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Bilateral Agreement Coordinated Care

While the framework did not explicitly mention coordinated procurement, these principles have been a reference point for their future development. In particular, the latest statement was seen as an important indicator of the government`s willingness to go into coordinated or administered care. As already said, testing should be cost-neutral, with the exception of initial design and installation costs. Studies should not be an additional source of funding for new and additional services. Policymakers already knew that more money would be invested in the system to increase available services and likely health outcomes. The aim of the studies was to see if it was possible to extract better health value from existing funding levels. This is a double challenge. First, to find better mix of services that meet needs at a lower cost (to fund the overhead costs of care coordinators and administration), second, to ensure that the existing level of funding is maintained. Maintaining funds has been difficult, as in Australia, almost a third of total health spending is made by individuals (through gap fees and out-of-pocket expenses) and by health funds. This meant that Trials had to make arrangements so that customers could continue to pay an equivalent amount. Behind the rhetoric of more “efficient” and substitute services lies the reality that the money allocated to trials for services must be distributed more finely if they are to succeed. (25) The management of user-friendliness tariffs has been particularly difficult.

Patients are already paying a significant amount for their own care (up to a third in some cases) through insufficient payments to family physicians and full payments for ancillary benefits. If these revenues were not further increased, the test pools would lose an important source of money. The Coordinated Flow of Care is for people with more complex and persistent needs who are having difficulty familiarizing themselves with the service system and maintaining the right mix and balance of services that ensure the best possible care. (13) The studies used a large number of methods to select their target groups. Some have looked for general indicators of complexity, such as the number of diagnoses, repeated hospitalizations or high costs, and have clients generally described as “frail” or “with high needs”. Others focused on conditions where it was known that community-based interventions could avoid hospitalizations or intense episodes of care. These latter studies often have client groups defined by diagnoses such as diabetes, asthma or cardiovascular disease. A series of initiatives announced in the 1999-2000 Commonwealth budget have clearly demonstrated the importance of coordinated procurement. In a significant boost for funding, the budget dedicates $54.5 million over four years to involve general practitioners in coordinated care planning.

An additional $33.5 million will be spent on new and existing studies on coordinated care over four years. The challenge of creating the pool is mainly to make sure it has the right size..