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Grahame Danaher - Westfund - Consumers, regulation and change

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Grahame Danaher delivered the presentation at the 2014 Health Insurance Summit. …

Grahame Danaher delivered the presentation at the 2014 Health Insurance Summit.

The 2014 Health Insurance Summit focused on how legislative changes affect the future of health insurance in funding, membership and services.

For more information about the event, please visit: http://bit.ly/HISummit14

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  • 1. Consumers, Regulation and Change Grahame Danaher Chief Executive Officer Westfund Health 13th Annual Health Insurance Summit
  • 2. “… there needs to be a frank, fearless and far reaching discussion on our health system” “… our health system has no prospect of meeting the needs of the health of our nation in the 21st century!” Address by the Minister for Health, Peter Dutton, to CEDA Conference, February 2014 The Case for Change
  • 3. Our Health System is like a Mercedes 450 SEL  Like the 450 SEL, our system was great in its time but it would not meet today’s expectations.  The Minister is saying that our system needs to get to the next level – quickly.
  • 4.  Preventative health  Pain reduction  Immediate and appropriate treatment  Longevity What is the formula for health happiness?
  • 5. Key factors affecting better health:  Unhealthy stress  Smoking  Lack of exercise  Better nutrition  Co-morbidities (diabetes, asthma) Our system supports sickness insurance - not health insurance  Hormone profile  Muscle mass  Lack of sun exposure  Lack of sleep  Poor dental hygiene
  • 6. The key roadblock to health happiness Are Doctors remunerated appropriately?  Does their remuneration model encourage better health outcomes?  Would an alternative remuneration model push treatment programmes that assisted health happiness?  Can you have improved financial performance AND improved health outcomes?
  • 7. Encouraging healthy outcomes  Can we finance health outcomes more efficiently by focusing on health happiness?  Capitation AND fee for service seems to make sense as a remuneration model  Does this model help our system focus on health happiness?  How could it work?
  • 8. A remuneration model that drives dental “happiness”  Westfund operates two dental practices in regional areas (Lithgow, NSW and Mackay, Qld) treating 650 patients a week.  It provides a preventative/minimally invasive approach to treatment programmes.  A preventative approach sees eradication of dental disease.
  • 9. A remuneration model that drives dental “happiness” continued  The preventative philosophy is driven not only by the stated philosophy but by the way our dentists are remunerated.  Our dentists are paid by capitation (payment per patient seen) and fee for service. They receive above average earnings which capitalises on the efficiency of treating a large number of patients instead of a small number of patients with expansive treatment programmes.
  • 10. It is hard to change unless you have support and incentive to change your behaviour. Turning Sickness Insurance into Heath Insurance – 8 ideas for change
  • 11.  Manage unhealthy stress by giving people information and incentive to create a more hopeful future.  Smoking is still a major health issue so why don’t smokers pay a higher premium? It is an effective deterrent of the government’s programme to reduce smoking.  More and better education about what is good nutrition (some governments overseas have banned trans fats from restaurants).  Co-morbidities (Diabetes, Asthma) – are we assisting co- morbidities as well as we could? Are our testing and screening programmes appropriate for early detection and management? 8 ideas for health insurance
  • 12.  Muscle mass – better management will certainly delay the onset of osteo-arthritis and/or other skeletal problems.  Adequate levels of sunshine – how does this play into worldwide Vitamin D deficiency?  Lack of sleep – around 1 in 3 people have at least mild insomnia. Do we have adequate programmes to deal with sleep depravation?  Dental hygiene – over 75% of Australia’s population suffers dental disease (largely preventable by visiting the dentist regularly). 8 ideas for health insurance
  • 13.  Patient treatment. The system generally treats us very well when we are ill.  We are generally happy with our general care, our nursing care, the administration associated with our care, and the outcome of our care.  We are not so happy about waiting times and the things we would like to have fixed and medical gaps. Better health
  • 14.  Do health funds know what health outcomes their members want?  Health funds cannot survive by simply collecting premiums and paying claims. There need to be significant programmes that support health happiness which can be determined by how we remunerate our doctors but will doctors survive under the current remuneration model from which they operate? Are health funds financing the care its members need?
  • 15. Minister Dutton is right in saying private health funds could do more.  The Government needs to be more proactive in supporting deregulation while maintaining community rating.  The health industry needs to share more in the community interest and with less self interest to build a sustainable health system. This can begin if we concentrate on what people need to have to generate health happiness. Conclusion
  • 16. Grahame Danaher Chief Executive Officer Westfund Health 13th Annual Health Insurance Summit