Education and debate

Health reform through coordinated care: SA HealthPlus

BMJ 2005; 330 doi: 10.1136/bmj.330.7492.662 (Published 17 March 2005)
Cite this as: BMJ 2005;330:662

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  1. Malcolm W Battersby, senior lecturer in psychiatry and the SA HealthPlus Team (malcolm.battersby@flinders.edu.au)1
  1. 1Flinders Human Behaviour and Health Research Unit, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
  • Accepted 14 February 2005

How can care for chronic illness best be coordinated? An Australian study sought to move towards collaborative and patient centred planned care

Introduction

Chronic illnesses contribute 60% of the global burden of disease, which by the year 2020 will increase to 80%.1 With ageing populations, no developed country can afford the projected increase in costs of chronic illness. To address this crisis, governments and healthcare organisations in developed countries have initiated programmes aimed at shifting the focus of health care from acute illness to chronic illness. Australian governments have initiated health reform using trials of coordinated care. We describe the largest of these trials, SA HealthPlus, its aims, outcomes, and lessons learnt.

The problem

In Australia, state and commonwealth governments share the financing of health—the states being responsible for hospitals and the commonwealth being responsible for primary care. This has provided financial and clinical barriers to the management of care for people with chronic illnesses. General practice is funded on a fee for service basis, reinforcing a reactive rather than a planned model of care. This has led to poor coordination and inadequate attention to prevention of crises and complications of chronic illness. Public hospitals face excessive demand and bed shortages. Emergency departments are under pressure, with patients waiting unacceptably long periods for assessment and admission.

The questions

The SA HealthPlus trial asked several questions. Can coordination of care for people with multiple service needs, where care is accessed through individual care plans and funds pooled from existing commonwealth and state programmes, result in improved individual client health and wellbeing within existing resources? Given a research design, would the trials facilitate health reform to help general practice to move towards collaborative and patient centred planned care? Would hospitals become partners with the primary care system, and would funding reward outcomes rather than output?

The evidence

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