Australian Healthcare & Hospitals Association (AHHA)

Alison Verhoeven

Healthcare costs in Australia are on the rise due to an ageing population, an increasing burden of chronic disease, and the costs associated with new technologies, treatments and medicines. Australians have an average life expectancy of approximately 83 years. However, for many people, their life’s journey is expected to include chronic disease – which is likely to increase healthcare costs, both at an individual level and for the country.

In Australia, for more than 30 years, we have had Medicare – a universal health care system funded by the government, which ensures that all Australians have access to free public hospital care and free or subsidized care by general practitioners (most general practices being privately operated businesses). We also have a strong private health system, including private health insurers, private hospitals, dental services and allied health services such as physiotherapy. With increasing moves towards a more privatized system and higher out of pocket costs for consumers, the challenge is to continue to afford a universal healthcare system where everybody gets equal access to services and the opportunity to lead a healthy life. This is particularly the case when it comes to technological innovation and our expectations for technologically advanced facilities and medicines which may be costly.

"While investing in newer technologies, healthcare providers need to look at the outcome of the implementation, the cost associated with it and how that is going to reap benefit for citizens"

A strategic approach to investment

Because individual health services and providers make their own business investment decisions, investment in digital technologies varies from one healthcare provider to another. As a result, the digitization strategies for critical health system assets are often siloed and unconnected, notwithstanding current efforts by Australian and state and territory governments to ensure more coherent digital strategy. If we are to manage costs in our health system better, this fragmentation needs to be addressed.

"While investing in newer technologies, healthcare providers need to look at the outcome of the implementation, the cost associated with it and how that is going to reap benefit for citizens"

Notwithstanding the hybrid public-private health system, governments have the lead responsibility for stewardship of the Australian healthcare system. For this reason, the Australian government must take a proactive and leadership role in setting digital health standards and a framework for developing a uniform infrastructure – and it’s pleasing to see the Australian Digital Health Agency’s current work in this field.

The Agency is tasked with leading work on a national digital health strategy and to improve healthcare through the delivery of digital systems. Following the implementation of an opt-out approach for Australia’s national electronic medical record (MyHealth Record), the Agency is currently focusing on system interoperability. Ideally, the Agency will work with clinicians, health services and software providers to come up with a set of standard rules and tools which will support improvements in health services offered to Australians. This is complemented by work being undertaken by state and territory governments to implement digital health strategies across public hospitals.

Some barriers to overcome

While the pace of health innovation and technological change is rapid, the response of funders and healthcare organizations to these changes often lags, as governments and large siloed health organizations are unsurprisingly risk averse.

Cybersecurity issues are an example. There is justified consumer concern about the safety and security of data collected through electronic medical records. While both government and private healthcare providers have increased their focus on the privacy concerns of consumers, there has yet to be a fulsome debate in Australia about the privacy and security of health data, and this has led to reluctance by around 10% of the population to participate in the national MyHealthRecord. Equally, many clinicians and health services have been slow to participate, for reasons including concerns about security, the benefits of a national record, and the costs associated with participation. Addressing these concerns must be prioritized for a truly national electronic medical record and digital technologies more broadly, to become useful enablers for improving health care.

The cost of investment in technological innovation is also a challenge for public-funded health services that must prioritize the delivery of effective healthcare to an ever-increasing waiting list of patients, with limited budgets at their disposal. In this context, health technology assessments are critical. In making technology investment decisions, healthcare providers need to look at the potential health outcomes which will be achieved, the costs associated with implementation, and whether the investment represents a benefit for citizens.

One area that has received less attention than it should is the workforce. Investing in new technologies invariably will change workforce requirements – reducing the need for some skill areas, but opening or increasing need for other areas. An example is the health informatics workforce. There is much discussion about the power of big data, but skilled health informatics workforce is needed to realize that power. Likewise, a health business analytics workforce is required to support the acquisition, customization and implementation of new technological products. Innovations like artificial intelligence are rapidly changing the way that some clinicians, for example, radiologists and pathologists, perform their work. The education, funding and design of work across many clinical specialties will need an ongoing review to ensure value for patients, providers and health systems.

Personalized medicine is no longer a new frontier for exploration, as consumers seek more control over their health. Wearable medical devices like blood glucose detectors and heart health monitors can assist in improving health outcomes and reducing healthcare costs, particularly for those with chronic diseases. With an ageing population and a growing burden of chronic disease, keeping more people well for longer and away from hospitals is a goal for health systems in countries like Australia. Ensuring equitable access to technologically-enabled care will remain a challenge in our universal health system.

In a geographically diverse country like Australia, healthcare professionals need to leverage technology to make healthcare accessible and affordable for all people, wherever they live, including in regional, rural and remote locations. There is already significant use of telehealth in Australia, but provider payment models need to align with service models, and the limitations of internet infrastructure and speed must be addressed for comprehensive services to be made available. There is a role for governments to provide leadership in this area.

A last word

The decision to invest in new technologies is not about having the latest, shiniest, brightest equipment and is driven by much more complex considerations than simply cost-saving. All health investments must be able to demonstrate value for patients through better health outcomes, and increasingly that value equation must also be able to demonstrate value to the health system – in terms of both sustainability and equity. Technology can simplify and optimize the work of clinicians and health services to achieve better health outcomes, but it is not the purpose of this work.