Past President's reflections

Providing the best care and containing costs depends on sharing and applying information

The rate of change in health care delivery and the need to provide more affordable health care continues to accelerate. Health is a major concern for Australians now and into the future, making the politics of health an important issue at both state and federal levels.

I joined the leadership team of the Australian Medical Association (AMA) just after one prime minister vowed to fix the nation's public hospitals or take them over; and as I leave 5 years later, we have another prime minister vowing to fix primary health care with the proposed copayments for general practice and diagnostic imaging and pathology testing.

Both leaders clearly had laudable aims, with Tony Abbott intending to shift some of the costs and more of the responsibility for spending decisions onto the individual. History tells us that both may end up with compromises that don't quite deliver on their original intent.

Australia's problem is that health care costs are rising faster than the gross domestic product (GDP). This inevitably means a bigger spend in straight dollar terms and also as a proportion of GDP. The implication is that Australia will have less of its GDP to spend on education, roads and welfare.

At the same time, as the cost pressures on health spending are rising, the public's access to and demand for information is exploding. Patients want to know that they are getting the best treatment, and soon they will want to know that it is being delivered by the best doctor or, at least, that their doctor is delivering best practice.

In the United Kingdom, the medical system has already focused on the quality of doctors with the introduction of revalidation in 2012. Licensed doctors are required to demonstrate on a regular basis that they are up to date and fit to practise. Revalidation aims to give extra confidence to patients that their doctor is being regularly checked by their employer and the General Medical Council (our Medical Board equivalent). The Australian Medical Board has started a conversation about the need for revalidation in the Australian context.

Lord Darzi, one of the leading international figures in health reform in recent years, gave us some clear guidance in his keynote speech at the 50th AMA conference in 2012, including his view that one of the simplest ways of improving care delivery — and therefore patient outcomes and managment of costs — is to close the gap between “what we know and what we do”.

We already know we must strengthen the primary health care system to enable it to provide high-quality, personal care and support to people when they are sick, to help people manage their chronic illnesses and to help the population stay healthy.

We also need to stop practices that have not been shown to benefit patients and do more of the things that are of benefit. We need to measure and minimise unwarranted clinical variation and to ensure that high-quality care is a consistent part of everyone's experience of primary, community and hospital-based care, whether public or private.

We can only do this if we can measure what we are doing and share that information. This is where I think we will see the most change in the next few years. Already, the AMA and the Colleges are moving to more openness and more disclosure. Colleges are requiring more and more self-reflection as part of their continuing professional development programs; and we are beginning to see meaningful disclosure of outcomes in hospitals by way of the National Health Performance Authority's MyHospitals website.

The public want more granular information though, and I have no doubt that as we increase our use of information technology and see increased use of the nationally agreed standards like the Australian Medicines Terminology and SNOMED CT-AU, we will be able to provide the information required to demonstrate quality and allow comparisons within and between services.

Better data flows within the health system will improve efficiency and will improve outcomes and minimise misadventure at all levels, and we should be able to meet the information needs of the public, the needs of the regulators and the needs of governments while driving improved cost-effectiveness.

Dr Steve Hambleton, a Brisbane general practitioner, was Vice President of the AMA from May 2009 to May 2011 and President from May 2011 to May 2014.