Conditioning

Give us all Extras! Contributing to the prevention of MEC downgrades through subsidised healthcare ‘extras'

By Dominic Lopez July 28, 2020


More than 22% of personnel in my unit are medically downgraded.[1] Put another way, 129 soldiers - effectively an entire Company - are Left Out of Battle due to a physical or mental injury. This statistic has remained fairly constant over the past three years and, as a result, its impact on readiness and retention is well understood. Nonetheless, we have been unable to reduce the amount of injured personnel in our unit. What does a workforce with 22% of its workers downgraded look like on a daily basis and what is the impact of having 78% of the workforce do 100% of the work? Simply put: hollow platoons, ad-hoc teams, and disgruntled soldiers. Our training is necessarily hard and will cause injuries, but are we doing all we can to prevent them? Can Army, as the most physically demanding and human-centric Service, lead the way in facilitating access to preventative healthcare to help preserve its most important resource – its people?

The proposition

This article proposes that subsidising access to ‘extras’ is a good way to prevent some injuries and downgrades from occurring. The extras I refer to are those provided by private health insurers to their members: remedial massage, chiropractic care, exercise physiology, acupuncture, and private fitness classes - such as aerobics, yoga and pilates - as well as purchases of fitness equipment and public gym membership. Private health insurers subsidise access to these extras because it makes economic sense to keep their members healthy and out of hospital. For private health insurers, a healthy member is a cheap member. For Army, a healthy member is a deployable capability. My proposition: Army provide up to $1,000 per year for every SERCAT 7 member to access preventative extras through a Bupa recognised healthcare provider or business.

This article examines three areas: the need for extras; the gap in our current healthcare; and how extras could be provided. The need for extras is based on my observations as an infantry officer over the past eleven years. It is my opinion that our medical system is too reactive and our soldiers need to take more responsibility for their own fitness. Subsidising extras seeks to address these shortcomings.

This article also builds on numerous Cove articles that have argued for a greater emphasis on preventative healthcare. The following quotes stand out to me: ‘all levels of the ADF would benefit from proactive intervention…’[2] ‘none of us plan for a personal injury, but maybe we should’[3] ‘make yourself as resistant to injury and the effects of injury as much as you can’[4] and ‘there has been minimal investment in pre-injury support for a soldier.’[5]

Why do we need ‘extras’?

Despite our best efforts, the amount of medically downgraded personnel, along with the types of injuries that occur, isn’t decreasing.[6] At my unit, a Strength and Conditioning program has been implemented to ensure soldiers adhere to a graduated and tailored physical training program. Additionally, medically downgraded personnel attend remedial PT and anyone who has failed a BFA attends BFA focused remedial PT. Vending machines that stock healthier options have also been installed. These initiatives should be reducing the quantity of J31 members but they aren’t.

Ultimately, too many in our workforce provide restricted service, many due to preventable injuries. A subsidy for extras would compliment my unit’s current initiatives as well as the Human Performance initiatives in other units. It would also help to build a culture of prevention within our healthcare system.

What is wrong with our current approach to healthcare?

The Army has become both liable and very good at looking after our people from the point of injury. As a result, our system is reactive rather than preventative. For example, a fit soldier will interact with the healthcare system once a year for a dental check up and once every five years for a medical review. Vaccinations are the exception but, regardless, none of this care is designed to prevent a fit soldier from becoming medically downgraded. Instead, it is designed to catch problems after they’ve occurred and then manage them with an appropriate downgraded employment classification.

As a result, the healthcare that a fit and healthy member receives isn’t sufficient. It does nothing to prevent injury and will only kick in after a crisis. It seems ludicrous that a soldier needs to be injured in order to access healthcare that could prevent that same soldier from becoming injured in the first place. Like all catch-22 scenarios, this situation is paradoxical and needs to change. In line with all the talk recently about force preservation, our approach to healthcare needs to prioritise both prevention and cure. Providing subsidies for extras is an opportunity to do this.

How do you solve a problem like 22% downgrades?

Firstly, we need to stop adding to the problem. To do this, we must focus on the other side of the J31 equation – those who are uninjured and just need preventative care and management.

Full disclosure: I see a chiropractor and massage therapist once or twice a month as part of my preventative healthcare regimen. This medical care, in my opinion, keeps my niggling injuries in check and helps me to continue to provide unrestricted service. I’d prefer Army recognise the benefit of these services and ultimately subsidise my visits.

The decision to act, implement, and administer extras in Army for all SERCAT 7 personnel seems fairly straight forward. Firstly, the need to do something to reduce the amount of downgraded personnel is obvious. Secondly, Army has an affiliation with the private insurer Bupa who has access to all the healthcare providers that Army personnel would require. Finally, most soldiers will appreciate the opportunity to access a service that they deem meets their needs. Once this had occurred, they would submit their application for a refund along with their receipt to their orderly room.  

It would be easy to dismiss this idea as too expensive, too difficult, not clinically indicated, and beyond the scope of our contract with Defence (which is based on equivalency with Medicare). Perhaps these obstacles are insurmountable, but what we are currently doing – waiting for a health crisis before taking action – isn’t solving our J31 problem.

As a first step, I propose a twelve month trial at 7 RAR.

Conclusion

Providing subsidies for extras is an opportunity to reduce an input to a growing problem. Furthermore, it reinforces Army’s value of 'Initiative' by giving soldiers some autonomy and responsibility for their healthcare. It also has the potential to improve retention. I propose Army give its personnel a few extras in order to prevent unnecessary and preventable medical downgrades.

 

End notes:

[1] As at 22 June 2020, 22.59% of 7 RAR was classified MEC J31 or greater (total workforce 571). This figure does not include dental downgrades.

[3] Groth, Benjamin, So You Think You Can Escape Injury?, 14 August 2018

[4] Ibid.

[6] 7 RAR Left Out of Battle Analysis Report, 2019. This report showed that the reason personnel were downgraded remained fairly consistent throughout the year. 80% were caused by physical injury (30% lower body, 70% upper body).


Portrait

Biography

Dominic Lopez

Major Dominic Lopez is Officer Commanding Support Company at the 7th Battalion, The Royal Australian Regiment.

 

The views expressed in this article are those of the author and do not necessarily reflect the position of the Australian Army, the Department of Defence or the Australian Government.



Comments

Interesting perspective Dominic, I agree on multiple points- particularly that we need better focus on injury prevention. The health continuum can be broken down into Primary Prevention, Secondary Prevention (addressing musculoskeletal complaints prior to entering the medical system) and tertiary treatment (after the point of injury and once you are seeing MOs/Physios etc). There is, as you state, a lack of focus on the primary and secondary prevention areas, and this is something the Directorate of Human Performance is addressing (albeit slowly, as we need to collect data that supports the right strategies, in order for it to be measurable to assess success). What I don't necessarily agree with is the funding of passive treatments such as massage, chiropractic and other modalities that, while they may make you feel better (don't get me wrong, I love a good massage too) there isn't good quality evidence / research that supports those modalities actually improve performance or prevent injuries. Once you start reimbursing for such items it opens up a can of worms as to what should be funded, and arguably the potential for a reliance on those passive treatments rather than what we know works, which is active recovery combined with an appropriate training program. But I also think the medical system needs to improve its treatment of Defence members. Physios need to stop using passive treatments (mainly on chronic injuries) that reinforce patients beliefs that they are being 'fixed', and focus on better exercise prescription and active recovery. MOs need to stop relying on imaging where it is not clinically indicated just because a patient feels it is their 'right', often leading to a misunderstanding of their diagnosis. Underpinning all this, we need a better injury surveillance system that can inform where our injury prevention strategies should focus on. We need to get to the root cause of the injuries and then implement evidenced based strategies at all points of the health continuum.

I have been thinking about this for a few years, absolutely agree it needs to be addressed. Another option is partnering with Bupa / Defence Health / Navy Health to offer a private health insurance package catered specifically to current serving members. This cuts out Army as the middle man for reimbursements

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