Medicare must pivot to self-care to stay viable: new modelling
Medicare must urgently shift towards funding evidence-based self-care if the health system is to remain financially sustainable, according to new economic modelling by Mandala released this week by the Australian Self-Care Alliance.
The report, released in the week of International Self-Care Day (24 July), finds that a targeted program of preventive health assessments and structured health coaching for Australians aged 55 to 59 would deliver $233 million in combined health, income and fiscal benefits for every annual cohort of participants.
Medicare currently funds a comprehensive health assessment at ages 45 to 49 and again from age 75, leaving a 25-year gap during precisely the period when chronic conditions such as type 2 diabetes, cardiovascular disease, chronic kidney disease and osteoarthritis typically emerge and progress silently. A patient identified as high risk currently receives no funded support to change course.
The proposed ‘Preventive Care+’ program would close that gap with a Medicare-funded comprehensive health assessment for all Australians aged 55 to 59, followed by six health coaching sessions over three months for those identified as at risk. Coaching would be delivered by a nurse, health coach or allied health professional on referral from a GP.
The Mandala modelling finds the program would deliver the following benefits for each cohort:
- $233 million in combined health, income and fiscal benefits
- A net saving of $26 million to the public health system (from $85 million in gross health savings after program costs)
- Participants remaining in the workforce for an additional one to three years, generating $159 million in additional income
- An average gain of $78,500 in lifetime income and $9,300 in superannuation for each person who avoids or delays a chronic condition
- $29 million in additional tax receipts from extended workforce participation
Australian Self-Care Alliance CEO Randall Pearce said the findings showed self-care belonged at the centre of health policy.
“Healthcare costs are growing at double the rate of the economy, and the federal government has wisely committed to directing 5 per cent of health spending to prevention. Yet current expenditure sits at just 2.3 per cent,” Mr Peace said.
“We need to move the notion of self-care from an individual consumer concept to a measurable health policy lever.”
Australian Self-Care Alliance Chair Karen Booth said primary care was the right place to intervene, and called for the program to be trialled through GP clinics.
“Integrating more preventive health assessments and structured health coaching where indicated into primary care is the only viable mechanism to reduce the downstream burden on hospitals,” Ms Booth said.
“We’re calling on the federal government to get behind us and fund the Preventive Care+ project through GP clinics, so we can keep people well and out of hospital and intervene at a time when they’re ready and able to change the course of their health.”
Nephrologist and Melbourne University Professor Karen Dwyer said early intervention could transform outcomes for patients who would otherwise progress to the most severe and costly stages of disease.
“Prevention is not binary, it runs along a continuum,” Ms Dwyer said.
“If we can stop one person from progressing to stage 5 chronic kidney disease, we can give that person many more years of productive life and save the health system $68,000 per person.
“This gives us the opportunity to change the narrative from chronic disease to health preservation.”
Mandala report author Jun Tong said the economic case was clear.
“This modelling demonstrates that targeted preventive interventions for older workers provide a measurable return on investment for the federal budget,” Mr Tong said.
The full report, Time to make a difference: economic and fiscal benefits of Preventive Care+, is available here.