Research priority: make Australia's health system efficient, equitable and integrated

This article is part of our series on the Science and Research Priorities recently announced by the Federal Government. You can read the introduction to the series by Australia’s Chief Scientist, Ian Chubb, here.

Kathryn North
Director of the Murdoch Childrens Research Institute, David Danks Professor of Child Health Research at the University of Melbourne and Chair of the National Health and Medical Research Council (NHMRC) Research Committee.

The national science and research priorities have been developed with the goal of maximising the national benefit from research expenditure, while strengthening our capacity to excel in science and technology.

In the area of health, the “national benefit” includes the development of evidence-based therapies and preventative strategies to improve physical health and mental well-being at the individual and population levels.

In 2012–2013, Australia’s national expenditure on health was estimated at more than A$147 billion, or around 10% of GDP, and this cost has steadily increased over the past two decades. So it is imperative that our research strategies also generate economic benefits by increasing the efficiency of our health-care system, reducing unnecessary investigations and therapies, and fostering partnerships with industry so that Australian discoveries are translated and commercialised within Australia.

On this basis, the Chief Scientist, Professor Ian Chubb, convened a working group comprising of 15 opinion leaders in health and medical research across the major research disciplines (clinical, health services research, population health, basic science), as well as representatives from industry and government, to identify the following major priority areas in health and medical research:

1. Better models of health care and services that improve outcomes, reduce disparities for disadvantaged and vulnerable groups, increase efficiency and provide greater value for a given expenditure

2. Improved prediction, identification, tracking, prevention and management of emerging local and regional health threats

3. Greater involvement of Indigenous people in the health system, with strategies for both urban and regional communities

4. Effective technologies for individuals to manage their own health care using mobile apps, remote monitoring and online access to therapies.

This article brings together experts from across the health spectrum to offer their views on the merits, challenges and opportunities presented by this research priority.

Sally Redman
CEO, Sax Institute

High-quality Australian research will be critical to understand the drivers of health expenditure and to identify and test solutions that can help contain costs while maintaining quality of care. The inclusion of “research that will lead to better models of care and services that improve outcomes, reduce disparities, increase efficiency and provide greater value” among the priorities is therefore particularly welcome.

Australia’s excellent and world-leading big health data sets – including large, long-term research cohorts and routinely collected information such as hospital and Medicare data records – will be central to this effort. Over the past few years, much work has gone into strengthening these data resources and making them more readily and safely available.

There has also been significant growth in research capacity and methodologies to analyse and interpret them. However, much remains to be done and it is good to see the priorities identify the need for a whole-of-government strategic approach to big data.

Establishing better models of care and services across Australia will also require more sophisticated approaches to the often complex task of evaluating their impact. This will include new research methods, stronger research and policy partnerships, and more effective ways of embedding rigorous research into the roll-out of new policies and programs.

Research to improve health outcomes for Indigenous people is also a welcome inclusion in the priorities. Future investment in Indigenous health must be driven by stronger evidence about the impact and sustainability of potential policy, program and service delivery options. This research should be conducted in partnership with Indigenous communities and now is also the time to invest in Indigenous research leaders.

James McCluskey
Deputy Vice Chancellor (Research), The University of Melbourne

Governments justifiably scrutinise the benefits of public funding in research. Health research is no exception and the mantra of the last decade has been around more effective “translation” of research into the clinic or population.

It’s fair to expect research will impact on the community in some way. However, the implication is that a lot of health research makes no difference and that there is a clear boundary between basic and applied research.

Experienced scientists know this is bunkum. Most breakthroughs come on the back of years of incremental research, with lines of sight between basic discovery and practical outcome often spanning 20 years or more, involving global effort and requiring decades of investment across all parts of the sector. In the meantime, we all want good value from our taxes.

Any list of health priorities will be long and subjective because we don’t have all the information for rational decisions. There is good data that health services can be massively improved in their efficiency and safety through research.

There is an agreed need for electronic medical records across the nation to simplify patient interactions with the health system and drive new research. Indeed, “Big Data” in health needs to be better harnessed to inform public health policy and practice. Indigenous health, preventative health, the personalised medicine revolution (genomics) and health equity all deserve prioritised investment.

On top of this short list, there needs to be a discovery component to our health and biomedical research sectors, mainly across the laboratory sciences. Without this there will be precious little to translate in the future.

What’s the best solution for such a complex equation?

An organising principle might be encouraging more collaboration and better integration across the health research community. When scientists, doctors, allied health professionals, hospital administrators, pharma and patients work together, the different ways of understanding health can drive efficiencies, create better outcomes and highlight natural priorities.

The recent designation of a small number of national Advanced Health Research Translation Centres aimed to do just this and at meaningful scale, even though they have no resources beyond the operating budgets of the partners.

Arguments around where we invest in health research might make more sense when the disparate parts of the sector are better informed with high-quality data and are collaborative in their efforts. Perhaps a starting point is to better use some of our resources to drive more integration and shared vision across the different elements of our health ecosystem.

Jane Gunn
Head of Department, Chair of Primary Care Research and Director of the Primary Care Research Unit at the University of Melbourne

Australia must get better value from the money we spend on health care. Too often, the public experiences disorganised and expensive health care that can make things worse, rather than better.

In the past we have focused research on what health care interventions should be delivered rather than on how to deliver them. The nation’s new research priorities are a welcome step towards redressing this imbalance and reforming the health-care system.

The current system is not supported by a strong research culture, resulting in a poorly integrated health care system. Poor integration means that people with multiple conditions and complex problems are falling through the gaps. We must invest in research which helps us to bridge these gaps by joining up the system.

To do this, we need a research workforce specifically trained for this difficult task. Implementation science – the science of getting evidence into practice – is gaining momentum around the world, but is embryonic in Australia. Better implementation science is an essential part of realising the new research priorities and integrating the system to deliver more seamless care.

Clinical data should be used to inform efforts to improve the system. Currently we have no standardised system for recording diagnoses and management across separate health care settings. This makes it extremely difficult to keep track of what is happening to people as they interact with the health care system.

The result is gaps and duplication in care which we struggle to identify and resolve. In so many ways we are working in the dark. The new priorities offer a chance to build an integrated health system that places research at the centre of reform.

Read more in our Science and Research Priorities series

The future of manufacturing in Australia is smart, agile and green

On the road: research can improve transport across Australia

Australia could become a leader in cybersecurity research

Kathryn North receives funding from the National Health and Medical Research Council and other government and non-government competitive research funding agencies. She was a chair of the expert working group for the Health Priority as a part of the Science and Research Priorities consultation process. She was Chair of NHMRC Research Committee from 2012-2015.

Jane Gunn receives funding from the National Health and Medical Research Council and other government and non-government competitive research funding agencies. She was a member of an expert working group for the Health Priority as a part of the Science and Research Priorities consultation process. She was a member of the NHMRC Research Committee 2009-2015. She is Chair of the Board of the Northern Melbourne Medicare Local Ltd and member of the Board of the Eastern Melbourne Healthcare Network.

Jim McCluskey receives research funding from the ARC, NHMRC and has been a recipient of Cancer Council Victoria grants. He is a director of the Walter and Eliza Hall Institute for Medical Research; the Bionics Institute; UoM Commercial, ASHA for Indian Slums; and is Chair of Nossal Institute Ltd. He has shares in ImmusanT, a U.S. Based company developing a vaccine for Celiac disease.

Sally Redman was a member of an expert working group that identified practical challenges for the Health Priority area as part of the Science and Research Priorities consultation process. The Sax Institute receives core funding from the NSW Ministry of Health and is supported by other government, non-government, philanthropic and competitive research funding agencies.