Ten Takeaways: How to future-proof our health system

By Croakey editor Jennifer Doggett

This report is published in collaboration with cohealth as part of their Health Equity Champion membership of the Croakey Health Media funding consortium

During the past three years of the global pandemic, long-term planning for our health system has taken a back seat to short-term crisis management. But it’s time to start focussing on the changes that are needed to ensure our health system is equipped to meet the challenges of the future.

Below are ten suggestions to future-proof our health system, drawing on the expertise of three senior cohealth leaders: Dr Richard di Natale, cohealth public health adviser, GP and former leader of the Australian Greens; Research Chair, Professor Virginia Lewis, and Dr Kim Webber, Executive Lead – Strategy, Impact and Development.

1. Reform pain now for future gain

Experts agree that Medicare needs structural reform.  But as many Health Ministers have found previously, this is both practically and politically very challenging.

If the current Government’s reform agenda fails, the structural deficits within Medicare are likely to worsen as the burden of disease continues to tip towards chronic and complex conditions.

Accepting the pain of reform now, will give Medicare a fighting chance of meeting our healthcare needs in the future.

2. Address geographic inequities

Dr Kim Webber describes the current Medicare system as one where health financing is driven by the needs of the health workforce rather than those of patients.  Addressing geographic and other inequities will require a fundamental re-think of how Medicare funds services but it’s necessary to reverse the impact of the “inverse care law”.

“We need to put the dollars where the patients are – not where clinicians are,” Webber says.

3. Get better at measuring outcomes

Moving Medicare from an activity-based funding mechanism towards one that incentivises outcomes, patient experience, prevention and health promotion is vital to address the growing burden of chronic disease.

But this will require more sophisticated ways of measuring and incentivising quality care.  Without these, Lewis warns that new funding incentives could lead to cherry-picking by private GPs and leave public providers to pick up less lucrative patients.

4. Break down professional silos

As our healthcare needs change, so should our health workforce. Dr Kim Webber proposes a new approach to health and medical education focussing on core minimum level competencies across disciplines to break down current silos.

This would require a new credentialling and regulatory framework but would give our future health workforce more flexibility to meet evolving community needs.

5. Harness the power of peer workers

cohealth has recently moved towards making peer navigators a key role in primary healthcare teams, a strategy Webber says can overcome fragmentation between providers, services and jurisdictions.

“Peer navigators speak the language of both consumers and providers – they are the key people to join up the system. We can learn from Aboriginal Health Workers who are ten years ahead of the rest of the rest of the health system,” she says.

6. Keep people at the centre

New technologies offer opportunities but can also present ethical challenges and widen existing health inequities.

Lewis suggests learning from our experience with e-health during the COVID-19 pandemic to ensure patient experience is central to the introduction of new technologies.

“We need to make sure we preserve the human element of health care while implementing mobile health and e-health,” she says.

7. Prepare now for new technologies

Dr Richard Di Natale sees a technology-driven shift in the clinician-led model of healthcare on the horizon. He highlights the need to improve our regulatory processes to maximise the potential benefits of these new technologies while minimising their risks.

“Our current framework for evaluating medicines and technologies is not built for the emerging individual health care technologies – we need to move quickly before get away from us,” he says.

8. Broadening the health agenda

Mitigating the catastrophic impacts of climate disruption will require a whole-of-system approach.

According to Dr Di Natale, this includes broadening the focus of health policies and programs to include the environmental and other determinants of health.

“We need to see the home and urban environment as part of health infrastructure. Currently the design of our houses and cities is determined more by developers than human health,” Di Natale says.

9. Addressing climate inequity

Like many other determinants of health, climate change will have a disproportionate impact on the most disadvantaged in our community.

To reduce the inequitable impact of climate disruption, Dr Kim Webber suggests a need for more public messaging on how to reduce the health impacts of heat. She also warns that health services should be prepared for increasing numbers of climate refugees with high healthcare needs.

10. Start sharing the power

The changing role of patients and the community in the health system will require new strategies for engagement between providers and consumers.

“Our current approaches lack subtlety and are not always effective but hopefully in 30 years we will have worked out how to share power and have a more sophisticated approach to co-design,” says Professor Virginia Lewis.

Click here to read It’s 2050. How is our health system holding up? on Croakey.

Click here to read Caring for our future, we face stark challenges and choices in health policy on Croakey.

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