COVID-19 is the biggest crisis to face our healthcare system this century.
Yet the pandemic also presents an opportunity for reinvention and innovation with a more integrated and holistic approach to health provision in the community, ensuring higher levels of wellbeing in the future, and generating positive economic outcomes.
The release of the 2020/21 Federal Budget last week did not offer any major changes to the current healthcare system. While there were certainly positive moves by the government to address some immediate issues, including extending funding for telehealth services and more assistance for rural health, there are missed opportunities in recognising the role of allied health services in Australia’s post-coronavirus recovery.
For too long the contribution by the diverse range of health professionals working in this space has been downplayed and sidelined by the existing structure of the current health system.
Allied health represents 25 per cent of the healthcare workforce. Many of these professionals are unsung heroes working at the coalface in the community, both in cities and in more remote regions to speed recovery from illness, and to help people of all ages to live comfortable, independent, and fulfilling lives. In many instances they are also ensuring better workforce participation which aids the economy.
Need for an integrated team approach to healthcare delivery
The problem lies in the fact that the three pillars of healthcare (medicine, nursing and allied health) are currently not designed to work as an integrated multidiscipline team, especially out of the hospital setting. In addition, access to Medicare-rebated services for allied health services can be a complicated process. Out-of-pocket expenses remain a barrier to patients accessing the therapies they need for long-term recovery, or quality of life. This needs to change if we are to have any hope of improving outcomes.
While the role doctors and nurses have in the diagnosis and treatment of patients is clear, the contribution of other primary care providers including clinical psychologists, social workers, occupational therapists, dieticians, and various rehabilitation professionals is still not widely understood or acknowledged, despite significant research demonstrating how various allied health interventions result in measurable health outcomes.
If policies could encourage healthcare professions to come together rather than working separately, it would ultimately reduce the economic burden on the healthcare system which is now under extraordinary pressure.
In 2015 a Deloitte Access Economics study (Value of Accredited Exercise Physiologists in Australia) demonstrated that Accredited Exercise Physiologist (AEP) interventions provided significant return on investment when treating people with chronic conditions, including diabetes, mental illness and cardiovascular disease.
In the case of cardiovascular disease, one of the most significant health issues in Australia, the total lifetime burden of disease savings resulting from intervention with an AEP was estimated to be $11,847 per person annually, compared to a delivery cost of $1,903. Similar results were found in research papers examining post-stroke recovery, especially in rural and regional areas where allied health workers are often in short supply.
An opportunity for change
Ironically, COVID-19 may be just what is needed to jolt the system into a reboot, with allied health professions now gaining more recognition around the world as policy makers begin to understand more about the economic and social benefits of a wider, person-centred approach to wellness and recovery from disease. We have only to look to the UK and Canada for inspiration where allied health workers have been at the forefront assisting medical teams with coronavirus recovery both in acute settings and in the community.
In Australia the 2020 aged care royal commission report has recommended more support from allied health services in aged care facilities and in-home settings. Likewise, with the tsunami of mental health issues now facing people across Australia, healthcare experts from all sides are lobbying for better funding of psychological support services.
Research needed for prevention and rehabilitation programs
Ongoing research is also important. Universities have been working hard at this time, not just to make sure allied health graduates are appropriately skilled to cope with the post-COVID-19 environment, but also in terms of understanding how new delivery modes like tele-health, Zoom sessions, and use of new technology (like virtual reality or music therapy apps, for example) can make a difference to delivering better health outcomes.
While the Federal Budget has included $1 billion in additional funding for research at universities around the country, much work will be needed in the development of evidence-based preventative health programs to aid rehabilitation for a range of health problems. Already work is progressing on innovative exercise therapies to address anxiety and depression, and programs to address the rising incidents of dementia and social isolation in the elderly.
Skills may be in short supply as demand increases
Supply of future allied health workers may also be an issue. Disruptions during the lockdown have caused delays to clinical placements for final-year students. Universities may not be able to produce graduates fast enough to meet the demand in key areas like mental health, disability care, education and social support, and aged care.
Increasing the number of partnerships between healthcare providers in the public, private, and tertiary training institutions will be required so we can build better workforce capacity into the future.
COVID-19 is the biggest health, social and economic catastrophe we have faced in our lifetime. But if there is one thing that this pandemic has taught us, it is the need to be flexible and open to doing things differently.
An estimated 80 per cent of the burden of disease and injury suffered by Australians is now attributable to chronic conditions, COVID-19 is likely to make that worse. Greater access to early intervention, prevention, and treatment programs managed by allied health professionals will help to improve outcomes and save money.
Allied health can no longer be viewed as an optional extra: rather it is an investment for our future.
Professor Esther May is Dean of Health Sciences at UniSA and chair of the Australian Council of Deans of Health Sciences
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