This week, the Prime Minister, John Howard, announced that, if returned, the Coalition Government would provide funds to general practitioners to employ practice nurses to visit people over 65 in their own homes. The plan is estimated to deliver 800,000 home visits over the next four year, at a cost of $164.5million.
This could be an excellent extension of Medicare services. But it could more likely to be a waste of money, competing with current systems which have been demonstrated not to work effectively.
And irrespective of the virtue of this plan, it might not be deliverable in an environment where nurses, especially those with geriatric training, are in extremely short supply, and where safety concerns arise when nurses, mostly women, visit patients in their homes.
Keeping the growing number of older Australians, many of them with multiple health problems and increasing frailty and disability, safely and comfortably functioning in their own homes and communities is a major challenge for the healthcare system. Most geriatric services are concentrated in the acute care sector with only weak connections to general practice, community care and social services.
Many of the health problems and disabilities present in elderly people living at home are not known to their general practitioner, who may not ask questions about urinary incontinence, ability to get out of the bath, nutrition problems due to broken teeth and compliance with medication regimes.
Work done in Scotland and Europe in the 1980s showed that comprehensive geriatric assessments conducted in the home by specially trained healthcare workers help identify risk factors that can be ameliorated by medical and social interventions to prevent functional impairment, delay the onset of dependence, and reduce emergency department visits and hospital admissions.
These studies provided the supporting rationale for the introduction in 1999 of a new Medicare item under which general practitioners are reimbursed for an annual health assessment for their patients aged 75 and over. Doctors receive $167.45 for an assessment done in their offices and $236.85 for an assessment done in the patient's home.
However, several Australian studies have concluded that this particular intervention does not provide any improvements in health status, makes no significant difference to the probability of hospital admission or death, and that the small benefits in quality of life seen did not justify the costs involved.
These findings were supported by an international analysis in 2002 of 18 such studies which showed that preventive home visits are cost-effective only if they are targeted at the population which is most likely to benefit and include multiple follow-up home visits to ensure problems, once found, are addressed.
Apparently unperturbed by budget blow-outs of 60 per cent since 1999 and lack of demonstrable cost-effectiveness, the Government recently reauthorised the health assessment program for people aged 75 and over for four more years at a total cost of $234.6 million.
Now a new program, which seems to have no greater likelihood of delivering health benefits, will be laid over the top.
The research highlights that the plan to offer a Medicare reimbursement of $205 for a nurse home visit will fail to deliver any real benefits unless there are multiple visits, targeted at those most in need, and there is a mechanism to ensure health problems that are discovered are not merely reported but are adequately followed up and addressed.
It's not clear what nurses will be able to do, if anything, to tackle the social welfare, disability and aged care problems they will also undoubtedly uncover.
It was the announcement of this plan which apparently delayed Health Minister Tony Abbott's appearance at the health policy debate at the National Press Club on Wednesday.
It's a pity he didn't just delay the announcement that would have given him time to meet his media engagements and to address the policy details of this program.
Ensuring that these details are covered, and that there is integration with other, non-health services that people aged over 65 will need, means the difference between a waste of money and a cost-effective program that can prevent or delay the onset of functional impairment and help keep older Australians living independently in their communities.
Dr Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.