Coronavirus has boosted telehealth care in mental health, so let’s keep it up


Agenturfotografin/Shutterstock

Ian Hickie, University of Sydney and Stephen Duckett, Grattan Institute

Australia’s health system has embraced telehealth during the coronavirus pandemic, with patients getting care online, by video or by phone. But what happens to this post-pandemic is uncertain.

Unfortunately, the pandemic’s spatial isolation converted quickly into social isolation, and this created stress and anxiety for many. All of this means that after the pandemic, there will be a surge in demand for mental health services.




Read more:
How to manage your blood pressure in isolation


This extra demand will put still more pressure on an already overloaded mental health system.

Digital help is on hand

It’s crucial that public and private mental health services adopt new technologies now to help meet this future demand.

Compelled by the massive health services dislocation accompanying the COVID-19 pandemic, Medicare this year finally moved to support for the most basic form of telehealth, supporting both telephone and video consultations.

That’s 144 years since Alexander Graham Bell produced the first working telephone in 1876. Let’s hope it doesn’t take quite as long for our general health care system, and particularly our mental health system, to incorporate the power of 21st-century digital technologies.




Read more:
Want to Skype your GP to avoid exposure to the coronavirus? Here’s what you need to know about the new telehealth option


Australians are fortunate to have already benefited from many innovations in digital mental health care, such as moodgym, eHeadspace and Project Synergy, all offering online support to people in need.

This has been led by partnerships between major universities, non-government organisations and industry.

ReachOut was the world’s first online service when it launched in Australia in 1996 to reduce youth suicide.

Slow uptake of telehealth services

But telehealth systems have not been widely deployed or accessed. Of the 2.4 million visits to psychiatrists in 2018-19, only 66,000 involved telehealth.

Clearly too many Australians who seek mental health care do not gain the potential benefits of what’s available in telehealth innovation.

This failure is not unique to Australia. Pre-COVID-19, the World Economic Forum highlighted the massive gap in mental health service provision between developed and developing countries. It’s calling for rapid deployment of smarter, digitally enhanced health services.

The World Health Organization and every other major health body is warning of the urgent need to expand mental health services in response to the economic and social dislocation caused by the pandemic.

The cruel lesson of past economic recessions is that for people hit hardest, mental health deteriorates rapidly. Without a swift and targeted response, suicide attempts and death by suicide will increase.

A boost to the system

To prevent this in Australia, we need widespread social and welfare investments and a better mental health system.

Pre-COVID-19, the Productivity Commission in its draft report on Australian mental health care highlighted a lack of sustained investment (relative to the social and economic costs of poor mental health), poor coordination and a fundamental lack of responsiveness to the needs of those most affected.

It also called for more prevention and early intervention measures, particularly for children and young adults.

Australia has two separate mental health systems. State-based systems are highly focused on emergency departments and acute and compulsory care. These benefit principally the smaller number of people with very severe and persisting illnesses.

Private hospitals provide additional hospital beds to people with private health insurance, but also support day programs that cost a lot but provide limited value.

The upshot is that Australia has a missing middle – big service gaps for the people most in need of care.

We need more specialised but outpatient care and multidisciplinary care for those in need. That means GPs, psychiatrists, psychologists, nurses and other skilled health workers, working in coordinated team structures. These services are desperately needed in outer urban, regional and rural communities.

A digital future, now!

A digitally enhanced, 21st century-style mental health service may be the answer.

Smart digital systems, such as smartphone apps and other technologies, can help to assess quickly the level of need and direct people to the best available clinics.

They can help our highly talented mental health professionals provide better care. They also bring the world of other tools, peer support and enhanced social connections to the client, no matter where they are located.

Access to online forms of cognitive-behavioural therapy, such as those offered by Mindspot, THIS WAY UP and other evidence-based psychological interventions can be delivered to meet demand.

These innovations can bring real expertise to the lounge room of those in rural and regional areas who typically live most distant from quality face-to-face care.

In one of our research trials, a child and adolescent psychiatrist operating in Bogota, Colombia, was able to provide same-day specialised assessments to young people in Broken Hill, New South Wales.

Mental health services in Australia have already been radically transformed during the pandemic. Video-style consultations are now central to the work of mental health professionals.

Psychologists and psychiatrists all around the country are reaching out to their clients online. Many clients find it much more convenient and far less costly than attending regular clinics.

Time to act

The digital future is not just about making small changes. A digitally enhanced future for mental health involves a fundamental rethinking of models of care.




Read more:
What can you use a telehealth consult for and when should you physically visit your GP?


Online or helpline-supported screening tools should be used to guide people along the best, evidence-based treatment path for them.

Primary health networks – the regional health authorities funded by the commonwealth to coordinate primary care – should ensure the services they commission are using digital technology appropriately and tracking the provision of care.

These new forms of digitally enabled care will make the whole mental health system more efficient, freeing up resources to help the backlog of Australians who need more intensive clinical care.

Australia’s governments must seize the opportunity that COVID-19 has created. Digital systems must now be viewed as essential health infrastructure, so that the most disadvantaged Australians move to the front of the queue.The Conversation

Ian Hickie, Professor of Psychiatry, University of Sydney and Stephen Duckett, Director, Health Program, Grattan Institute

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Even in a pandemic, continue with routine health care and don’t ignore a medical emergency



Shutterstock

Serra Ivynian, University of Technology Sydney; Caleb Ferguson, Western Sydney University, and Michelle DiGiacomo, University of Technology Sydney

As we continue to navigate the coronavirus pandemic, many hospitals and health services are actually less busy than usual.

Fewer patients are presenting to emergency departments and primary care services in Australia and around the world.

They might be choosing to stay away for fear of catching coronavirus, or because they don’t want to put pressure on the health system at this time, or both.

But particularly if you’re someone with a chronic health condition, it’s essential you continue to seek medical care routinely, and especially in an emergency.

Delaying or avoiding necessary medical care could lead to preventable deaths.




Read more:
How we’ll avoid Australia’s hospitals being crippled by coronavirus


Anxiety and fear

Delaying or avoiding medical care despite health problems is not a new concept. People often downplay the severity of their symptoms, believe they will resolve on their own or perceive they can manage themselves at home.

This reasoning is now compounded by fear of becoming infected with COVID-19 as well as overburdening the health-care system.

Hospitals remain well-equipped to care, particularly for time-critical events like heart attack and stroke. So in an emergency, don’t delay.
Shutterstock

Some people living with chronic conditions such as heart failure, lung or kidney disease may be more concerned about contracting COVID-19. This is justified. People with chronic conditions tend to get sicker than the overall population if they catch coronavirus, and are more likely to die.

Concerns about overburdening the health-care system, which people already perceive to be stretched, has been a common reason for delayed care-seeking, even before the current pandemic.

But constant reports of overflowing hospitals and scarce resources during the coronavirus crisis may serve to validate this concern for people who are considering whether or not to seek medical care.




Read more:
Why are older people more at risk of coronavirus?


While it’s too early to have definitive statistics, Australian estimates suggest attendance at hospitals and general practices could be down by as much as 50%.

Why it’s important to continue to seek care

People with chronic health conditions may need to seek medical care for a range of reasons. This could be routine care for a chronic disease such as chronic obstructive pulmonary disease (COPD), asthma, diabetes, cancer, bowel or heart disease.

They may need to seek unscheduled care if their condition flares up. For example, for a person with chronic heart failure, it would be important for them to seek timely health care if they were experiencing symptoms such as breathlessness, fatigue, or peripheral oedema (the accumulation of fluid causing swelling, usually in the lower limbs).




Read more:
How to recognise a stroke and what you should know about their treatment


Importantly, if people delay seeking care for chronic illnesses, we may see an increase in preventable deaths.

For example, for people with heart disease, untreated symptoms could lead to long-term heart damage, need for intensive care, and death.

It’s also possible if a large number of people avoid seeking treatment now, hospitals will find themselves overwhelmed when the pandemic is over.

You can go out for medical care

While the global public health messaging urges people to stay home to save lives, it’s important to understand one of the key exemptions is medical treatment. And this doesn’t apply only to people with COVID-19 symptoms.

Regular GP or specialist appointments

People with chronic conditions may already be receiving advice from their health professionals about how regular appointments will be conducted.

To minimise risks to staff and patients, many health services are offering telehealth appointments (via phone or video conference). It’s best to contact your GP or specialist by phone prior to your appointment to see whether this service is available and appropriate.




Read more:
What can you use a telehealth consult for and when should you physically visit your GP?


There will be times when a telephone or video-conference is not suitable, such as when your doctor needs to perform a physical examination, administer therapies including medications, or you need tests such as blood tests or x-rays.

If you do need to attend a clinic or hospital in person, you should be assured they’re taking additional precautions to prevent the spread of infection during this time.

If symptoms flare up or in an emergency

If your symptoms get worse, you should still contact your GP or specialist if this is your normal course. This is important even if you don’t think your symptoms are urgent.

And it remains critical that in life-threatening circumstances – like if you believe you’re having a heart attack or stroke – you seek medical attention immediately by calling triple zero (000).

These are medical emergencies and our hospitals are well-equipped to respond, even during COVID-19.

Hospitals have extra procedures in place to minimise the risk of coronavirus spread.
Shutterstock

Some practical tips

The Heart Foundation offer the following advice for people living with chronic conditions during COVID-19:

  • keep looking after your health and stay connected with your doctor

  • get your annual flu vaccination

  • practise physical distancing and good hand hygiene

  • stay active and eat a healthy diet.

And most importantly: don’t ignore a medical emergency.




Read more:
For older people and those with chronic health conditions, staying active at home is extra important – here’s how


The Conversation


Serra Ivynian, Research Fellow, Faculty of Health, University of Technology Sydney, University of Technology Sydney; Caleb Ferguson, Senior Research Fellow, Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District &, Western Sydney University, and Michelle DiGiacomo, Associate Professor, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Can I still go to the dentist? How coronavirus is changing the way we look after our teeth



Shutterstock

Alexander Holden, University of Sydney; Heiko Spallek, University of Sydney, and Ramon Zenel Shaban, University of Sydney

The coronavirus pandemic is changing the way we access health care, and dental care is no exception.

Dentists are no longer allowed to provide a raft of care, such as regular check-ups and tooth whitening, to minimise the spread of COVID-19. However, if you’re in a lot of pain, your dentist will be able to treat you.

Here’s how the coronavirus is changing the way we look after our teeth.




Read more:
How often should I get my teeth cleaned?


Why are these restrictions in place?

When dentists work on your teeth, they can produce aerosols – droplets or sprays of saliva or blood – in the air.

This happens routinely when your dentist uses a drill or when scaling and polishing, for instance.

And dentists are used to following stringent infection control precautions under normal circumstances to lower the risk of transmission of infectious diseases, whether they are respiratory diseases or blood-borne.

These precautions help keep both patients and dentists safe because it assumes all patients may have an infection, despite the reality that most won’t.

But with the coronavirus pandemic, there is an increased risk of aerosols carrying the virus either directly infecting dental staff, or landing on surfaces, which staff or the next patient can touch.

This transmission may be possible even if you feel perfectly well, as not everyone with the virus has symptoms.

Who’s making these recommendations?

The Australian Health Protection Principal Committee – the key decision-making committee for health emergencies – has recently recommended dentists only provide treatments that do not generate aerosols, or where generating aerosols is limited. And all routine examinations and treatments should be postponed.

This is based on level three restrictions, according to guidance from the Australian Dental Association.

Recommendations of what is and isn’t allowed may change over time.

What does it mean for me? Can I still get a filling?

What’s not allowed?

Non-essential dental care is now postponed. This includes routine check-ups and treatment where there is no pain, bleeding or swelling. So treatments such as whitening and most fillings will have to wait.

Other conditions or treatments that will need to be postponed include:

  • tooth extractions (without accompanied pain or swelling)

  • broken or chipped teeth

  • bleeding or sore gums

  • halitosis (bad breath)

  • loose teeth (that aren’t a choking hazard)

  • concerns about dentures

  • crowns and bridges

  • clicking/grating jaw joint

  • scale and polish

What is allowed?

Some patients will need urgent care for acute problems requiring treatments that produce aerosols. So such procedures have a risk of spreading COVID-19.

Permitted treatments are limited to:

  • tooth extractions or root canal treatment when someone is in acute pain caused by damage to, or death of the nerve in the tooth

  • where upper front teeth are significantly damaged, for example, in an accident (this is an instance where a filling could be provided)

  • management of ulcers or other problems with the lining of the gums and mouth

  • providing care for patients with complex medical conditions and where not treating may lead to worsening of their general health

  • managing patients who have dental problems linked to social or cultural factors and that will develop quickly if professional care is not given

  • where a patient is referred by a doctor for care that is medically necessary.

Can I still go to my regular dentist?

Many dental practices are only open to manage dental problems causing pain, that are urgent or are an emergency.

So check with your usual dentist to see what services they can provide. And be prepared for prearranged treatments to be cancelled.

What if I have COVID-19 or may have it?

If you need urgent dental care and think you may have COVID-19, it’s important to call your dentist to discuss your particular situation.

You may be able to be treated at your usual surgery, where infection control precautions will be stepped up.

But if you have a dental emergency and have been diagnosed with COVID-19, you will be referred to a hospital with appropriate facilities.

What can I do in the meantime?

COVID-19 is going to be with us for many months. So it’s important to look after your oral health by maintaining a healthy diet and oral hygiene routine.




Read more:
How to (gently) get your child to brush their teeth


The Conversation


Alexander Holden, Senior Lecturer in Dental Ethics, Law and Professionalism, University of Sydney; Heiko Spallek, Professor, Head of School and Dean, Sydney Dental School, University of Sydney, and Ramon Zenel Shaban, Clinical Chair and Professor of Infection Prevention and Disease Control at the University of Sydney, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Why coronavirus may forever change the way we care within families



AAP/Maria Zsoldos

Leah Ruppanner, University of Melbourne; Brendan Churchill, University of Melbourne, and William Scarborough, University of North Texas

The global spread of COVID-19 has illuminated the “care crisis” that has been building for decades.

Women, through their unpaid housework, childcare and elder care, have kept families functioning. However, COVID-19 is putting a strain on women’s abilities to keep the cogs of daily life turning. We are now starting to see the impact of what happens when women are unable to do it all.

What is the care crisis?

For decades, scholars have warned that the bulk of the unpaid domestic work carried by women is unsustainable. The ageing of populations across Western nations will add to the burden even more as women care for elderly parents, spouses, friends and family. This will in turn significantly reduce the employment pool and add strain on those providing the care.




Read more:
No, pregnant women aren’t primed to ‘nest’. It’s a myth that sets women up for a lifetime of housework


Mothers do almost twice as much housework as fathers, even when they are earning most of the family income. Greater time in housework is at the expense of their time in employment, leisure and sleep.

Without free childcare or flexible work, families are patching together a tenuous web of caregivers and family members to smooth before- and after-school transitions and to tend to sick children. COVID-19 exposes our care system as being held together by a thread, based on the unpaid and perpetual labour of women.

For decades, researchers have shown women are stressed, pressed and emotionally unwell from the constant struggle to manage these competing demands. The data are clear – women’s larger share of the care is making them sick.

Once COVID-19 started to spread, the world changed dramatically. Now, the invisible unpaid work started to become visible. And someone has to do it.

Worried about childcare? What our searches can teach us

To better understand how childcare during coronavirus is worrying Australian parents, we draw data from Google searches over the past 30 days from the United States and Australia. The US is further along in the coronavirus journey, so can offer some insights into how worry about the virus changes over time.

At first, Americans were more concerned about the economy. But as schools, workplaces and non-essential services start to shut down, the threat of the care crisis has emerged – the concentration of Google searches for coronavirus that include “daycare” and “elderly” intensifies. The work is coming home. Who is now going to do it?



Author provided/The Conversation, CC BY-ND

Australia is now preparing more aggressive social-isolation measures to slow the spread of COVID-19, with school and non-essential service closures reported only this week and only in some states.

However, Australia, too, has been slow to respond and the federal government has resisted school closures in part because 30% of healthcare workers in Australia are women. What will happen to this group of workers if they have to look after their children and those affected by COVID-19?

Do all states exhibit the same worry?

Across the US, trends in search terms vary dramatically across states. In the past week, searches in most states have been concentrated on how coronavirus will impact the economy.

But something interesting is happening to the states in the middle of the country – Nebraska, Kansas, Iowa and Minnesota. In these states, searches for daycare and coronavirus are more common than searches related to coronavirus and the economy, grocery stores and the elderly.



Author provided/The Conversation, CC BY-ND

Our research shows mothers in these states have access to better childcare resources – more affordable childcare, longer school days and more expansive after-school care. A forthcoming book, Motherlands, shows mothers in these states are more likely to work full-time, including right before and right after childbirth. These states are exemplars, offering parents the best childcare resources.




Read more:
Sharing the parenting duties could be key to marital bliss: study


But what happens for families in these states when everything shuts down?

When we dig a little deeper, we see searches for daycare centres being open during coronavirus soared by 100%. Questions about whether those centres will charge fees even while closed increased by 400%. Nebraskans are also worried about their financial futures, but theirs are more tightly linked to daycare.



Author provided/The Conversation, CC BY-ND

Over the past week, Australians are increasing their searches of daycare, with some regional variation. People in Australian Capital Territory, New South Wales and Victoria are most likely to ask Google about daycare. Families in these states average 31 hours of weekly childcare, or equivalent to another full-time job – time that families will have to fill.

What is the future of care?

COVID-19 will be devastating in its effect on our health, families and economy. But, as we face this new brave world together, it is important to understand the role of caregiving and the importance of carers in this crisis.

To date, women have done this work freely for families. But now the burden is too big and we need to see this work for what it is – important, essential and of great economic value. Individuals can use this as an opportunity to try something new, but also take stock of what we value as a society.

It is an opportunity to realise that the unpaid labour of grandparents and women is not enough – we need real solutions for a problem that, until now, has remained invisible.The Conversation

Leah Ruppanner, Associate Professor in Sociology and Co-Director of The Policy Lab, University of Melbourne; Brendan Churchill, Research Fellow in Sociology, University of Melbourne, and William Scarborough, , University of North Texas

This article is republished from The Conversation under a Creative Commons license. Read the original article.

How to care for and recover personal items after bushfire



The burnt out remains of a house in the Southern Highlands town of Wingello. There are three main factors to consider when thinking about the impact of bushfires on your personal treasures – smoke, heat, and water.
Mick Tsikas/AAP

Vanessa Kowalski, University of Melbourne

The devastation wrought by the Australian bushfires has been immense and, as the fires continue to burn, the final loss won’t be known for many months. While the impact on the environment, human and animal life is overwhelming, for many individuals the loss of personal items such as photographs, documents, artwork and personal treasures is significant.

Heirlooms and artworks are often cherished for the people, events and experiences they represent rather than their monetary value or cultural importance. They can be integral to understanding our personal history, culture and identity.

While damage to them can be heartbreaking, even a badly damaged family treasure may hold immeasurable personal significance.

For those threatened by bushfire, planning for the preservation of your treasured items can start now. Planning resources are available online. For those who have been affected by fire damage, you may still be able to salvage items.

There are three main factors to consider when thinking about the impact of bushfires on your personal treasures – smoke, heat, and water.

The most obvious damage from smoke is soiling.
Shutterstock

The most obvious damage from smoke is soiling. Soot, ash and other particulate matter are usually dark and greasy. When deposited on the surface of an object, colour and detail are obscured. Damage from high heat exposure can result in blistering, melting, warping, charring and partial or complete loss.

If water has been used to put out the fire, water related damage can be an issue. Water can cause shrinkage, distortion, discolouration, mould and partial or complete loss of original material.

The possible damage to your items will depend on the material types. Here are some tips for handling them.

Paintings

Paintings can be affected by all three factors.

• If an artwork is framed, it is recommended that you leave the frame in place. Exposure to high heat can soften the paint layer, which may cause it to stick to the frame. A specialist should remove the work from the frame.

• The particulate nature of smoke means that it can cause abrasion as the soot is wiped away. Get advice before undertaking any cleaning. Do not use water.

• Assess the surface for loose material (lifting paint, blistering). Take care when handling to ensure no loss of fragile material. Retain any loose elements in a Ziplock bag. These can be reattached later.

Paper documents, prints and photographs

Though potentially affected by all three factors, water damage can be the most severe for these items, with the risk of mould.

• Allow wet items to slowly air dry, indoors if possible. Increase indoor airflow with fans, open windows, air conditioners, and dehumidifiers. Do not use hair dryers, ovens, irons.

• Photo albums can stick together. Do not try to open them. Ask a conservator for advice.

• Dry paper documents and photos can be cleaned of soot with a vacuum and dry sponge.

Dry photos can be cleaned of soot with a vacuum and dry sponge.
shutterstock

Textiles (i.e. sporting memorabilia)

Textiles can be affected by all three factors.

• Handle with care, as they may be fragile.

• Low powered vacuum removal of soot may be possible if fabric is not weak (shedding).

Glass, metal and ceramic objects

These items can be affected by high temperatures and smoke. Heat can distort shape (melting) or alter surface finishes (i.e. glaze on pottery). Such damage is usually irreversible. Smoke damage can leave a darkened layer of soot on the surface.

• Care is need when removing soot to ensure abrasion of the surface doesn’t occur.

• Heat can make these objects brittle. Care is needed when handling.

• Use gloves when handling. Skin oils can damage the surface.

What else can you do

You may not be able to save everything, so focus on prioritising what is most important to you. Personal safety is the highest priority when entering damaged buildings. Wear protective clothing, footwear, goggles, gloves and masks to protect from hazardous material and possible mould spores.

Items may be more fragile than they look, so consider using something rigid to support them when lifting and transporting such as a piece of tray, pieces of cardboard, box, a plastic container or lid.

Retain any items that are recognisable, it may be possible to restore them.

The national conservation body, the Australian Institute for the Conservation of Cultural Materials, provides a number of useful fire recovery resources.

Details for accredited conservators can also be found through the AICCM website. A conservator will be able to provide advice on how to best approach the recovery and ongoing preservation of your heirlooms and artworks.The Conversation

Vanessa Kowalski, Painting Conservator, Grimwade Conservation Services, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Pregnant women should take extra care to minimise their exposure to bushfire smoke



Pregnant women should try to stay inside when the air pollution is high.
From shutterstock.com

Sarah Robertson, University of Adelaide and Louise Hull, University of Adelaide

Smoke haze from Australia’s catastrophic bushfires is continuing to affect many parts of the country.

Although there’s no safe level of air pollution, the health hazards tend to be greatest for vulnerable groups. Alongside people with pre-existing conditions, smoke exposure presents unique risks for pregnant women.

Research shows prolonged exposure to bushfire smoke increases the risk of pregnancy complications including high blood pressure, gestational diabetes, low birth weight and premature birth (before 37 weeks).

These conditions can have short-term and lifelong effects on a baby’s health, with increased risk of conditions including cerebral palsy and visual or hearing impairment. Even babies born only a few weeks early can experience learning difficulties and behavioural problems, and have an elevated risk of heart disease in later life.

So it’s especially important pregnant women protect themselves from exposure to bushfire smoke.




Read more:
How does poor air quality from bushfire smoke affect our health?


Why are pregnant women at higher risk?

Pregnant women breathe at an increased rate, and their hearts need to work harder than those of non-pregnant people to transport oxygen to the fetus. This makes them particularly vulnerable to the effects of air pollution, including bushfire smoke.

We often measure poor air quality by the presence of ultra-fine particles called PM2.5 (small particles of less than 2.5 micrometres in size). These particles are concerning because they can penetrate into our lungs, and into blood and tissue to cause inflammation throughout the body.

Importantly in pregnant women, environmental pollutants can cause inflammatory damage to the placenta’s blood supply. This can interfere with the placenta’s development and function, which can in turn compromise the growth of the fetus.

What the evidence says

Many studies have linked poor air quality, particularly high PM2.5 levels, to poor pregnancy outcomes. Data from 183 countries showed in 2010, an estimated 2.7 million premature births, 18% of the total, were associated with PM2.5 pollution.

A 2019 study of more than 500,000 pregnant women from Colorado looked at the effect of bushfire smoke on pregnancy outcomes. The authors analysed data on air quality, fire incidence and pregnancy and birth records from 2007-2015, during which time Colorado was regularly affected by smoke from fires burning in California and the Pacific Northwest.

The study found PM2.5 due to bushfire smoke was linked to spikes in premature birth, especially in women exposed during the second trimester.

In women exposed to smoke during the first trimester, birth weight was lower than average. Further, exposure during any trimester increased the chance of gestational diabetes and high blood pressure.

The effects were detectable even with low exposure to smoke and small increases in PM2.5. For every 1 microgram/m³ increase in average daily exposure to PM2.5 during the second trimester of pregnancy, the risk of premature birth increased by 13%.

To put this into context, in Canberra in the first week of January, PM2.5 levels averaged more than 200 micrograms/m³, compared with the typical background concentration of 5 micrograms/m³. EPA Victoria classifies PM2.5 levels above 25 micrograms/m³ as unsafe for vulnerable people.




Read more:
Evacuating with a baby? Here’s what to put in your emergency kit


In another large study, a 24% increase in premature birth was seen after 10 micrograms/m³ increase in PM2.5.

As well as PM2.5, bushfire smoke contains larger PM10 particles, nitric oxides, carbon monoxide and other gases and toxic chemicals. These all have potential to impair lung and heart function in the mother, activate inflammation, and directly affect fetal and placental development.

Smoke threatens fertility, too

Air quality is also a factor for couples attempting to conceive or dealing with infertility.

Population studies suggest air pollution compromises human fertility by reducing ovarian reserve (the number of eggs in the ovary) and affecting sperm number and movement.

Direct exposure to fire, burns and fire retardant chemicals can also negatively impact fertility.




Read more:
How to monitor the bushfires raging across Australia


Precautions to take if you’re pregnant

The best strategy is to reduce smoke exposure as much as possible. Recommendations from NSW Health include staying inside on high-risk days, sealing the house to prevent smoke infiltration and using air conditioning to keep cool.

Avoid creating smoke by cigarette smoking, burning candles, or frying and grilling. Use PM2 (N95) masks and air-filtering devices if possible, and avoid exposure to ash, which contains particulate material you can inhale.

Studies have shown when women are exposed to bushfire smoke during pregnancy, the rates of premature birth increase.
From shutterstock.com

Pregnant women in a fire region should carefully follow emergency services’ direction. It’s better to evacuate early, with an emergency supply kit containing clothes, medications, water and food you don’t need to cook.

Make sure your medication and prenatal vitamins are accessible, continue to take them, and stay well hydrated. Inform authorities and shelters you are pregnant and need to maintain your antenatal care.

Be aware of the signs of premature labour including abdominal cramps or contractions, a heavy vaginal discharge, loss of fluid or vaginal bleeding, pelvic pressure and low backache. Seek help if you think you may be going into labour.

Given what we know about the consequences of poor air quality on pregnancy outcomes, it’s critical pregnant women are given top priority when it comes to bushfire relief and health care support.




Read more:
From face masks to air purifiers: what actually works to protect us from bushfire smoke?


The Conversation


Sarah Robertson, Professor and Director, Robinson Research Institute, University of Adelaide and Louise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The world has a hard time trusting China. But does it really care?



Wes Mountain/The Conversation, CC BY-ND

Graeme Smith, Australian National University

As China grows more powerful and influential, our New Superpower series looks at what this means for the world – how China maintains its power, how it wields its power and how its power might be threatened. Read the rest of the series here.


One of the earliest guests I had on The Little Red Podcast, the podcast I co-host with former China correspondent Louisa Lim, said something that stuck with me about the view of China in the rest of the world. John Fitzgerald, a well-known historian of China’s diaspora, confidently declared that the Chinese Communist Party (CCP) “couldn’t care less” about what non-Chinese Australians thought of it and its actions.

Looking through the results of the recent Lowy Institute Poll on Australians’ attitudes toward China, this is probably a good thing for the party.

The Australian public’s confidence in China’s ability to act as a responsible power has fallen off a cliff. In just one year, it dropped from more than half of Australians to just 32%. That’s a dire number.



That wasn’t the only surprise in the poll. Four-fifths of respondents agreed with the proposition “China’s infrastructure investment projects across Asia are part of China’s plans for regional domination”, and 73% believed Australia should try to prevent China from expanding its influence in the Pacific.

The poll was released in late June, at a time when China’s image was taking a hit internationally. Millions of people took to the streets in Hong Kong to protest a now-defeated extradition bill that could have seen Hong Kong residents sent to China on suspicion of crimes.

Then came news in Australia that the wife of an Australian writer who has been detained since January was herself interrogated by Chinese officials and blocked from leaving the country.

Even for a country that purportedly doesn’t care what the rest of the world thinks, trust is hard to come by these days.

A matter of trust

It’s not entirely clear why so many Australians now distrust the Chinese state to the point where they believe our government should actively counter it (although perhaps not go to war with it).

There’s little evidence to suggest that one issue alone has caused this sharp decline in trust. For instance, the Communist Party’s most egregious recent violation of human rights, the detention of up to 1.5 million Uyghurs simply for being, well, Uyghurs has touched relatively few Australians.

Nor has the Australian government felt the need to act – it has said little on the matter.




Read more:
Xi Jinping’s grip on power is absolute, but there are new threats to his ‘Chinese dream’


Rather, the decline in trust seems to be the result of an accumulation of negative news on China — some well-informed, some half-baked (such as the 60 Minutes expose on a Chinese “military base” in Vanuatu). And for some, it’s based on personal experiences.

Last month, for instance, Australian National University revealed a massive data breach in the school’s computer system, including tax file numbers, bank accounts and passport details. The sophistication of the attack, which came after multiple attempts, meant there was only possible one suspect, according to senior intelligence officials: China.

Stealing people’s bank details might be profitable for the hacking team, but it doesn’t win hearts and minds for the Chinese state. Actions like this do more to damage China’s image than the words of noted China critics Clive Hamilton and Clive Palmer.

This sort of intimidation has been on the rise under Xi’s leadership in recent years. Academics who are critical of China now expect to be targeted by the CCP.

A podcast like mine, banned in China, doesn’t help. In the wake of an episode about China’s real-time censorship of its own historical record, I was hit by a denial-of-service attack that our university’s IT service struggled to fix. I gave up doing research inside China a while ago, after it became clear that my former colleagues and friends in rural China were increasingly at risk.

Even colleagues who have signed petitions calling on the Australian government take an evidence-based approach to China policy have been warned off continuing their in-country research by their Chinese research partners, ending collaborations which often stretched back decades.

To the outside world, this obsession with control looks like weakness rather than strength. A sanitised image of life inside China will do nothing to build trust in China as a responsible power.

This is the image of China that Xi Jinping wants to export to the world: happy, prosperous and non-threatening.
How Hwee Young/EPA

Misplaced attempts at soft power

So how does China go about winning back a 20-point drop in trust?

To answer this question, I have to borrow a famous line from the film, The Princess Bride:

You keep using that word. I do not think it means what you think it means.

When it comes to the concept of soft power, the Chinese state misses the basic point that it doesn’t work particularly well. Money can’t buy you love, or in Joseph Nye’s terms, if your ideology and your culture have no appeal, cash won’t fix that.

Yet, the Communist Party is now a firm believer in soft power, built around its confidence that China’s ancient culture can return it to its legitimate status as the preeminent civilisation in the world. This confidence may be misplaced, as anyone who sat through the ponderous, state-backed, blockbuster film The Great Wall can testify.

To date, the target of China’s soft power push appears to be a largely Chinese audience. The purpose of its designated soft power tools, from Confucius Institutes to the English-language news service CGTN, is to impress on both the domestic constituency and Chinese communities abroad that China now looks and acts like a rejuvenated great power.




Read more:
Explainer: what are Confucius Institutes and do they teach Chinese propaganda?


This officially approved cultural soft power package might not sell to non-Chinese audiences in Australia or, well, anywhere. But China has recently been trying another tactic – economic soft power. This is specifically aimed at the developing world: China positions itself as a nation that overcame colonial oppression to emerge from grinding poverty and become an economic powerhouse.

Under former President Hu Jintao, the party tiptoed away from the notion that China would pursue a “peaceful rise”, because they worried the word “rise” sounded threatening, even preceded by “peaceful.”

Now, under Xi’s watch, there is a new catchphrase to describe China’s rise. Anchors on CGTN happily ask European and African interlocutors about the merits of “the China model” for economic development, in which the state acts as chess master, guiding the economy and society at every turn.

Some nations are buying into this. Last weekend, a taskforce of Solomon Islands MPs and bureaucrats presented their recommendation to parliament over whether to switch diplomatic recognition from Taiwan to China. While many Solomon Islanders, including Prime Minister Manasseh Sogavare, are reluctant to switch, the country’s close economic ties with China make such a move feel inevitable.

A Chinese development model that promises an escape from poverty has appeal across the Pacific – and beyond.

Trust on both sides of the wall

Whether Beijing is able to turn around this trust problem depends, in part, on how much China begins to trust itself in the rest of the world.

Forthcoming research my ANU colleagues and I are conducting with Hong Kong-based researchers examines attempts by Chinese state actors to influence the 2019 Australian federal election.




Read more:
With China’s swift rise as naval power, Australia needs to rethink how it defends itself


Preliminary results indicate that the Communist Party didn’t give a hoot which party won. The goal of Chinese propaganda during the election, rather, was to create a sense of distrust among Australian-Chinese communities by depicting Australia as a racist, unwelcoming place.

We should be mindful of attempts by elements of the Communist Party to influence our political processes. Yet it’s crucial to remember the CCP targets many groups in Australia, including private businesses run by former Chinese citizens, religious groups and student organisations, not because they are all loyal party stooges, but because the party does not trust them.

The challenge for China, if it wants to be trusted by the rest of the world, is how to move beyond Mao Zedong’s famous dictum:

Who are our enemies? Who are our friends? This is a question of the utmost importance for the revolution.

This thinking should have no place in a globalised world, but in CCP circles, it’s back in vogue.

The challenge for Australia’s leaders is to recognise China’s current political reality, but not be drawn into the same binary, simplistic thinking. There’s enough of that going around.The Conversation

Graeme Smith, Research Fellow, Department of Pacific Affairs, Coral Bell School of Asia Pacific Affairs, Australian National University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Cutting cancer costs is a worthy policy, but we need to try to prevent it too


Terry Slevin, Australian National University and Simone Pettigrew, Curtin University

Removing the financial worries from Australians diagnosed with cancer is bound to be a popular move.

The Opposition’s A$2.3 billion cancer care plan – announced in Bill Shorten’s budget reply speech on Thursday night – aims to ensure cancer treatment costs for scans, specialists and drugs are bulk billed or subsidised under the Pharmaceutical Benefits Scheme (PBS). It would be a hard heart indeed that did not welcome such a move.

Maybe even better than avoiding the out-of-pocket costs of treatment is preventing future cases of cancer. Around one-third of all cancers are preventable by not smoking, staying at a healthy weight, eating healthy food, being physically active, minimising alcohol consumption, and avoiding excessive sun exposure.

But apart from a small commitment to tobacco control in the 2019 budget, neither the government or opposition has made even the vaguest commitment to, or investment in, cancer prevention.




Read more:
Budget 2019 boosts aged care and mental health, and modernises Medicare: health experts respond


So far we have heard virtually nothing from either party on efforts to tackle obesity, promote healthy eating, encourage more physical activity, reduce alcohol consumption, promote sun protection, or boost efforts to increase participation in cancer screening and vaccination programs.

The government currently spends around A$2 billion a year on “public health”, which includes monitoring, regulation, as well as prevention and vaccination. This amounts to less than 2% of the nation’s total health expenditure of A$170 billion. That is about half of what we spend on patient transport.

A boost to 5% – or closer to A$8.5 billion – could make enormous strides in better prevention programs, driven by high-quality research.

Poor track record

When it comes to investment in disease prevention, the story is not strong for the Coalition.

The Rudd Labor government established the Australian National Preventive Health Agency (ANPHA) in 2009, with funding of around A$60 million a year. The agency ran national programs focusing on tobacco, alcohol, healthy eating and reducing alcohol consumption.

But the new Abbott government axed the agency in 2014, after drafting legislation to expunge it from the books.




Read more:
INTERACTIVE: We mapped cancer rates across Australia – search for your postcode here


From 2008 to 2014, the National Partnership Agreement on Preventive Health (NPAPH) funded programs in Australia tackling unhealthy eating, physical inactivity, drinking too much, and smoking, via a funding pool of A$872 million.

Programs such as Live Lighter and Foodcents, for example, provided evidenced-based and practical help for people to live healthy lives. Other programs improved the availability of nutritious foods, and ensured walking and cycling were safe and viable components of transport planning.

In 2012, the then Labor government committed to the continuation of the NPAPH to 2018, but it was axed by the Abbott government in the 2014 federal budget.

Prevention programs aim to make it easier for people to make healthy choices, such as being physically active and eating a nutritious diet.
Annie Spratt

This took hundreds of millions of dollars otherwise committed to prevention efforts out of the federal budget calculations.

All of these discontinued efforts were likely to have had a major effect on reducing future generations of Australians from hearing those awful words: you have cancer.

Like any human endeavour that aims for big changes in systems and behaviours, stopping and starting the programs that lead these changes diminishes the prospect of success.

So why is it hard to get governments to invest in prevention?

Strong and influential industries consistently lobby governments to protect their commercial interests. That’s what happens in a market economy democracy. The alcohol, processed food and even tobacco industries continue to exercise an influential voice in the halls of power.

Unsurprisingly, industry aggressively opposes higher taxes on these products (“sin taxes”) and programs discouraging their use.




Read more:
More than one in four Aussie kids are overweight or obese: we’re failing them, and we need a plan


It is common to hear politicians tell stories of individuals, “real people” who benefit from a new treatment or access to new life-saving medical care or drugs. We all connect with these heart-warming stories and they illustrate the importance of the public funding investment.

Such stories are harder to tell in prevention. How do we find the 64-year-old enjoying his granddaughter’s first day at school, largely because he did not die of a smoking-related disease in his 50s because tobacco control efforts in his youth meant he did not take up smoking?

To tell of our success, we revert to dry and dusty but impressive statistics, with one estimate of 500,000 premature deaths prevented over the past 20 years.

Effective prevention policies, such as putting a minimum floor price on alcohol, work to reduce alcohol-related harm. But making it more difficult to reduce the price of alcohol is politically unpopular.

Reforms such as expanding smoke-free areas are taken for granted now, but were opposed when first introduced.

Tobacco control measures are now accepted and welcomed, but that wasn’t always so.
Patrick Brinksma

Finally, the benefits of prevention often take many years, even decades, to arrive. Political timeframes are often linked to election cycles of three or four years.

A long-term view is vital. Each dollar invested in skin cancer prevention, for example, returns about A$2.20 in cost saving in avoiding cost of treating the disease. But there are decades between reducing kids’ sun exposure and avoiding treatment when those kids reach their 50s and 60s.

As the election campaign unfolds, let’s hope both aspiring Australian governments continue to show a genuine interest in the health of Australians and commit to preventing disease. Is 5% of the health budget too much to ask for that?The Conversation

Terry Slevin, Adjunct Professor, School of Psychology, Curtin University and College of Health and Medicine, Australian National University and Simone Pettigrew, Professor, School of Psychology, Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Labor’s cancer package would cut the cost of care, but beware of unintended side effects



File 20190408 2909 1dbbi9k.jpg?ixlib=rb 1.1
The median out-of-pocket expenses for breast cancer treatment is A$4,192.
ESB Professional/Shutterstock

Kees Van Gool, University of Technology Sydney and Jane Hall, University of Technology Sydney

Labor’s big-ticket election promise is a A$2.3 billion package to provide free medical scans and specialist consultations for cancer patients, plus automatic listing of new cancer therapies on the Pharmaceutical Benefits Scheme (PBS) once they’re recommended by the nation’s expert advisory panel.

One in two Australians will be diagnosed with cancer by the age of 85, and around 145,000 new diagnoses are made each year. So most of us have a close relative or friend who will be affected by the policy.

But there are some important policy considerations a Shorten government would need to plan for to ensure the package provides optimal care, improves patient outcomes, and does actually reduce out-of-pocket costs.




Read more:
Shorten promises $2.3 billion package to relieve costs for cancer patients


What’s the problem with cancer care?

New therapies for cancer are rapidly evolving, and are often extremely expensive. Seeking treatment involves navigating a complex array of public and private providers across multiple health care sectors, often leaving patients with high out-of-pocket costs.

These costs are highly dependent on which providers the patients choose (and the fees they charge), the level of private insurance cover, and the volume of services used.

A recent Queensland study found the median out-of-pocket expenses for a breast cancer patient, for example, was A$4,192.

It’s possible but very time-consuming for patients to “shop around” to reduce costs. But this is an unreasonable burden to place on patients.

The Labor proposal provides an opportunity to develop a comprehensive cancer control program that encompasses prevention, early diagnosis, treatment and follow-up – at a reasonable cost.




Read more:
Cutting cancer costs is a worthy policy, but we need to try to prevent it too


Better care for cancer patients

Cancer treatment is well researched; there are clear evidence-based guidelines that establish clinical pathways for the best treatment.

Nevertheless, there is substantial variation in treatments given to cancer patients. This difference cannot always be explained by their clinical conditions, and sometimes the care is not evidence-based.

It’s important that the proposed reforms do not just fund more care, but support more of the best care.

The approach that has shown promise in other countries is known as “bundled payments”.

Under bundled payments, a series of health care services – that can span over time and across multiple health care sectors and providers – are bundled together for funding purposes. This gives providers or institutions greater flexibility in how they spend money delivering care to the patient.

There is a danger that bundling can provide incentives to skimp on care, because the provider receives the same amount of funding no matter how much care is provided. But this can be addressed by monitoring the quality of care and the patients’ outcomes.

Ensuring the financial benefits flow to patients

Australian governments have made several attempts to provide better safety nets that cushion patients from extra charges.

Study after study shows that, in these circumstances, providers are likely to raise their fees. So while patients get some financial benefit, the doctors benefit also.

Under current Medicare rules, the Australian government does not and cannot determine doctors’ fees. It can only determine the amount of the Medicare benefit.

In general practice, most consultations are bulk-billed implying that the fee the doctor charges is equivalent to the Medicare benefit.

Only 31% of specialist consultations are bulk-billed, leaving more patients with an out-of-pocket payment.




Read more:
Specialists are free to set their fees, but there are ways to ensure patients don’t get ripped off


What can government do to encourage cancer care providers to bulk-bill?

Labor has announced they will add a bulk-billing incentive payment, as occurs in primary care. Specialists will receive an additional payment if they bulk-bill a cancer-related service.

This will not guarantee that every patient will not incur any out-of-pocket costs – although it should increase the likelihood that they will. Indeed, the Labor target is that 80% of patients will be bulk-billed.

However, previous research has shown that while the GP bulk-billing incentive led to a reduction in costs for those eligible (concession card holders), it also increased costs for those not eligible.

Careful monitoring is required to ensure the volume of services – and their fees for non-cancer patients – do not go up.

Not all cancer care is based on the best available evidence.
Napocska/Shutterstock

A further unprecedented complication is that for some services, it will be necessary to differentiate Medicare payments on the basis of the patient’s cancer status.

To guarantee patients face no out-of-pocket costs would require more radical reform. Again, the bundled payment system could be a vehicle for such reforms whereby payments are conditional on all the patient’s service providers agreeing to deliver care with no additional fee to the patient.

Depending on whether a patient is privately insured, the bundled payment could be financed by private health funds and Medicare.

Of course, it’s not yet clear that bundled payment schemes can be directly applied to the Australian setting.

The Labor cancer package requires careful and rigorous research effort to inform and guide the policy development.

A new vision for Medicare

Medicare is now 35 years old. It was built on fee-for-service payment, and focused on short, acute episodes of illness.

Now it’s time to move to new funding mechanisms that provide better care for complex, ongoing conditions, at a cost patients and the country can be sure represent efficient use of resources.




Read more:
More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up


Cancer is a good place to start and it could indeed be the most significant reform of Medicare so far.

Imagine a health system where every Australian was assured of optimal care, no matter what their illness or economic circumstances. That is a health system worth paying taxes for.The Conversation

Kees Van Gool, Health economist, University of Technology Sydney and Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

More visits to the doctor doesn’t mean better care – it’s time for a Medicare shake-up



File 20190214 1726 18vyxyz.jpg?ixlib=rb 1.1
The number of Medicare claims Australians make in a year doubled between 1984 and 2018.
By Sopotnick

Jane Hall, University of Technology Sydney and Kees Van Gool, University of Technology Sydney

This is part of a major series called Advancing Australia, in which leading academics examine the key issues facing Australia in the lead-up to the 2019 federal election and beyond. Read the other pieces in the series here.


Over the last 35 years, Medicare has given Australians access to high-quality health care at a reasonable cost. But, despite our justifiable pride in Medicare, it’s time to reconsider the way we pay for health care.

Australia’s Medicare system is a A$20 billion-a-year program. It subsidises most of our out-of-hospital doctor consultations, blood tests, X-rays and scans, physio appointments, eye tests and many other health services. It’s based on a long list of items and each time an item is provided, Medicare pays a benefit.

But paying doctors and other health providers a set fee for each service they deliver is not delivering optimal value for the health dollar. There are two reasons for this.

First, it encourages a higher volume of services, but not necessarily better-value services.

Second, it constrains doctors into delivering the care based on the items in the schedule, which often don’t meet the needs of complex patients.




Read more:
Explainer: what is Medicare and how does it work?


One promising alternative is “bundled payments”. Rather than paying doctors a “fee for service”, they would be paid a prospective lump sum to care for the patient’s medical problem, over a specified period.

The lump sum would be a pooled payment for all services provided to treat the condition. The provider’s role would be to coordinate the patient’s care across different parts of the health system and work with a range of health professionals to deliver high-quality care.

This would give doctors greater flexibility to manage the care patients need. At the same time, doctors would be held accountable via measurements of the quality of their care.

Importantly, this would give patients greater access to a broader range of services and make it easier to navigate our complicated health system.

Why health costs are rising

Between 1984 and 2018, Australian government spending on services outside of hospitals has increased from A$426 to A$818 per person, after adjusting for inflation.

This increase is almost entirely due to service volume. Back in 1984, the average Australian made 7.25 out-of-hospital Medicare claims a year. By 2018, this had escalated to 15.34; a doubling in the average number of claims.

The biggest growth has been in the number of pathology claims for blood and tissue tests (1.4 in 1984 to 5.2 in 2018), followed by GP consultations (4.2 compared to 6.3) and diagnostic imaging, including X-rays and other types of scans (0.3 versus 1.0).

This is not just the result of population ageing. At every age, we are making more Medicare claims. In 1985, people aged between 75 and 84 made 16.1 Medicare claims per year. In 2018, this number had grown to 44.6 claims per person per year.

Medicare prices have been very steady. For GP consultations, for example, the benefit paid per service has increased by 72% over the 35-year period, and mostly as a direct result of policy initiatives such as the Strengthening Medicare reforms introduced in 2004-05.

In fact, since 2005, the benefit per service has declined by 6% in real terms. This is a result, in part, of the Medicare freeze imposed by government between 2012 and 2018.

So price control is only one part of constraining expenditure growth. The other is the volume of services.




Read more:
FactCheck: has Medicare spending more than doubled in the last decade?


The medical care market has undergone considerable corporatisation. Corporate entities now own around 10% to 15% of all GP practices in Australia.

Corporate entities can own and run primary care practices as well as pathology laboratories, diagnostic imaging services and even pharmacies. This creates more incentive to refer patients to their own businesses for blood tests and imaging to increase the volume of claims, and therefore increase profits.

Greater spending doesn’t mean better care

The second critique of Medicare is that current funding arrangements create disincentives for delivering optimum care over a longer period, particularly for complex patients who require multiple services from multiple providers. They might have cancer, for instance, or multiple chronic diseases such as heart disease and diabetes or dementia.

Currently, Medicare makes a payment for every claim made within what we call an “episode of care” – a set of services to treat a condition, or a procedure. Each provider in that episode has an incentive to increase their own volume of care, but there are virtually no incentives to coordinate or deliver an optimum pathway of care for the patient.

Further, there are too few opportunities and rewards in this system to give doctors flexibility to offer different types of care for patients. This includes care provided by nurses, physiotherapists or dietitians; email or telephone consultations; patient education; and coordination services.

Instead, pay doctors a lump sum

The main feature of a good payment system is that it creates the right incentives for providers and patients to use health care resources effectively, efficiently and equitably.

Bundling payment involves working out the best care pathways for each condition. Cancer, for example, is a complex disease that requires ongoing care from primary, specialist and hospital services.

Under a bundled payment, the patient’s GP clinic would be paid a lump sum to ensure the patient receives all the services they need. This includes consultations, health checks, blood tests, physiotherapy, dietetics, patient education, and so on. The GP would have more control over how each of those services is delivered.

Sometimes will be best cared for by a physiotherapist.
Africa Studio/Shutterstock

If viable, the GP could bring some of these services into their practice, or they could subcontract them to other organisations.

The practice would be held accountable for providing high-quality care through various performance measures. These could range from patient satisfaction measures to objective measures such as timeliness of care or fewer avoidable complications. Payments could, in part, be made conditional on meeting performance targets.

Ultimately, because we are giving the provider more say over how care is delivered, the model of care can be more easily adapted to the needs of the patient.

Health reform must be based on evidence

In the small number of countries where bundled payments have been piloted, they are associated with improved quality, financial savings and increased patient satisfaction.

A bundled payment for hip-fracture patients in England, for example, resulted in more patients receiving surgery within 48 hours after admission and lower death rates.




Read more:
Creating a better health system: lessons from England


Although these studies show promise, the evidence base is still in its infancy.

Successful reform in this area will require careful design of the bundles, the payment levels and patient selection process, as well as how best to monitor quality care. In particular it requires robust evidence to determine:

  • what constitutes an optimal bundle of care for a particular condition
  • the cost of delivering those services
  • how the payment should be adjusted for the specific characteristics of a patient
  • the role performance targets may play in motivating health providers to deliver high-quality care.



Read more:
Is it time to ditch the private health insurance rebate? It’s a question Labor can’t ignore


The Conversation


Jane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology Sydney and Kees Van Gool, Health economist, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.