Challenge: Uncoordinated funding sources for health and medical research leads to breaks in the pipeline, inefficiencies and exclusions
Health and medical research is funded and administered by at least five separate federal portfolios (Health, Education, Industry/innovation, Defence & Foreign Affairs). State and territory governments are also providing varying levels of funding, so too are non-government organisations across philanthropy, private healthcare and industry.
While each provides valuable funding, these sources have grown independently with little inter-scheme coordination resulting in duplication of effort and inefficient allocation of funding in some places. Most importantly running multiple, uncoordinated streams of research adds to the administration costs for funders. It is a disincentive for attracting funding from other sources, including private capital and philanthropy.
Another area of focus is consistency of funding. Funding and incentives are available for some stages along the journey for both commercial and non-commercial translation, but the connections between these different stages are tenuous, or do not exist. While the National Health and Medical Research Council (NHMRC), Medical Research Future Fund (MRFF), Australian Research Council (ARC) and other programs provide strong funding for projects at particular stages, there is not seamless support for research and innovation from concept to delivery. There are too many barriers to collaboration between publicly funded researchers, the private sector and the health system.
Multiple funding streams exacerbate the problem that researchers expend several months every year submitting numerous applications to programs with low success rates.
As a consequence of this lack of strategic coordination, Australia is not fully exploiting health and medical research and innovation as a resource to improve the efficiency and productivity of our health system and its health workforce.1 With Australian healthcare expenditure in 2018-19 estimated to be $196 billion, even small improvements in efficiency and productivity can provide significant dividends benefitting the health of Australians, and the broader economy.2 We are also failing to capitalise on the full commercial potential of our research and innovation, and the job opportunities and prosperity doing so can provide.
There are examples in other parts of the Australian economy we can draw on, such as the drive for clean energy. Basic research is undertaken at universities, funded by the Australian Research Council. Translational research is undertaken by a broader range of organisations, including universities, the CSIRO, Cooperative Research Centres and companies, and is funded from a broader range of sources. Demonstration programs are implemented by companies with support from research organisations and funded by the Australian Renewable Energy Agency (ARENA). Funding for early stage commercial deployment of technology by companies is funded by the Clean Energy Finance Corporation.3
A National Health and Medical Research Strategy
Imagining and preparing for the Australia we want in 50 years’ time must start today. An overarching national research strategy that ensures coordinated, strategic public investment in all stages of research, would maximise impact in areas of greatest need and exploit areas of international competitive advantage.
Over half of the 20 reviews into health and medical research conducted in Australia over the last 15 years have recommend establishing a National Health and Medical Research Strategy. The McKeon Review said a national strategy would, ‘…deliver the vision to build and maintain a healthy and wealthy Australia that has the world’s best and most efficient health system.’4
A 2021 report from Industry, Innovation and Science Australia (IISA) recommends whole-of-government innovation, science and research priorities to drive investment decisions. The IISA report also recommends appropriate funding for the indirect costs of research and ensuring investment in basic research does not fall below current levels (22% of overall R&D investment).5
Similarly, the 2020 National Strategic Action Plan for Rare Diseases recommends a national research strategy ‘…to foster, support and drive all types of research for rare diseases, contributing to agreed priorities and systematically addressing gaps’.6
There is support from the sector itself for reframing of Australia’s ‘system’ for funding health and medical research.7
As a result of COVID-19, now, more than ever, there is public goodwill toward this national capability. A modern National Research and Innovation Strategy for Health could be focused around:
- a clearly defined process for funding health and medical research from basic research to translation (commercial and non-commercial) with clearly articulated, complementary roles for the multiple streams of federal funding;
- implementation, including manufacture, of a product or technology and/or adoption as routine clinical care;
- connecting research innovation to improved public and patient outcomes;
- a coordinated plan for selecting priority translational Australian biomedical research; and
- situating health and medical research within national research priorities of related areas including industry and innovation policy.
Challenge: Who drives a National Health and Medical Research Strategy?
While there are currently different bodies responsible for parts of health and medical research policy and funding, there is no body with the remit for a whole-of-government national strategy.
Such a body could provide guidance on high-level national research priorities and the collaborations that can be formed to support those priorities. Its role would include an information exchange to avoid unnecessary duplication of research efforts and funding programs within the Commonwealth as well as with the state and territory governments and other sources such as philanthropy and industry.
Such a body will require careful implementation. It must be cognisant of the roles and activities of state and territory governments and provide opportunities for their participation, particularly as providers of health services. It should not replicate or replace the AMRAB or the NHMRC’s Research Council.
The United Kingdom’s independent Office for Strategic Coordination of Health Research (OSCHR) offers a possible model for Australia.8
The OSCHR was created to facilitate a cultural change among the public funders of health research to address the barriers to research collaboration and to support the application and translation of basic research into patient care and economic benefit.9
OSCHR Board is made up of key representatives from government departments and agencies, universities, medical research institutes, research funding bodies (like Australia’s MRFF, NHMRC, ARC) and other representatives from the Wellcome Trust, Association of Medical Research Charities and Research England.
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1 Similar issues lead to the creation of the UK Office of Strategic Coordination of Health Research
2 Australian Institute of Health and Welfare 2020. Health expenditure Australia 2018–19. Health and welfare expenditure series no.66. Cat. no. HWE 80. Canberra: AIHW.
3 See for example, https://www.cefc.com.au/
4 Department of Health, Strategic Review of Health and Medical Research Summary Report, 2013
5 Ibid, Australian Government, Industry, Innovation and Science Australia, 2021
7 Research Australia polled 1200 medical researchers in June 2020 and Nearly two thirds of medical researchers (62.5%) support a longer-term restructure of Australia’s health and medical research funding framework.
9 HM Treasury, A review of UK health research funding, 2006.