The George Institute for Global Health congratulates Professor John Myburgh and Elsa Atkin for their Queens Birthday Honours.

Professor Myburgh, the head of TGI’s critical care and trauma division,has been recognised as an Officer (AO) in the General Division of the Order of Australia for distinguished service to medicine as an intensive and critical care practitioner, educator and researcher, and as an international innovator in patient management.

TGI board member Elsa Atkin was also recognised as a Member (AM) in the General Division for significant service to the conservation and protection of the natural, built and cultural heritage environment, to women, and to the arts.

We are proud to have such high calibre, national leaders associated with the institute.

Professor Chris Maher has been ranked as one of the world’s most expert back pain specialists.

Professor Chris Maher, of the George Institute for Global Health and The University of Sydney, leads the Institute’s musculoskeletal division. His ranking came from comparisons with 33,200 other research authors.

Professor Maher says he is delighted to be named as one of the world’s most pre-eminent back pain researchers.

“On any given day in Australia, one quarter of the population is suffering back pain, and nearly 80 per cent of adult Australians will experience back pain some time during their lives. It’s very, very common.”

Back pain is the leading cause of work loss days with 25 per cent of sufferers in the 18-44 age group taking 10 or more days off per year and costs Australia around $4.8 billion each year for health care. Yet research has shown that only a minority of people receive the best treatment for their back pain, said Professor Maher.

“Back pain is the most burdensome health condition in Australia, but ignored when setting health and research priorities. Partly that is because pain is invisible so some people tend not to think of it as a real health issue. Part of my role is change those sorts of misconceptions" said Professor Maher.

Expertscape is a medical ranking website, identifying and ranking expert based on scientific articles published.

“Among the individual experts and institutions demonstrating particular expertise in back pain, Expertscape would like to recognize the following ten for their pre-eminent contributions to its understanding and treatment,” Expertscape said in a statement.

Top Experts – Back Pain

1. Dr Maurits van Tulder – Vrije Universiteit Amsterdam
2. Dr Christopher Maher – George Inst for Global Health/University of Sydney
3. Dr Bart Koes – Erasmus University Rotterdam
4. Dr Richard Deyo – Oregon Health Sciences University
5. Dr Roger Chou – Oregon Health Sciences University
6. Dr Julie Fritz – University of Utah
7. Dr Steven P. Cohen – Johns Hopkins University
8. Dr Eugene Carragee – Stanford University
9. Dr Kate Dunn – University of Keele
10. Dr Steven George – University of Florida

Top Institutions – Back Pain

1. Vrije Universiteit Amsterdam
2. University of Sydney
3. University of Washington
4. University of Keele
5. Johns Hopkins University
6. Erasmus University Rotterdam
7. Mayo Clinic Rochester
8. University of Queensland
9. Maastricht University
10. Oregon Health Sciences University

The George Institute Principal Director Stephen MacMahon highlighted the need for smarter health spending, as he participated in a discussion held at the Australian Financial Review with Health Minister Peter Dutton.

The discussion centred on challenges around healthcare funding and the new medical research future fund.

“The George Institute has much to contribute to this debate,” said Professor MacMahon.

In the discussion, he emphasised the following points:

We need to be smarter about spending on healthcare and better identify waste:

Imaging for back pain costs $220M a year, of which no more than $20M is justifiable.

In addition, about 800,000 people are admitted every year for heart attack, with most discharged on treatment proven to prevent recurrence and early death by half. But after 12 months only 60% are still on their medication, with continuing declines thereafter.

Another way to spend smarter is making better use of routinely collected date - for example, using big data analytics and a single, shared electronic health record.

We need to strive for better health outcomes for all:

We need care innovations for the most vulnerable groups. Economic, ethnic or geographic disadvantage is associated with much greater use of public hospital services, and people in the lowest socio-economic groups suffer the greatest disease burden

Innovative programs are needed to care for older people, socio-economically disadvantaged people, people living in rural remote area and indigenous people - groups for whom Medicare co-payments are most likely to provide a financial barrier.

Innovation is also needed for improving the coverage, quality and integration of care, while controlling costs using:

• Technology – a single electronic health record, clinical decision support, remote monitoring, continuous quality management
• A greater role for non-physician healthcare workers, such as pharmacists, in primary healthcare

We need a stronger evidence base to inform healthcare reform:

A major focus of the medical research future fund should be to fund research on innovative strategies to improve healthcare quality while controlling costs. Large benefits could be achieved quickly if strategies were developed to improve delivery of treatments of known benefit. For example, improving care for patients with heart disease, which currently costs around $10B.

In addition, the amount of research funding directed to healthcare delivery investigations should be raised dramatically.

In 2013 the NHMRC budget total was $740M. The amount directed to basic laboratory research was $350M, or 47%, while the amount directed to research on healthcare delivery was $35M, or 4.7%.

Health industry and business leaders agreed that Australia’s health system requires urgent reform to ensure its sustainability, at a breakfast panel discussion held by The George Institute for Global Health at the Museum of Sydney to mark World Health Day.

The panel included Chair of the House of Representatives Standing Committee on Health and Ageing Steve Irons MP, AMA president Dr Steve Hambleton, George Institute board member and Chairman of Myer Holdings Paul McClintock AO, Professor Andrew Wilson, director of the Menzies Institute for Health Policy, and Professor Vlado Perkovic, director of The George Institute Australia.

The panel MC was ABC radio presenter Norman Swan.

The panel discussion took place against a backdrop of the run-up to the 2014 Budget, on the 30th anniversary of Medicare, and in a climate where elements within the Federal Government have repeatedly signalled an intention to focus on changes to Medicare.

Paul McClintock pointed out the Federal Government alone was spending $65b this year, including $19b on Medicare, with the Medicare levy raising just $9b of that amount. He said these programs had growth rates well in excess of CPI, and at the moment well in excess of the growth in tax revenue.

Two things could prompt Government action on creating a sustainable health system for Australia, he said.

“Firstly, the Commonwealth Government has a medium term fiscal challenge which will force it to spend considerable political capital educating the population to the idea that resources are limited.

“Secondly, the same government is committed to a fundamental review of the federal system, leading to a white paper during this term.  As soon as you start that process you hit the health system, and that will throw up an opportunity to look at the issues through a different lens.”

He said Australia should look to Dutch health reforms as a path forward, he said, as had been suggested by the 2009 National Health and Hospitals Reform Commission report.

Vlado Perkovic said health reform should begin now, as changes could take years to take effect. “What’s important is not what’s being spent now, it’s how much we will be spending as percentage of GDP in 10 or 20 years.”

He said it was important not just to rein in spiralling health costs, but also to improve the quality of health care, and reduce the colossal amount of waste. He pointed to a survey carried out by the ANZ Intensive Care Society, that found only five per cent of treatments given to an intensive care patient were supported by reasonable evidence.

Steve Hambleton said that Australia’s health care crisis was currently hidden behind comparisons to other countries, where the percentage of health spending was higher than in Australia. For example, Canada spends 12 per cent of GDP on health, compared to Australia’s nine per cent.

With the Australian Government saying it currently cannot afford to spend more on health, Dr Hambleton said the key was being smarter with health funding by concentrating on programmes and services where there is clear evidence of patient benefit. He said health care costs were rising because of an ageing population, more people with chronic and complex conditions, and high costs of new technology and hospital care.

Andrew Wilson said the crunch point that would finally prompt action on health care reform would come when it was recognised that Australia’s states, which have very limited revenue raising capacity, could no longer afford to run hospitals.

He was also concerned he said, about the affordability of healthcare for consumers, with rising out-of-pocket expenses, and a two-tiered health system that saw insured consumers able to access more extensive health care through the private system than those who used the public health system, even though 60+% of private health care costs were funded directly or indirectly by the public purse.

He suggested that it was important to look at the costs of the whole health care system and not just the public sector services. “Private health care services are experiencing the highest growth in the Australian health care system and if government is concerned about the total cost of health care, it needs to have strategies to look at this and not just to transfer these increasing costs to individuals through increased out-of-pocket expenses”.

Steve Irons said a current priority for the Government was a sustainable health system. “Research is a major part of our health system.” He said consultation was an important part of the Government’s approach, and it would be necessary to engage with the health industry. “We have to be mindful that health is such a big part of the Budget, and we have to get it right.”