Hospital in the home makes a lot of sense
The Hospital in the Home Society of Australasia wants the government to tweak the Medicare Benefits Schedule, and they have the figures to show them why.
Above: Associate Professor Gideon Caplan
By Stephen Easton
Slight changes to the Medicare Benefits Schedule to allow more hospital treatments at home would deliver better outcomes for patients, free up acute care beds and cut health costs by hundreds of millions of dollars, the president of the Hospital in the Home (HITH) Society of Australasia said today.
HITH Society president, Associate Professor Gideon Caplan, said that while tens of thousands of people every year already receive hospital-standard care where they live – including older people in residential aged care facilities, travellers in backpacker hostels and homeless people on street corners – slight changes to health funding mechanisms would allow the service to be expanded.
“We reckon there’s a lot more potential to increase this kind of treatment around Australia with the support of [state and federal] governments,” Professor Caplan said. “It could be made much more widely available with minor tweaking of the Medicare Benefits Schedule.”
Current funding mechanisms, he said, created a financial disincentive for doctors to be involved by making it impossible for many to get paid for providing treatments at home.
“If hospital treatment can be delivered at home, and that’s better for the patient, then they should get that straight away, but the funding mechanisms tend not to be that simple. We want to the system to allow people to get the best treatment in the best place.”
A report produced by Deloitte Access Economics, and released by the HITH Society last week, looked at the cost-effectiveness of hospital in the home treatment for six conditions – cellulitis, venous thrombosis, pulmonary embolus, respiratory infection / inflammation, chronic obstructive pulmonary disease (COPD) and knee replacement.
The report found that on average, across the six conditions, the cost to taxpayers was 32 per cent lower for hospital in the home treatment.
“There’s a very impressive saving from having hospital in the home treatment compared to in-hospital treatment,” Professor Caplan said. “When you look at the data, which shows it’s just as safe and patients are as just happy with the treatment, it’s got to be a winner.”
“And certainly, it’s something that’s very suitable for older people because we know older people do less well in hospital than other people, because of hospital-related adverse events like infections, falls and acute confusion. They suffer less of those problems in their own homes.
“Hospitals tend to concentrate all the worst infections in the community, whereas at home there’s just all the bugs you already know – you’re already immune to them.”
Professor Caplan confirmed that hospital in the home treatment has already saved countless older people living in retirement villages, residential facilities and in the community, from trips to emergency department and hospital stays that could last for several months.
The Society defines hospital in the home as “acute, sub-acute and post-acute care for stable patients with an uncomplicated diagnosis but in need of short-term intensive treatment”, not to be confused with home nursing.
Hospital in the home is provided by a multidisciplinary team of clinicians from a number of specialities including infectious diseases, gerontology, general practice, emergency medicine, orthopaedics, cardiology, paediatrics, rehabilitation, respiratory, nursing and haematology.
This would be of great assistance to the aged care sector. We have mixed emotions about sending some residents to hospital due to their frailty. Their relatives and our residents themselves dont always see the need to send people to hospital but in the current structure we have no other alternative. Hospital in the home would free up the beds in the hospitals and allow our residents to stay comfortable and secure within their familiar surroundings.
Hi Giddeon, I think hospital in the home requires relatives and friends of the patient to want this to happen. Often the patient is sent home without enough support and this can lead to other concerns such as falls, feelings of helplessness, social isolation and depression. Many families cannot cope with their sick relatives or dont want to as it disrupts their routine. Often women relatives are coerced into a carers role, more so than men, and this also needs to be addressed. The 30% reduction in cost may be due to women or men providing free care with little or no financial reward. Great idea but need fine tuning.
Shoshana Gaida RN RM