Welcome to our blog. We plan for this to be fun, and informative for people who want to improve health care services in Australia.
‘Fixing health care’ has been a policy cry for decades in numerous countries, including Australia. I am sorry to say that healthcare cannot be fixed. I told this to a robotics engineer at my University and he furrowed his brow and sternly told me “everything can be fixed”.
We debated this, and I argued that health care is a special case…
- there is almost unlimited demand for it
- providing services are labour intensive and so high cost
- we don’t have – relatively speaking – that much money to pay for it
- it often means the difference between life and death
- no two patients are the same in terms of their health services needs
- lots of powerful people currently make lots of money from it
- politicians are vulnerable to media beat ups if they change something
This makes it hard to fix.
More realistic than ‘fixing health care’ is to make incremental improvements and creep towards a better health system. Evidence needs to be assembled, relationships need to be brokered and risk averse decision makers comforted. Given the current funding crisis in the public sector the creep might become a walk and hopefully a jog in the next few years.
Improving health care services can be done by finding those services that don’t produce any health benefits, but we spend money on them. Adam Elshaug drew up a list of more than 150 of these that are funded by the Australian government (Med J Aust, 2012). Here are three: arthroscopic surgery for knee osteoarthritis; prostatectomy for early stage prostate cancer; open surgery for carotid occlusive disease. We should stop doing these things and release money for other stuff that does produce health benefits.
Next we might look at what productive services remain, estimate the cost per unit of health benefit gained for each of them and concentrate on supplying the best value for money services. This will mean we disinvest from services that give us lousy value for money. Some candidates for disinvestment might be doing cardiac on surgery on old and already very frail people; screening for cancer among populations with a very low risk of detection; funnelling co-morbid and desperate patients into renal dialysis services that won’t really help them. I like this quote from Alan Williams, who was a founding father of health economics in the 1980’s.
“Procedures should be ranked so that activities that generate more gains to health for every £ of resources take priority over those that generate less; thus the general standard of health in the community would be correspondingly higher” (BMJ, 1985)
Fairness and equity must of course be included as a health service focused only on efficiency could be terribly unfair. Saving very premature neonates is unlikely to be cost-effective, but we feel it is the right thing to do as a society, for example.
Probably the easiest place to start, and what AusHSI is currently focused on is to make simple and evidence based improvements to our current portfolio of services. We seek lower cost ways of delivering services, and ways of boosting health outcomes for no extra cost. This work is the domain of health service researchers who come together from a range of academic disciplines: economics, epidemiology, statistics and psychology; and work in partnership with clinicians from nursing, medical, and allied health disciplines.
AusHSI’s primary objective is to build capacity for health services research in Queensland. We fund research projects, provide education and training, we have our own research groups funded working on NMHRC and ARC projects and we do consulting. Visit our website to find out more about what we do.
Some or our most exciting projects were led by health care professionals
- Kathryn Plonka, a dental technician from Logan, found a telephone intervention prevented serious tooth decay among children from low socioeconomic households. If widely adopted it would lead to savings of over $160M per year in Queensland.
- Joan Webster and Claire Rickard from Griffith University are nursing researchers, looking at the value of changing intravenous catheters routinely versus only when clinically indicated. Doing the latter would save over $1 M per year.
- Alison Mudge is a physician at RBWH who found team-based care, focussing on nutrition and getting patients walking earlier can speed recovery and reduce complications in elderly surgical patients. This change to services reduced length of stay and improved patient outcomes.
We love simple but important research projects that improve our health care system. Many of our ideas match those put forward by Simon McKeon in his recent review of health research. And we hope that health services research gets the investment he recommends.
If you would like to work with us please register on the AusHSI website, or just keep following this blog, we are going to discuss many examples of simple improvements to health services from the perspective of groups of health services researchers.