Volume 199 - Issue 4
Better information to drive health investment decisions
Authors: Sally Redman and Robert W Wells
Med J Aust 2013; 199 (4): 235. || doi: 10.5694/mja13.10885
Published online: 19 August 2013
Published online: 19 August 2013
The quality and effective use of data must be strengthened if Australia is to meet the challenge of rising health care costs in the next electoral term.
Strengthening the use of data will prevent health decisionmakers from “flying blind”
Federal and state governments spend a large and increasing proportion of their budgets on health care. Although rising costs are partly driven by an ageing population, increases in the volume of services per patient are also a major cause, while advancing science, community expectations and defensive medicine contribute to “doing more”. The major challenge facing the Australian health care system in the next electoral term will therefore be to rein in rising costs while maintaining high standards of care and meeting new demands.
Better information about the delivery of health programs and services in Australia must drive policy responses to this challenge. Such information will inform community dialogue about our health care spending priorities and underpin decisions about when new programs, tests or treatments should be offered, continued or ended.
The past decade has seen progress towards high-quality, timely and locally relevant information required by health decisionmakers. However, if Australia is to meet the challenge of rising health care costs, the information and its effective use must be considerably strengthened — otherwise, health decisionmakers are “flying blind”. For example, a better understanding of the causes of unwarranted variations in practice can provide powerful insights into how to reduce costs while maintaining the quality of care and meeting growing demands. In the United States, a twofold difference has been found between geographic regions in per capita Medicare spending; but for some conditions, higher spending does not result in better patient outcomes.1 Considerable variations in practice also exist in Australia.
Improved data systems and more sophisticated approaches to understanding the causes and meaning of variation will be required to make good use of this information in health decisions. A recent article in the Journal illustrates the importance of testing the methods and data, if the right conclusions are to be drawn from performance monitoring and analysis.2
Another opportunity to inform health decisions is to embed rigorous evaluations into the rollout of new policies, programs and service delivery models. It is sometimes possible to structure the rollout of a program to provide for rigorous testing of policy alternatives. For example, in the United Kingdom, a randomised trial was established within the implementation of the national breast cancer screening program to test whether inviting women aged in their forties reduced deaths from the disease.3 More often, it would be possible to establish multifaceted evaluations that shed light on different components of the program, such as that established by the Scottish Government to assess the impact of a smoking ban in public places. Seven separate evaluations examined the impacts of the program, including its effect on hospital admissions for acute coronary syndrome, reduction in second-hand smoke exposure in 11-year-olds, reduction in second-hand smoke at public bars and public support for the policy.4 The evaluation of both of these initiatives influenced subsequent policy decisions.
Although evaluating the operation of programs and services in routine practice is critical to investment or disinvestment decisions, rigorous evaluation is not commonly practised in Australia. Where it does occur, evaluation is often insufficient to draw meaningful conclusions about costs and benefits. The failure to routinely incorporate rigorous evaluation means “we have wasted huge opportunities to learn”.5 The political will to encourage or mandate routine high-quality evaluation of new policies, programs or services would do much to inform health decisions. In the UK, for example, the Treasury places evaluation at the heart of programs and planning.6
Finally, a strong information base for health decisions will require closer partnerships between researchers and health decisionmakers. Health decisionmakers often report that research does not address the questions of most interest to them such as program cost and scalability, and the most likely beneficiaries. Engaging health decisionmakers as partners in the design and implementation of research will result in more robust information for health decisions. Several agencies overseas have pioneered new models of research funding, including the Canadian Health Services Research Foundation and the UK National Institute for Health Research. In Australia, the National Health and Medical Research Council has initiated Partnership Projects and the new Partnership Centres for better health.
The recent McKeon Review emphasised the benefits of continued support for research intended to inform health decisions.7 Supporting this type of research will, over time, help improve care while keeping costs under better control.
Competing interests
No relevant disclosures.
References
- Fisher ES, Wennberg DE, Stukel TA, et al. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 2003; 138: 288-298. 0_BABIGDIE
- Nagree Y, Camarda VJ, Fatovich DM, et al. Quantifying the proportion of general practice and low-acuity patients in the emergency department. Med J Aust 2013; 198: 612-615. 0_i1115608
- Moss, SM, Cuckle H, Evans A, et al; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomised controlled trial. Lancet 2006; 368: 2053-2060. 0_i1115610
- Pell JP, Haw S, Cobbe S, et al. Smoke-free legislation and hospitalizations for acute coronary syndrome. N Engl J Med 2008; 359: 482-491. 0_i1115613
- House of Commons Health Committee. Health inequalities: third report of session 2008–09. Vol 1. London: House of Commons, 2009. http://www.publications.parliament.uk/pa/cm200809/cmselect/cmhealth/cmhealth.htm (accessed Jun 2013).
- HM Treasury. The green book: appraisal and evaluation in central government. https://www.gov.uk/government/publications/the-green-book-appraisal-and-evaluation-in-central-governent (accessed Jul 2013).
- Department of Health and Ageing. Strategic review of health and medical research. http://www.mckeonreview.org.au (accessed Jul 2013).
Provenance: Commissioned; not externally peer reviewed.