A lot of really interesting attempts to change the way health care is being delivered are foundering because people can’t work out how to fund them.
There are certain pockets of money available: seed grants and step-change funds that get projects started, but often these are term-limited and there is rarely any chance of ongoing funding.
One of the unspoken principles underpinning a lot of new models of health care (including primary care, health promotion, inter professional practice, patient-centred care), is that they will cost less, (or at least they will shift the responsibility for payment onto the individual and away from the state.) But few people have yet worked out ways to make the transition from traditional care in the absence of secure funding.
Physiotherapists are ideally placed to respond to the changing economy of health care. Name another profession that can boast diagnosticians with a high social standing, who can speak the language of biomedicine but work with the whole person, using techniques that are portable and inexpensive? Despite this, physiotherapists have been slow to move away from their traditional roles and service responsibilities.
Physiotherapists working in the public health system appear to be reluctant to abandon what is increasingly looking like a sinking ship, having learnt to tolerate more than 30 years of cuts and compromises. And private practitioners seem to be working towards elite specialisation as their future practice model rather than looking to funding that might provide a ‘breadth’ of employment opportunities.
So if money from central government is in decline, it is likely that the profession will pass into a period of both insecurity and opportunity. Today’s graduates will likely find public sector jobs harder to come by, and they will need to find work in a range of different sectors. It is likely that partially funded, relatively short-term projects will become more common, and the ability to be innovative about one’s work patterns and service responsibilities will change.
It would be lovely to imagine returning to a time when graduates entered the public health sector and had a job for life, but those days are gone, and the sooner we come to terms with this and look to the possibilities for new funding models, the sooner we will learn what new opportunities lie ahead for us.
Hi David
My institution is currently in the process of developing a new Institutional Operating Plan, part of which is to identify the challenges facing South African higher education institutions. The mandate is to look at the things that we are all struggling with, especially those issues that have financial implications, and to figure out how to take advantage of them. The language of the document is very interesting in that it identifies these challenges are opportunities to make inroads into areas of practice that everyone is having difficulty with, and by doing so, to differentiate ourselves from others. Stop thinking of challenges as obstacles, and rather as opportunities to grow into new areas that we know other institutions are also having problems in. It’s an interesting perspective that has got me looking at every challenge as an opportunity to differentiate ourselves in ways that others will find difficult to replicate.
Thanks again for the thought-provoking posts.