Bold new proposal tackles palliative care’s core challenges

Liz Callaghan“Any strategy that employs a whole of system approach, reducing fragmentation and removing incentives for the cost shifting, is to be commended and should improve efficiency within the health care system.”

Palliative Care Australia (PCA) has proposed an ambitious new approach to overcoming the gaps and cost-shifting between different levels of government which detract from the delivery of palliative care nationally.

PCA announced the proposal in its Pre-Budget submission, suggesting a new National Cooperative for Palliative and End-of-Life Care, which relies on governments sharing risk and reciprocating cost-saving measures, rather than increasing health budgets.

PCA CEO Liz Callaghan said the Cooperative would be supported by an initial study which would identify best-practice service delivery models, nationally and internationally, and determine what resource allocation their broader implementation would require.

The Australian Government would kick-start the process with an upfront investment to develop and implement the Cooperative, which would achieve health budget savings for all levels of government. Other levels of government would reciprocate by also implementing measures to improve performance across the sector.

Ms Callaghan gave the example of the Federal Government investing in greater palliative care support in residential aged care facilities.

“That would reduce the number aged care residents presenting to hospital emergency departments and bed days, which would mean considerable savings for State and Territory Governments.

“In turn, the States may agree to invest these savings in improving transition to community based care, maybe by contributing to education and professional support. By doing that, the States would be reducing pressure on the Australian Government’s residential aged care budget and services.”

Health economist with the Palliative Care Clinical Studies Collaborative, Dr Nikki McCaffrey told ehospice the concept had the potential to make a significant difference to the delivery of palliative care and the broader health sector.

“Any strategy that employs a whole of system approach, reducing fragmentation and removing incentives for the cost shifting, is to be commended and should improve efficiency within the health care system,” she said.

“The concept of the cooperative is laudable and I think palliative care is an excellent case study to test out this approach, given that palliative care services do span all health care settings and are funded at federal and state level.”

Based on current evidence, she predicted the most significant health care savings would be realised from measures that reduced hospital admissions and time spent in intensive care. Savings may also stem from reducing the use of futile health care that is not accordance with patient wishes, such as chemotherapy towards the end of life which in some instances may harm, rather than benefit patients.

She said it would be important for the Cooperative to consider the significant care contribution made by unpaid caregivers such as friends and family.

“Informal caregivers provide a significant amount of care for people at the end of life and health service evaluations often ignore the costs and outcomes of that group. Without that support we are not going to be able to meet patient preferences for care at home at the end of life. It is vital to assess the impact that any new models of service delivery have on the care givers as well.”

Dr McCaffrey said given that the concept requires a significant leap of faith from governments, ongoing evaluation of outcomes would be critical to its success.

PCA plans for the Cooperative to harness changes brought about by reviews, such as the Reform of the Federation, the Medicare Benefits Schedule Review and Primary Health Care Review.

“The more they can build on existing programs and all of those reviews the better. It is important to capitalise on the experiences and existing expertise that has been developed,” said Dr McCaffrey.

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