icare makes submission to SIRA healthcare regulation consultation

icare welcomed the opportunity to contribute to the State Insurance Regulatory Authority’s (SIRA) consultation on the ‘Regulatory requirements for health care arrangements in the NSW workers compensation and CTP schemes’.

During the 2018/19 financial year, more than 55,000 medical and allied health service providers delivered treatment and services to injured NSW workers.

icare recognises the positive contribution these providers make to the well-being of our community in NSW, including helping injured people return to employment.

However, as far back as 2003, the Australian House of Representatives’ Standing Committee on Employment and Workplace Relations identified structural weaknesses in the system, that provided opportunity for over-servicing by some service providers, and inappropriate behaviour by a small group of others.

Medical costs, and the utilisation of medical services, in the NSW workers compensation system have been rising rapidly. In fact, medical costs have gone up by 40 per cent in the last four years alone and now account for a third of the scheme’s overall costs.

“We believe the best approach to overcoming these structural weaknesses and helping injured workers is through delivery of ‘value-based’ care, which is advocated by NSW Health, coupled with a more robust regulatory framework,” said Dr Chris Colquhoun, Chief Medical Officer at icare.

Value-based care is becoming increasingly recognised globally as a more effective approach to limiting unsustainable healthcare costs than traditional approaches.

Value-based care seeks to improve:

  • the health outcomes that matter to patients
  • the experience of receiving care 
  • the experience of providing care 
  • the effectiveness and efficiency of care. 

icare’s submission outlines the benefits of value-based care, and how we believe it should be extended to injured people in NSW through:  

  • improved processes and governance
  • indexed health care provider fees
  • clearer guidelines for healthcare providers
  • more effective use of data and evidence to correctly assess what interventions injured workers will gain the best outcomes from. 

icare is also taking action to address rising healthcare costs and the issues raised in the submission, including implementing a medical strategy to enhance medical decision-making protocols and ensure there is an evidence base for treatment requests. We are also working with healthcare service providers to ensure the latest evidence better informs the treatment provided to injured workers.  

NOTE: This submission was made to a consultation separate to SIRA’s review of the Nominal Insurer.

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