role played by health and hospital systems in rural and remote communities, and the beneficial impact of local employment, income and services have on rural and remote communities that support good health.