New healthcare models | |
Supramedicine. From health outcomes to outcome medicine. Eddie Price. Beacon Hill, NSW: Murray David 1997 (322 pp.). ISBN 0 95873 290 6. |
The uptake of information technology (IT) in healthcare has lagged behind its use in industries such as manufacturing and banking because of the comparative difficulty in defining and measuring the output of healthcare. In other industries expenditure on IT can be justified using cost-benefit models for more efficient production of outputs, but this is not so easy in healthcare.
Supramedicine presents models for defining and measuring health outcomes at the community, hospital and national level. This focuses on a shift from individual and curative medicine to population and preventive medicine. With his extensive experience as a clinician, Dr Price has proposed several outcome-based models to provide efficient and effective healthcare. These models provide incentives for clinicians to achieve health-outcome targets and conservative self-funding programs. While there is a brief review of generic health-outcome measurement instruments, the book supports the use of the SF-36 (a questionnaire assessing quality of life) as a valid generic outcome-measurement tool for the Australian population. There are two minor criticisms of the book. Firstly, an important way of changing doctors' behaviour in the future, not covered in the text, is to have some input into their university training and increase the emphasis on population and preventive medicine. Secondly, as the saying goes, there are "lies, damned lies and statistics": aggregate reporting of statistics to meet proposed targets can hide important results at subpopulation levels. As an example, setting population-level targets, such as the one proposed for the "supramedical general practitioner" to reduce the proportion of their patients who smoke, clearly has merit. However, in attempting to reach this target, the GP may overlook increasing rates among women or among a particular age cohort. Comparisons of National Health Surveys1 would show a marked reduction in the smoking rate for the overall population in 1989-90 to the rate in 1995 but would hide the important fact that the rate had changed little for young adults. Overall, Supramedicine is a thoughtful text. It challenges traditional models of healthcare, in a descriptive way, and is suitable for clinicians, bureaucrats and health service managers. Deborah Black
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