By Stephen Janz BAc BN MPH Clinic Director: Kenmore Centre for Health, Brisbane.
Productivity Commission Inquiry into Veterans’ Health
Anzac Day and Remembrance Day is a time when the community reflects on veterans and their service. Many veterans and their dependants don’t need an annual reminder as it is with them every day, with the consequences of their service often affecting their physical and mental health. The Department of Veterans Affairs (DVA) is the government agency responsible for delivering rehabilitation and compensation to veterans affected by their service. Currently there is an inquiry instigated by the Treasurer and conducted by the Productivity Commission investigating how this can be done better. This inquiry is investigating:
- whether the arrangements reflect contemporary best practice, drawing on experiences of Australian workers’ compensation arrangements and military compensation frameworks in other similar jurisdictions (local and international);
- the use of the Statements of Principles as a means to contribute to consistent decision-making based on sound medical-scientific evidence;
- and whether the legislative framework and supporting architecture delivers compensation and rehabilitation to veterans in a well targeted, efficient and veteran-centric manner.
Acupuncture Improves Veterans’ Health and Wellbeing
As a former ADF member (reserve) and son of a Korean war veteran, I have had a keen interest in veteran’s health. Veteran centred care involves respecting and being responsive to the choices of veterans for their health and wellbeing rather than dictating service delivery based purely on a disease model (1). In the US this approach has resulted in the development of personal health plans and the incorporation of pro-active complementary and integrative health approaches which include nutrition; acupuncture; stress reduction; yoga; tai chi; mindfulness and health coaching (2.3). Veterans in the US, Canada and New Zealand all have access to acupuncturists under various arrangements (3-5). While acupuncturists are available to injured workers through ComCare and WorkCover QLD (6,7), veterans are denied access as the DVA lags behind.
At our clinic it is frustrating to have veterans and war widows enquire about receiving acupuncture treatment only to find that the DVA does not cover acupuncturists (8). In the context of veteran’s health, acupuncture combined with usual medical care has been found to be helpful for stress, anxiety depression and chronic pain, and a recent trial found acupuncture combined with usual care helpful in reducing symptoms associated with post-traumatic stress disorder (9-11). It is time to allow Australian veterans and their dependants freedom of choice in the care they seek in keeping with the inquiry’s terms of reference to deliver veteran centric care (2,12,13).
Clinic’s Submission Available on the Commissions Site
The clinic has taken the opportunity to put a submission into the inquiry on behalf of veterans and their dependants seeking access to acupuncture as part of their health care. The Productivity Commission is due to release its draft report in December. Submissions can be found at https://www.pc.gov.au/inquiries/current/veterans/submissions and the clinic’s submission is number 65. Members of the public can make a brief comment to the inquiry at any time via the same webpage and I encourage anyone with an interest to do so.
- US Department of Veterans Affairs. Whole health for life: What is patient centered care? 2017 [Available from: https://www.va.gov/PATIENTCENTEREDCARE/clinicians/what-is-patient-centered-care.asp.
- Locatelli SM. Veterans’ experiences of patient-centered care: Learning from guided tours. Patient Experience Journal. 2014;1(1):88-94.
- US Department of Veterans Affairs. [Available from: http://www.blogs.va.gov/VAntage/23201/va-implements-the-first-of-several-veterans-choice-program-eligibility-expansions/.
- Veterans Affairs Canada. Benefits and Services – Programs of Choice (POC) [updated 21/12/2014. Available from: http://www.veterans.gc.ca/eng/services/health/treatment-benefits/poc#poc12.
- New Zeland Government. Veterans’ support regulations 2014. In: Office PC, editor. 2014.
- Australian Government Comcare. Allied health rates. 2016; Available from: https://www.comcare.gov.au/claims_and_benefits/benefits_and_entitlements/fees,_rates_and_reimbursements/allied_health_rates.
- Workcover Queensland. Other Treatment. Available from: https://www.worksafe.qld.gov.au/service-providers/allied-health-providers/othertreatment.
- Australian Government Department of Veterans’ Affairs. Factsheet HSV131 – Alternative Therapies 2018 [updated 18 May 2018. Available from: https://www.dva.gov.au/factsheet-hsv131-alternative-therapies.
- Engel CC, Cordova EH, Benedek DM, Liu X, Gore KL, Goertz C, et al. Randomized effectiveness trial of a brief course of acupuncture for posttraumatic stress disorder. Medical care. 2014;52(12 Suppl 5):S57-64.
- Hempel S, Taylor SL, Solloway MR, Miake-Lye IM, Beroes JM, Shanman R, et al. VA Evidence-based Synthesis Program Reports. Evidence Map of Acupuncture. Washington (DC): Department of Veterans Affairs; 2014.
- McDonald J, Janz S. The Acupuncture Evidence Project: A Comparative Literature Review: Australian Acupuncture and Chinese Medicine Association Ltd; 2016.
- Australian Commission on Safety and Quality in Health Care (ACSQHC). Patient-centred care: improving quality and safety by focusing care on patients and consumers: Discussion paper draft for public consultation. 2010.
- Berwick D M. What ‘Patient-Centered’ Should Mean: Confessions Of An Extremist. Health Affairs. 2009;28(4):555-65