Australian health policy research and development

To the Editor: In concluding that health policy research in Australia is a virtual desert,1 Van Der Weyden failed to acknowledge several recent developments.

The Health Services Research Association of Australia and New Zealand, formed in late 2001 (www.chere.uts.edu.au/hsraanz/), and its biennial conferences (the next to be held in Melbourne in November 2003), are evidence of good quality research across a range of topics. Particularly Australian contributions include economic evaluation as a basis for funding decisions in both pharmaceuticals and medical services; the Coordinated Care Trials; and the adaptation of casemix funding to Australian cost structures and payment mechanisms.

Health policy development around the world borrows freely from other countries, but, unlike the generalisability of biomedical and clinical research, health services research can only be transferred after taking into account the characteristics of each country's unique system.

Nonetheless, health services and policy research are underfunded and underdeveloped in Australia. Is the answer an internationally acclaimed Australian Institute for Health Policy? Not entirely. A well-funded institute would overcome some of the lack of security of tenure faced by health services researchers — and would certainly be a welcome advance over the usual Australian practice of spreading the available funds so that a paltry amount goes to each State or Territory. However, according to the Wills Review,2 Australia requires not one but several research centres with the necessary critical mass.

We need a multifaceted strategy that goes beyond the organisational base. Funding is needed for investigator-initiated long term research to address underlying theory and methods, as well as contemporary policy issues. Researchers need to be able to build sustained inquiry into a specific area, instead of moving rapidly from topic to topic just to maintain their funding. Recognised avenues for training, education and further professional development are needed to build a critical mass of researchers. Only then will the success rate of National Health and Medical Research Council (NHMRC) project grants for health services research move from its current 5% or less to the success rate for public health of around 20%, or even the overall success rate of 25%–30%.

Finally, the US-based Harkness Fellowships in Health Policy and Practice are important,3 but support only two Fellows each year. This program needs to be complemented by an Australian-based program of training and international exchange on a similar scale to the various public health training programs.