Getting the healthcare we deserve

Governments are spending record sums on health research, yet arguably much of what will be spent will have little immediate relevance to the health experiences of ordinary individuals. It will provide little benefit to our children and their children and have even less impact on our own health: neither during the life of current governments nor during the long line of governments to follow will the impact of that research be seen.

That’s a big problem as we face spiraling health spending from rising costs and an ageing population. In Australia, the government’s proposed healthcare reforms rightly emphasize preventative healthcare to head off illness and avoid the need for later expensive procedures or treatments. But scrutiny of the procedures and treatments themselves has been scandalously scant, despite the blow-out in the health budget from four per cent to ten per cent of GDP since 1960. While the system is scrupulous in applying evidence-based research to determine the effectiveness of new drugs, similar safeguards seldom apply to procedures and treatments already in place. Consequently many treatments of dubious effectiveness continue to be used at the expense of exploring positive alternatives.

This brings us to the key role of research. Research is considered by many to be the unglamorous end of the medical profession, even when it holds the promise of a breakthrough. However, research that assess how best to implement known cures, treatments and procedures – is right at the bottom of this glamour hierarchy, much to our cost. We’ll never get a Nobel Prize for research that identifies how best to get older people to undertake exercise to improve balance and prevent falls. Yet this unglamorous research has the potential to substantially curtail healthcare costs, because fall-related fractures are a major contributor to long hospital stays, nursing home costs, disability and death.

So who should be setting the research agenda? Surely there is an important role for those who are trying to manage patients and the healthcare budget?

Notably, the UK has switched a significant proportion of its health research spending to issues of healthcare delivery rather than biology. The British Government has recognised that end users, healthcare providers, and governments should have a major role in determining research priorities and that these stakeholders, should determine where health research dollars are spent.

We are working in partnership with Oxford University and the UK government to develop a greater research focus and approach to innovation in healthcare, involving researchers, health decision makers and clinicians. In this model all the links in the health chain – hospitals, community health centres, medical research institutes, universities and governments – will be integrated around a national centre which ensures government and community priorities are translated into a research focus.

Taken together with similar initiatives in Australia, India and China in which The George is also involved, a vision emerges of a global network of national centres for healthcare innovation.

We have much to share with China and India as their healthcare systems grow in scale and sophistication to meet the challenges of providing adequate healthcare in rural as well as urban areas. But there is no way China and India will be able to afford, in our lifetimes, healthcare systems with comparable per capita costs to our own, so more cost effective treatments and procedures simply have to be found.

Government policies to date have arguably been driven, in large part, by political, financial and bureaucratic considerations. Global health reform provides the opportunity, for a research agenda where the majority of funding targets the questions of greatest immediate relevance, with benefits to the community that are sustainable in the longer term.