Jennifer Doggett writes:
There are not many issues that the broad spectrum of health stakeholders agree on, but the need for health reform is one of them. In fact, even the Government appears to support the need for major changes to the way in which we fund and deliver health care.
In her recent National Press Club address, Health Minister Sussan Ley described Medicare as having “50 year old foundations” and stated that:
“…just pouring more money into the same inefficient system day-after-day; year-after-year; without complementary reform won’t necessarily deliver the improved outcomes we want.”
In arguing the case for health system reform, the Minister posed the following question “We continue to spend more on health care – but are we getting good value from this in terms of better health outcomes?”
Her Government’s response to this question thus far has been to set up numerous inquiries and consultation processes in key areas of the health system, including the MBS, private health insurance, mental health, therapeutic goods and aged care.
These processes have filled thousands of hours of stakeholders’ and bureaucrats’ time as they prepare and read submissions, as well as attend the associated meetings and roundtable discussions.
Consultation and review processes are always useful to some extent (even when they are limited and biased in their scope, as is the case with the private health insurance consumer survey).
However, their contribution is often limited by the various stakeholders simply pushing their own agendas and seeking to protect their ‘turf’ rather than working collaboratively to develop the best reform options for the community as a whole.
On the need for robust research
If the Government is serious about finding workable and sustainable strategies to improve the efficiency and efficacy of Medicare, the current slew of consultation processes needs to be informed by robust research into the various options for reform.
This includes research that focuses on the delivery of health care and which compares the outcomes of various health systems around the world to assess which are the best options for Australia.
This is the sort of research that will be presented by both Australian and international researchers at the 9th Health Services and Policy Research Conference, hosted by the Health Services Research Association of Australia and New Zealand (HSRAANZ).
The HSRAANZ conference will be held in Melbourne from Monday 7 December to Wednesday 9 December 2015 and covers the broad spectrum of the health system, including a number of the issues on the current reform agenda, from a health services research perspective.
Health Services Research (HSR) is a multidisciplinary field of research that examines how people get access to health care, how much care costs, and what happens to people as a result of this care.
It is a relatively young discipline that brings together a number of different social science perspectives with the contributions of individuals and institutions engaged in delivering health services.
While biomedical research often grabs the newspaper headlines with stories of new ‘breakthrough’ discoveries and the promise of miracle cures, it is HSR that does the ‘heavy lifting’ of developing and implementing changes in health policies and programs.
However, despite its importance, HSR does not have the same profile in Australia as it does in some other countries.
For example, the United Kingdom invests in applied health research via the National Institute for Health Research, Canada has a specific Institute of Health Services and Policy Research and the United States funds clinical effectiveness research through the Patient-Centered Outcomes Research Institute.
Australia has no comparable body. In fact, some key health services research bodies, such as the Australian Primary Healthcare Research Institute, have recently had their funding cut by the current Government. These bodies have been vital in providing information and support for researchers working in the area of health services research.
This is disappointing given the importance of HSR in helping Australia address the growing pressure on our health system from increasing health costs and rising rates of chronic disease.
This pressure will become even greater as our population ages and as our economy moves away from a mining and resources-fueled period of rapid growth.
HSR is also critical in addressing the rising rate of chronic diseases which currently affect around one in three Australians and, in many cases, could be prevented.
Current estimates suggest that up to 80% of heart disease, stroke and type 2 diabetes and more than one-third of cancers worldwide could be prevented by eliminating shared modifiable risk factors—mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol.
Lifestyle-related risk factors for chronic diseases, such as these, are unlikely to be eliminated via breakthroughs in biomedical research but can be significantly impacted upon by changes to our health policies and services.
Examples of how this occurs in practice will be showcased at the HSRAANZ conference in sessions which examine the data on the role of regular GP visits in managing diabetes and which showcase new innovations, such as TXT2BFit – a mobile phone administered app to reduce obesity.
The keynote sessions, delivered by high profile Australian and international speakers, cover a broad range of topics, including the role of researchers in working within government to influence policy development.
This is an important issue for Australia but one which typically receives little attention within both government and academic circles. This is surprising given that the biggest reform in the history of our health system – the introduction of Medicare – was largely dependent upon the close engagement between the Government of the day and two academic health economists John Deeble and Dick Scotton.
Helping to fill this gap at the conference will be keynote speaker Professor Sherry Glied from New York University. Professor Glied has had a distinguished record in advising the US government on health care, including as Senior Economist for health care and labor market policy on the President’s Council of Economic Advisers in 1992-1993, under both Presidents Bush and Clinton, and as a member of the Clinton Health Care Task Force.
She will discuss the role of health policy research in informing the political process of achieving the health care reform in the USA and provide valuable advice for any researchers interested in hearing how they can influence policy development and implementation in the current health reform environment.
Another keynote speaker, Professor Libby Roughead, from the University of South Australia, will focus on the use of data and development of data analytic systems to improve health care. Her work involves taking data from computerised health claims data and electronic medical records and using data analytics underpinned by behavioural theories.
This is an important issue for many areas of health care. Since the introduction of Medicare in 1983, the amount of data collected in the health system has exploded, along with technologies that allow access to this data. However, the data being collected is often not used to its best advantage (or not even used at all).
In her address, Professor Roughead will present examples of using this innovative approach to improve medicine use within the Australian veteran community and discuss the opportunities and potential for health services research using data analytics and distributed network approaches to improving Australian health care.
International perspectives on health care will be well represented at the conference, including a number of presentations from experts in Canada and New Zealand who collaborate with Australian researchers on issues common to Indigenous peoples in these countries.
These include Tanya Hosch, the Joint Campaign Director for Recognise, Jill Gallagher, CEO, Victorian Aboriginal Community Controlled Health Organisations, Tanya Allport, Director of Research at Te Pou Matakana and Dr Graham Scott, a former Secretary to the New Zealand Treasury and Chair of the New Zealand Health Funding Authority.
Profiling Canadian innovation
The Canadian health system is often described as the one most closely related to Australia’s, and the conference will showcase some of the most recent and innovative Canadian research in areas directly relevant to Australia.
This includes Josée Lavoie from the University of Manitoba in Canada who will present a session on strategies to generate rural/remote relevant research evidence to support health service decision-making. Another important session will be presented by Cathie Scott from the Alberta Centre for Child, Family and Community Research in Canada who will compare the Australian and Canadian health systems on access and equity and discuss the learnings from her research in this area.
Another researcher with expertise in two countries is Dr Gary L. Freed from the University of Michigan and the University of Melbourne. He is an expert on child health policy and will discuss why children aged 0-4 years make up the greatest number of Emergency Department (ED) presentations.
The consumer voice will be central to the Conference with Jen Morris from the University of Melbourne. She is a patient perspectives consultant, patient advocate, and healthcare quality and safety researcher who speaks and publishes extensively on issues relating to healthcare quality and safety, healthcare regulation, service improvement, and patient perspectives.
The role of government in health care will also be well represented with Kym Peake, Acting Secretary, Victorian Department of Health and Human Services who will speak in the first plenary session.
Providing breadth and depth
Break-out sessions over the three days of the conference cover a broad range of issues, including research translation, workforce and planning, rural and remote, use of evidence, general practice, data linkage, allied health, quality improvement and consumer and community engagement.
Some of the stand-out presentations from these sessions include:
- Hospital Nurse Attraction and Retention: A review of hospital workplace design characteristics by Lucio Naccarella, The University of Melbourne
- Data linkage and Australian health services research: Progress, challenges and opportunities by Philip Clarke, Centre for Health Policy, Australia
- How good is it really? An evaluation of New Zealand’s Population-Based Funding Formula by Erin Penno, Centre for Health Systems, University of Otago, New Zealand
- Improving population-based health through pay for performance by Verna Smith, ISCRR, Australia
- The Australian Burden of Disease Study: an important resource for health service planning and supporting policy by Lynelle Moon, Australian Institute of Health and Welfare, Australia
- Reciprocal Accountability: A mystery at the heart of Indigenous and government relations in primary care with presenters from Australia, New Zealand and Canada
- The benefits of public reporting of hospital performance: Does it deliver what consumers want? By Margaret Kelaher, Centre for Health Policy, Australia
Along with an extensive poster display, the conference also incorporates a number of interactive workshops, including one focused on early career fellowship funding for people completing their PhD as well as those embarking on their postdoctoral research career. This workshop will provide practical tips for structuring career pathways and for completing grant applications.
Another seminar will look at population health and other data related to chronic diseases and their risk factors, and how this information can be used to influence policy and practice. The discussion will use Australia’s progress with regard to World Health Organization (WHO) Noncommunicable Disease goals and targets as a starting point, and focus at initiatives that relate to these international policy directions.
There will also be a pre-Conference Indigenous Workshop: Sharing successes, strengths and staying strong. This will be held on Sunday 6 December and will bring together international Indigenous researchers to share success stories and discuss emerging platforms to support Indigenous health service research and empower communities.
HSR may have a lower profile than biomedical research, but the scope and quality of the research being presented at the HSRAANZ conference demonstrates how this field of research is making a difference every day in the lives of Australians. To ensure it continues to inform the development of future health policies and programs – particularly in the current reform environment – it is vital that HSR in Australia receives ongoing funding and support.
Professor Nick Zwar argued in Croakey recently that Australia needs a funding agency whose specific focus is applied health research. He suggested that such a body could be funded from the initial $1 billion investment in the Medical Research Future Fund and that research funded by this agency would contribute to identifying the savings in the health care system needed to grow the Future Fund over time.
The HSRAANZ conference in December might be the ideal place for researchers engaged in this field to explore this proposal further and to work together on strategies to promote the central role of HSR in informing current and future health system reforms.