Challenge: Incentivising state and territory health systems to rapidly invest in and adopt the latest and best evidence
Research can identify new practices that support the delivery of better, safe and higher quality health care, leading to faster and more complete recoveries and fewer readmissions, which are key drivers of cost. By identifying practices that are ineffective or sub optimal, research can reduce unnecessary expenditure on procedures, imaging and pathology.
Beyond hospitals and clinics, research provides the opportunity to prevent illness, injury and death through the identification of behaviours that increase mortality and morbidity and the design of programs that modify these behaviours.
However, this could only happen if our health systems can properly translate research findings into routine practice. In many areas we lack an understanding of the health outcomes that a particular research or innovation activity will support, or the process to achieve these outcomes. While change is everywhere, improvement in health system performance has flatlined: 60% of care on average is in line with evidence or consensus-based guidelines, 30% is some form of waste or of low value, and 10% is harm. The 60-30-10 ratio has persisted for three decades.1
In addition to being funders of and participants in research, state and territory health systems and health providers are a crucial ‘end user’ of health and medical research. We need to do more to engage the states and territories in the identification of research priorities and the design and conduct of research. Doing so will help build commitment to the adoption of research. This requires a more research aware and research active health system, as well researchers who are more engaged with end users of research.
Successive meetings of the Council of Australian Governments have emphasised the need for a whole-of-governments approach to innovation if we are to transform the delivery of healthcare.2 Although activity-based funding continues to be the preferred predominant approach for health care funding in Australia, many have suggested there is an opportunity for the addition of alternative funding models such as outcomes based and value-based funding models. These alternative funding models seek to align financial incentives with meeting a set of defined measures or are conditional on certain outcomes being achieved.3 These can have implications for how state and territory health systems and health providers participate in and utilise research.
2 At the December 2015 Council of Australian Governments meeting, the principle of a shared responsibility of the Commonwealth, state and territory governments for the planning and provision of healthcare was adopted.
3 the new National Hospital Reform Agreement Addendum 2020-25 introduces 6 long-term health reforms, and opportunities to establish the frameworks for system-wide attention to value-based health care, available at https://www.health.gov.au/initiatives-and-programs/2020-25-national-health-reform-agreement-nhra