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Replacing expensive hospitals with practical community care

 

I met up with a nursing college at a weekend house party. Over sausage rolls and rock and roll music, we swapped stories about working in a nearby, public hospital Emergency Department.

“Emergency departments are full of people with psychiatric, drug and alcohol and homeless issues because there is no permanent accommodation for them.” “Anxious mothers bring their babies into Emergency with minor illnesses like diarrhea and fever. They just need to see a practice nurse.” “GP’s don’t get paid to do long-term care and follow-up for people with chronic diseases. By the time they have paid their professional indemnity, professional development courses and the costs of running a clinic, they are struggling to survive.” I explained my idea to create a personal health app, making medical diagnosis understandable, explaining possible risks, giving practical advice on day to day health issues, and showing the latest apps, smart devices, and health startups. “What a great idea” was the universal response from the 50 to 60-year-old crowd. “Can you help me with my lymphoedema, chronic back pain, diabetes…”

While many General Medical Practices struggle to make ends meet, modern-day hospitals resemble palaces. Gleaming buildings situated in prime inner city locations support research projects and the latest equipment. Rows of hospital monitors endlessly beep, blink and make complicated equations. Helicopters whirl overhead, ferrying the most recent trauma patients to helipads. An army of medical specialists, pharmacists, nurses and allied health professionals rush through endless corridors.

You could be forgiven for thinking you are in a war zone. But who is the enemy? One in ten Americans were admitted to hospital last year. In 2013 to 2014 Australians had 9.7 million hospital admissions, out of our overall population of 23.13 million. But the reason for many of these hospital admissions is old age, chronic pain and a host of minor conditions that a GP could have more adequately treated, at a fraction of the cost. The most common reasons for people presenting in Australia to emergency departments are possible cardiac chest pain, non-cardiac chest pain, viral infection, abdominal pain and urinary tract infection. Estimates of how many people who present to Emergency Departments could have been seen by a GP range from 11% to 50%. One study showed that more than 70% of emergency visits could have been treated by a GP, with the figure rising to 90% for children 0 – 4 years. Another study showed that Australians waste 900 million a year on unnecessary Emergency Department admissions. So if the enemy is old age and a host of chronic conditions, why don’t we align our health services with patients actual conditions? Sell off the gleaming hospital/palaces and fund psych and addiction accommodation, software to link patients and chronic disease management teams, and acute home nursing services like Intensive Care at Home? Perhaps disease is not the real enemy. It might be the power of the nursing unions, medical associations, pharmacy guilds, health bureaucrats, health lobbyists and multinational corporations, all of whom profit handsomely from western governments misguided spending. The health industry is now the largest employer in Australia. Australia’s government health spending grew by 74% over the past decade. Hospitals are the most rapidly growing sector of the entire health industry. Australian hospitals now get $18 billion a year more than they did in 2002, an increase of over 95%. One in six dollars in the USA flows through the health industry. The global pharmaceutical industry is the world’s third largest industry, making 950 billion (USA) a year. Health was ranked the most profitable industry in the USA in 2013, growing at 138% over three years.

Australia has some wonderful health startups. Intensive Care at Home. Blamey Saunders Hears. Global Kinetics. Quanticare. But they survive on crumbs, while overpriced and inefficient hospitals squander millions every year.

Unlike Australia, Americans support startups, innovation, technology and efficiency. And they are seeing the rewards. Below are a few successful health startups focusing on chronic disease and long term home based care. I’d like to see more Australian companies with these sorts of services.

Prevent, a 16 week digital health program for people at risk of chronic disease Honor, an on line portal linked quality home carers and patients Chrono therapeutics, combining drug delivery, sensors and compliance monitoring Proteus, information to help doctors and patients tackle chronic diseases Health Loop, keeping patients and doctors in touch with easy to manage software

© Wikihospitals February 2016

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References Hospitals – Australian Institute of Health and Welfare – Federal Government – 2013 – 2014 Healthcare: Australia’s biggest employer – 19th July 2013 – Business Research and Insights, NAB Tough choices, how to rein in Australia’s rising health bill – 24th April 2014 – The Conversation – Stephen Duckett and Cassie McGannon. Costly and harmful – The Conversation – 29th September 2015 – Ray Moynihan Many Emergency Department visits could be avoided with a trip to the GP – University of Melbourne – 21st October 2015 – Faculty of Medicine, Dentistry and Health Sciences. ED dealing with many who could see a GP – Townsville Bulletin – 5th January 2015 – Rachel Riley Long way to go for Hospital targets – The Australian – 28th September 2012 – Adam Cresswell

  • Amount of the Australian health budget estimated to be wasted on unnecessary tests and treatments 33% 33%
  • Maximum amount that Emergency Department admissions are estimated to have been better treated by a GP? 40% 40%
  • Australian government health spending has increased by this much over the last decade 74% 74%
  • Percent that Australian hospitals have increased their spending over the past decade 95% 95%
  • Amount of savings possible by replacing hospital admissions with health startups for chronic disease 50% 50%
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