Shifting the Paradigm: From Chronic Disease Care to Ongoing Health Management
By Dr Bibiana Chan
Reflections from the Northern Sydney Wellbeing Collaborative Forum
With less than 48 hours before flying to Canada for a family reunion, I found myself at a thought-provoking forum hosted by the Northern Sydney Wellbeing Collaborative. Despite my upcoming trip, I couldn’t resist attending—especially when the focus was on a topic close to my heart: shifting the conversation from chronic disease management to ongoing health management.
It was encouraging to see a diverse panel—specialists, doctors, nurses, peer workers, and health policy strategists—emphasize the need for community voices (Ground Zero) in designing this new paradigm. After nearly six years of working at the grassroots level and founding a community-based mental health promotion organization, I finally felt that the clinical world and I were on the same page.
The Patient’s Role: Power Dynamics in Healthcare
As the last attendee to raise a question at the forum, I shared a perspective that resonated with many. Several fellow attendees came up afterward to support my voice. My question to the expert panel was:
“Many of you spoke about multidisciplinary care teams. How do you see the patient fitting into this team? Would the patient be considered part of the care team?”
I also emphasized that empowering patients is particularly important for Culturally and Linguistically Diverse (CALD) communities. Cultural knowledge can feed back into health programs, allowing patients to become contributing members of the care team.
What I didn’t get to share was that back in 2010, I was the lead author of a policy paper on multidisciplinary teamwork in chronic disease management. In that paper, I argued that the patient should be placed at the centre of the team and respected as a valuable member.
Patient empowerment, I believe, is far more powerful than many clinical teams might imagine.
A Personal Example: Challenging the Narrative
I recall a mental health conference where a speaker—most likely a psychiatrist—claimed that if a patient had two or more relapses, they would need to take antidepressants for life. This assertion struck a chord with me because I have personally experienced three severe relapses. Yet, I have been antidepressant-free for nearly four years.
How? I chose to take charge of my mental health. I practice laughter yoga and lead a laughter yoga group at a community center to reach out to senior members of the Chinese community. The laughter yoga sessions themselves, combined with the meaningful work of training others, have helped me wean off antidepressants. This experience underscores how patient activation, cultural knowledge, and community engagement can empower individuals to break free from dependency narratives often perpetuated by the healthcare system.
Funding Models: The Systemic Barrier
Beyond power dynamics, funding structures play a pivotal role. The forum touched on a critical challenge: Australia’s Medicare system. Under the current model, General Practitioners (GPs) are restricted to charging Medicare by available items. From my time in primary healthcare research, I recall that GPs often wouldn’t call a patient’s psychologist or allied health professional because there was no Medicare item to compensate them for that time.
In contrast, the UK and Canada have adopted more flexible funding models. Family doctors in these countries receive annual lump-sum rebates per registered patient, incentivizing them to provide holistic and coordinated care. These models recognize that multidisciplinary care requires time and collaboration—elements not easily broken into Medicare billing items.
The Reality Check: Comfort Zones and Election Candy
Interestingly, just as these thoughts lingered, Prime Minister Anthony Albanese announced billions in funding to ensure that 9 out of 10 GP visits would be bulk-billed. On the surface, this sounds like a win for accessible healthcare. But as tempting as this election candy might be, I can’t help but wonder if it merely keeps Australia in its comfort zone.
Bulk-billing addresses affordability and access but doesn’t tackle deeper structural issues like fostering interdisciplinary collaboration or shifting entrenched power dynamics. Without these systemic changes, the promising shift toward chronic health management risks stalling.
A Call for Shared Power and Systemic Reform
To truly embrace chronic health management, we need more than funding injections aimed at quick wins. We need a cultural shift where clinicians are willing to share power, recognizing patients as equal partners. We also need a funding model that values time spent on care coordination, not just face-to-face consultations.
Having worked across research, clinical contexts, and community settings, I believe that grassroots voices must continue pushing for these changes. Conversations like the ones at the forum matter. They plant seeds of change and challenge long-standing norms.
Patient empowerment isn’t just a buzzword—it’s the key to sustainable health outcomes. My own journey shows that when patients activate their own potential and leverage cultural knowledge to support others, remarkable transformations are possible.
Perhaps the next sweet candy in Australian healthcare will come with the healthy fibre needed for long-term systemic reform.
You can watch the speech of each of the panelists on YouTube, click HERE.
