tag:theconversation.com,2011:/fr/topics/mckeon-review-2879/articlesMcKeon Review – The Conversation2013-06-28T04:33:35Ztag:theconversation.com,2011:article/155902013-06-28T04:33:35Z2013-06-28T04:33:35ZCoalition policy aims to protect and streamline medical research<figure><img src="https://images.theconversation.com/files/26375/original/ywq7xn6g-1372385772.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Tony Abbott has a history of supporting medical research since his time as health minister under John Howard.</span> <span class="attribution"><span class="source">Paul Miller/AAP</span></span></figcaption></figure><p><a href="http://lpa-webdata.s3.amazonaws.com/policy/ProtectandStreamlineHealthandMedicalResearchFunding.pdf">The Coalition’s Policy to Protect and Streamline Health and Medical Research Funding</a> is one of the first documents off the blocks this election. Short and sweet, it is designed to appeal to medical researchers and to the broader community.</p>
<p>Implicit in the message is the familiar insinuation that current practice is bureaucratic and wasteful and in need of streamlining. But there are more interesting echoes in there as well.</p>
<h2>A strong history</h2>
<p>One of the main messages is that under the last Coalition government, medical research benefited from strong investment and Tony Abbott was an influential health minister who prided himself on an almost visionary commitment to funding high-tech research.</p>
<p>It was a good time to be a researcher. Across the world, medical research investment was booming. With John Howard’s support Abbott built on the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/8F72CFAE3493111DCA257058007A16BE/$File/summary_document.pdf">1998 Health and Medical Research Strategic Review</a> and pumped in resources. </p>
<p>And it was the right approach – investment in medical research is good for individuals and good for the economy. It was no surprise that when Abbott delivered his <a href="http://liberal.org.au/Budget_Reply_2013">budget response speech</a> this year, he began by celebrating Australia’s proud history of medical research.</p>
<p>Then, in Kevin Rudd’s previous government, health-care delivery displaced medical research and the research agenda turned to science rather than medicine under another effective minister, Kim Carr. Most recently, a bipartisan obsession with the budget deficit has delivered a series of research cuts and threats of cuts.</p>
<p>Each time cuts are foreshadowed there is debate and angst and in itself this is wasteful. Researchers recall Barry Jones’ stinging rebuke about scientists being political wimps. So now we mobilise. </p>
<p>A while back, <a href="http://theconversation.com/profiles/douglas-hilton-831/activities">Professor Doug Hilton</a> of the Walter and Eliza Hall Institute pioneered the <a href="http://www.discoveriesneeddollars.org/home/">Discoveries Need Dollars</a> initiative and headed off what would have been damaging cuts. His campaign prevailed and we are all grateful.</p>
<h2>Changing the grant process</h2>
<p>As well as the waste involved in constantly defending budgets, another type of waste has crept in. It’s no one’s fault really. In an effort to be fair, the fund allocation or granting process has become so elaborate that it is sapping our strength. </p>
<p>Some interesting work by <a href="http://www.qut.edu.au/research/research-projects/funding-evidence-based-medicine">Adrian Barnett, Danielle Herbert and Nicholas Graves</a> has exposed how much time (550 years for <a href="http://www.nhmrc.gov.au/grants/apply-funding/project-grants">NHMRC Project Grants</a> in 2012) and money (AUD$66 million in salary costs alone) is spent on the granting process. If you’re a researcher, you can contribute your own experiences via their survey <a href="https://survey.qut.edu.au/f/176988/ac9a/">here</a>.</p>
<p>The 2011 Strategic Review of Health and Medical Research (<a href="http://www.mckeonreview.org.au/">McKeon Review</a>) also pinpointed this problem. The Coalition policy focusses on this issue and suggests:</p>
<ul>
<li>aligning the National Health and Medical Research Council (NHMRC) and Australian Research Council (ARC) grant systems; </li>
<li>introducing a triage to cut out non-competitive applications; and </li>
<li>transitioning to five-year, rather than three-year grants. </li>
</ul>
<p>The 2011 <a href="http://www.theaustralian.com.au/higher-education/opinion/we-must-rebuild-our-grants-system/story-e6frgcko-1226516110682">Nobel laureate Brian Schmidt</a> has independently called for five-year ARC grants.</p>
<p>I fully support these aims but would warn that, at present, there are relatively few grants not deserving funding. There are grants from new researchers who are perhaps not quite ready but, during my career, I’ve seen very few dud applications. I expect the saving from the cull will be small.</p>
<p>There are other savings that can be made. A “just-in-time” system can be introduced so that only the fifth or so of grant applicants who are funded have to provide budgets and other details. That would save a lot of people from needless and painstaking tasks.</p>
<p>We could also do away with the repetitive summaries, synopsis and team record statements that arose as it became clear that whole grant applications were so long that they needed summarising. </p>
<p>We should also consider what value external assessors and rebuttals to these assessments provide.</p>
<h2>Becoming strategic</h2>
<p>Most importantly, the policy implicitly embraces the <a href="http://www.mckeonreview.org.au/">McKeon Review</a>. The Review recommended that rather than ad hoc start-stop funding, we adopt a strategic approach where a set proportion of health spending is dedicated to research for the future. This would be a huge step forward for Australia.</p>
<p>The main controversial thing about the policy is that by fixating on medical research, it tends to imply that other research is less valuable. Obviously, knowledge covers the spectrum like a rainbow, and it’s impossible to tell where medical research ends and other disciplines begin. </p>
<p>In my own work in molecular biology I use microscopes, centrifuges, and sequencing machines. Every day, I am grateful to mathematicians, physicists, engineers and others whose work has made my medical research possible. </p>
<p>I’m not sure how much further we’ll get if these people are sent to the back of the funding queue. All research, not just demonstrably applicable medical research, should be considered. </p>
<p>The Coalition policy is a start and what we need now is a strategy to provide stable funding, not just for medicine, but for all Australian research.</p><img src="https://counter.theconversation.com/content/15590/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merlin Crossley works for the University of New South Wales and receives funding from the National Health and Medical Research Council and the Australian Research Council.</span></em></p>The Coalition’s Policy to Protect and Streamline Health and Medical Research Funding is one of the first documents off the blocks this election. Short and sweet, it is designed to appeal to medical researchers…Merlin Crossley, Dean of Science and Professor of Molecular Biology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/139972013-05-12T20:08:40Z2013-05-12T20:08:40ZWho gets a piece of the pie? Spending the health budget fairly<figure><img src="https://images.theconversation.com/files/23532/original/yn5tv8f4-1368335371.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Health-services research can help work out how best to share the health-funding pie.</span> <span class="attribution"><span class="source">Wout/Flickr</span></span></figcaption></figure><p><em>In the eighth part of our series <a href="https://theconversation.com/topics/health-rationing">Health Rationing</a>, Philip Clarke and Nicholas Graves suggest ways to make the health-care system more efficient and affordable.</em></p>
<hr>
<p>Who would want be the health minister? If anyone is considering the job, they should watch the <a href="https://theconversation.com/qandas-health-debate-the-experts-respond-13685">recent episode</a> of <a href="http://www.abc.net.au/tv/qanda/txt/s3732232.htm">ABC TV’s Q&A</a> when Commonwealth Minister for Health Tanya Plibersek and the Shadow Minister Peter Dutton faced questions from key stakeholder groups.</p>
<p>With one or two exceptions, almost all questions were the same: my issue is X, so when will the government spend millions and, in some cases, billions of extra dollars to address my problem?</p>
<p>Governments have responded to this type of lobbying in the good times by spending more money, but we now live in much more difficult times. Scarcity of resources is biting hard, and the government expects budget deficits over the next few years.</p>
<p>The correct answer for the health minister to questions from stakeholders would now be that we need to allocate the funds we have more efficiently, so we can find the money for new projects. When we fund these projects we need to ensure they represent value for money.</p>
<p>Economists think about efficiency in two complementary ways. Allocative efficiency is where we are “doing the right things” and choosing the best mix of services to provide. Technical efficiency is “doing things right” and producing the best mix of services at the lowest possible cost. Both are required for the health-care system to be efficient overall.</p>
<p>There’s no better example of technical inefficiency in our health-care system than the way we set prices for generic drugs on the Pharmaceutical Benefits Scheme (PBS). Australians are paying some of the highest prices in the world for generic medications because of poor policy decisions as detailed in a recent <a href="http://ceda.com.au/">report</a> by the independent think tank Committee for Economic Development of Australia (CEDA). If we could improve our purchasing of generic drugs, more than a billion dollars extra a year could be released for other uses.</p>
<p>Australia prides itself on being one of the first countries to try to improve allocative efficiency by explicitly using economic evaluation when listing new drugs on the PBS. But the use of these methods is more the exception than the rule when making health-care decisions.</p>
<p>For instance, there’s no systematic attempt to evaluate hospital-based interventions to determine the ones that are the most cost-effective.</p>
<p>So where do we go from here? It is worth looking at the recently released <a href="http://www.mckeonreview.org.au/">McKeon Strategic Review of Health and Medical Research</a>, which concerned itself with making stronger connections between research evidence and the delivery of health-care services. The report flags building capacity among health economists and health-services researchers in Australia as crucial for improving health services.</p>
<p>A systematic program of health-services research is one way of separating vested interests from those of the whole community. Having academics undertake most this research is critical because unlike consultants, academics must test the evidence for any proposed policy changes through peer review and can come up with new solutions that go against the prevailing wisdom.</p>
<p>If our goal is to connect health economics and health-services research with clinicians and decision-makers, then existing ways of working are likely to be insufficient. The main approach identified in the review is to expand <a href="http://www.nhmrc.gov.au/">National Health and Medical Research Council</a> (NHMRC) funding in this area, and the creation of an institute of health-services research.</p>
<p>But we have been here before. Over the years, the NHMRC has introduced various initiatives, including several rounds of funding specifically for health economics and health-services research. Such funding generally goes to only a few groups and they have a maximum of five years’ funding to develop a research agenda.</p>
<p>We think an entirely different mode of funding is required and we could learn much from the <a href="http://www.nihr.ac.uk/Pages/default.aspx">National Institute of Health Research</a> (NIHR) in England.</p>
<p>The main role of NIHR is to commission policy-relevant research through boards that involve academics, policy makers and those involved in service delivery. This ensures the questions researchers are addressing are relevant to current decisions.</p>
<p>And having commissioning boards means there’s a separation between those commissioning work and those undertaking it. This makes the funding of health services-research in England flexible, transparent and competitive.</p>
<p>Another crucial feature of the English system is the framework for dissemination. While all researchers are encouraged to publish their commissioned research in peer-reviewed journals, the final report is published in its own <a href="http://www.hta.ac.uk/research/HTAjournal.shtml">Health Technology Assessment</a> journal. This ensures the findings of all past research can be found in one place. It also helps avoid duplication and makes it very easy for a policy maker to find relevant research on any topic.</p>
<p>We don’t want to sound like another lobby group asking for more money, so we suggest the funding for the expansion of health-services research should come largely from existing resources, such as the $40 to $50 million a year the commonwealth department of health currently spends on consultants. Setting up the right processes rather than the level of funding is likely to produce more bang for your health-services research buck.</p>
<p>An effective Australian health-services research institute would help future health ministers provide better answers to the kinds of questions they will face on shows like Q&A.</p>
<p><br>
<em><strong>This is the eighth part of our series <a href="https://theconversation.com/topics/health-rationing">Health Rationing</a>. Click on the links below:</strong></em></p>
<p><strong>Part one:</strong> <a href="https://theconversation.com/tough-choices-how-to-rein-in-australias-rising-health-bill-13658">Tough choices: how to rein in Australia’s rising health bill</a><br>
<strong>Part two:</strong> <a href="https://theconversation.com/explainer-what-is-health-rationing-13667">Explainer: what is health rationing?</a><br>
<strong>Part three:</strong> <a href="https://theconversation.com/a-conversation-that-promises-savings-worth-dying-for-13710">A conversation that promises savings worth dying for</a><br>
<strong>Part four:</strong> <a href="https://theconversation.com/phase-out-gp-consultation-fees-for-a-better-medicare-13690">Phase out GP consultation fees for a better Medicare</a><br>
<strong>Part five:</strong> <a href="https://theconversation.com/focus-on-prevention-to-control-the-growing-health-budget-13665">Focus on prevention to control the growing health budget</a><br>
<strong>Part six:</strong> <a href="https://theconversation.com/health-funding-under-the-microscope-but-what-should-we-pay-for-13788">Health funding under the microscope – but what should we pay for?</a><br>
<strong>Part seven:</strong> <a href="https://theconversation.com/comparing-apples-pears-and-hips-health-rationing-at-work-13785">Comparing apples, pears and hips: health rationing at work</a>r</p><img src="https://counter.theconversation.com/content/13997/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Prof Philip Clarke receives funding from the Australian National Health and Medical Research Council (NHMRC), the English National Institute for Health Research (NIHR), the United States National Institute for Health (NIH) and various Swedish Research Councils. Given that his research relates involves health economics, he may benefit from an expansion of health services research funding in Australia.</span></em></p><p class="fine-print"><em><span>Nicholas Graves receives funding from ARC, NHMRC, NIHR, QLD Government. He is the academic director of the Australian Centre for Health Services Innovation.</span></em></p>In the eighth part of our series Health Rationing, Philip Clarke and Nicholas Graves suggest ways to make the health-care system more efficient and affordable. Who would want be the health minister? If…Philip Clarke, Professor of Public Health, The University of MelbourneNicholas Graves, Professor of Health Economics, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/132892013-04-09T01:03:06Z2013-04-09T01:03:06ZDon’t bury the benefits of research to improve the health system<figure><img src="https://images.theconversation.com/files/22178/original/5mrmsgwn-1365399052.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Research should be routinely performed as part of health-care delivery.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>If you missed the release of the <a href="http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf">McKeon review</a> on Friday you’re not alone. The Commonwealth government released the <a href="http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf">Strategic Review of Health and Medical Research</a> just before the weekend – a time usually reserved for reports the government would rather bury – and it <a href="http://www.theaustralian.com.au/news/breaking-news/set-rd-health-budget-target-review/story-fn3dxiwe-1226613276340">barely got a mention</a> in the mainstream media.</p>
<p>The government commissioned the review panel, headed by Simon McKeon, in 2011 to investigate the state of health and medical research in Australia. The panel released a <a href="https://theconversation.com/mckeon-review-we-need-to-integrate-research-and-health-services-9742">consultation paper</a> October and delivered the final report to government in March. </p>
<p>The review sets out a ten-year strategy to better integrate health and medical research into the public health system. To improve the health system and contain its rising cost, the report states that “research must be routinely performed as a part of health-care delivery and there must be greater linkage between health-care providers and research organisations.”</p>
<p>This is an energising vision. The current reality could hardly be more different. Apart for pockets of clinical research, such as drug trials and evaluation research by <a href="https://theconversation.com/explainer-what-is-comparative-effectiveness-research-11319">specialist clinical groups</a> to assess the effectiveness and worth of medical interventions in real-life scenarios, research is not a strong player in the health system. </p>
<p>As a result, the connection of health services to research is informal and erratic, with <a href="http://www.mckeonreview.org.au/downloads/Strategic_Review_of_Health_and_Medical_Research_Feb_2013-Final_Report.pdf">estimates that 43% of Australians not receiving</a> appropriate, evidence-based care. The CareTrack Australia study found that nearly 90% of patients with sinusitis were prescribed antibiotics, where this was known to be ineffective. And just 18% of asthmatics had a documented action plan for when they had an attack.</p>
<h2>The solutions</h2>
<p>The McKeon Review explores how this might be remedied.</p>
<p>First, money. The report calls for the investment of 3-4% of government health expenditure in health and medical research, up from around 2%, or A$1-1.5 billion. </p>
<p>The rub will be in the extent to which this increased investment will be shared among state and territory health ministries and the Commonwealth. </p>
<p>But motivation to invest may be stimulated by the formation of <a href="https://theconversation.com/explainer-why-australia-needs-advanced-health-research-centres-1139">integrated health research centres</a> (IHRCs) which combine “hospital and community-care networks, universities, and research organisations such as medical research institutes”. These institutions would give state and federal governments a stake in the research conducted within them, with an open corridor to apply the research in the associated health-care facilities.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=971&fit=crop&dpr=1 600w, https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=971&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=971&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1220&fit=crop&dpr=1 754w, https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1220&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/22200/original/78kt95k2-1365468007.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1220&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Practical research would attract a greater proportion of NHMRC funding.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Strategic research, which encompasses research with a specific, practical focuses such as vaccine development and the evaluation of different forms of care for the frail aged, would be elevated from single figures to consume 10-15% of the <a href="http://www.nhmrc.gov.au/">National Health and Medical Research Centre</a> (NHMRC) budget. </p>
<p>This would be politically feasible only if the NHMRC budget was simultaneously increased: push-back from the laboratory scientists would otherwise prove intractable.</p>
<p>Second, dedicated funding will be needed to grow capacity within the research empire to contribute to the quality and efficiency of health services through research. At present, health services research sits low on the status totem of research, and funding for the development of a research workforce in this field is low, although it is growing. </p>
<p>Third, Australia should maintain its current excellence in research. This would enable Australian research to hold its head high in international research forums, rapidly access research findings for application in Australia, and grow the intellectual base of research so it can support applied and health service research efforts. </p>
<h2>Potential barriers</h2>
<p>When grand plans such as these emerge, we need to ask who’s buying and who’s selling. We need to see what the buyer (the various arms of the health service) will get for the money it is expected to contribute. The seller (the research community) will need to come up with far more impressive evidence that it can indeed help cut health care costs, improve quality and increase efficiency.</p>
<p>If the federal government considers the proposals to be good, it will need to reach deep into its pockets to convince the buyers that this is the product they have been waiting for. Federal health minister Tanya Plibersek <a href="http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr13-tp-tp025.htm">has said</a> she will take the report to the standing council on health for discussion with the states and territories. Her reception will be much warmer if she comes carrying gold.</p>
<p>Whatever is decided, any implementation implies change. I can’t imagine that the change required by this report will happen without elaborate, deliberate and adequately-funded management.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=717&fit=crop&dpr=1 600w, https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=717&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=717&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=901&fit=crop&dpr=1 754w, https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=901&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/22201/original/snj37wdb-1365468174.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=901&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Translational research will need to go far beyond introducing a laboratory insight at the bedside.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<p>For the McKeon report to succeed, we will need to invest more resources into bridging the cultural and intellectual gap between health services and research, which is currently very wide. Those who manage the system and focus on health-care delivery do not necessarily share the enthusiasm or expectations of career scientists.</p>
<p>Indeed, translational research (a very popular term without clear meaning) will need to go far beyond introducing a laboratory insight at the bedside. Clinicians will need to feel that the questions they are asking are being taken seriously by the research community. This is an exciting challenge, although a large one.</p>
<p>Overall, the McKeon review provides an energising view of what could be done to bring health care and research together in productive partnerships. Every innovative industry needs high quality research and development – and health is no exception. </p><img src="https://counter.theconversation.com/content/13289/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Leeder is a professor of public health and community medicine at the University of Sydney and chairs the board of the Western Sydney Local Health District.</span></em></p>If you missed the release of the McKeon review on Friday you’re not alone. The Commonwealth government released the Strategic Review of Health and Medical Research just before the weekend – a time usually…Stephen Leeder, Professor, Menzies Centre for Health Policy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/127292013-03-08T06:02:41Z2013-03-08T06:02:41ZHealth review panel adjusts funding recommendations<figure><img src="https://images.theconversation.com/files/21107/original/55y22pbt-1362722314.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The McKeon review of health and medical research funding is now in the government's hands with the review panel stepping up its focus on the return on investment.</span> <span class="attribution"><span class="source">Paul Miller/AAP</span></span></figcaption></figure><p>The McKeon review of health and medical research has reduced its short term funding bid in the face of current federal budget pressures.</p>
<p>The draft review, released in October last year, suggested an additional $2-3 billion a year for the next ten years was required to address the escalating cost of healthcare.</p>
<p>The final report, handed to the government last week, is understood to have divided the funding bid into two five year periods, with investment accelerating in the second half of the decade-long period.</p>
<p>The final report is also understood to have a much stronger focus on making an investment case for the government. Review chairman Simon McKeon said the review panel had to have some regard for the declining fiscal position of the nation.</p>
<p>“We looked more critically at our recommendations particularly around expenditure and in one or two cases they moved out a little bit over time,” he said.</p>
<p>“We think the package as a whole is the right one, it is affordable over a sensible time frame, but there’s a bunch of things that can be done in the first couple of years that don’t require a lot of funding.”</p>
<p>The review panel made 21 recommendations in the draft report, including redirecting at least 3% of the Federal Government’s public sector health budget to research.</p>
<p>It also recommended up to 1000 fellowships for doctors and the establishment of “Integrated Health Research Centres”, bringing together hospital networks, universities and medical research institutes, to fast-track the discoveries that would bring the greatest benefits to patients.</p>
<p>Mr McKeon said the panel wasn’t suggesting a pilot as was the case with the National Disability Insurance Scheme, but that it was important for the process to be reviewed after an initial five-year period, given its size and importance.</p>
<p>He added that after 19 months, the review panel still didn’t have an answer to the critical question of how much is spent on health and medical research and what the country gets in return.</p>
<p>“There does need to be developed a focus on health economics that we don’t have enough in this country,” he said.</p>
<p>Health economist Nicholas Graves said Australia needed to generate some systematic programs of health services research, a large part of which includes measuring costs and outcomes.</p>
<p>“Scarcity and lack of funding is the biggest public health issue we face and the way we respond to it is going to be the biggest issue over the next decade.”</p>
<p>He cited the UK’s National Institute for Health and Clinical Excellence as a body that helped the government of the day make decisions about health funding.</p>
<p>“It’s something for the politicians to hide behind,” Dr Graves said.</p>
<p>“We can generate the evidence but actually getting decision makers to act on the evidence is very difficult indeed.</p>
<p>"Bold reform in health is a dangerous activity because if they get it wrong they get hung out to dry by the media and they lose their portfolio.”</p>
<p>Mr McKeon said the community as a whole regularly said that health was the most important issue.</p>
<p>“The government often talks about jobs and the economy but actually survey after survey says if you’re only allowed to focus on one thing, it’s health.</p>
<p>"We have the opportunity to build on what is a good system but we can’t take it for granted.”</p><img src="https://counter.theconversation.com/content/12729/count.gif" alt="The Conversation" width="1" height="1" />
The McKeon review of health and medical research has reduced its short term funding bid in the face of current federal budget pressures. The draft review, released in October last year, suggested an additional…Charis Palmer, Deputy Editor/Chief of StaffLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/101452012-10-17T00:34:42Z2012-10-17T00:34:42ZMcKeon review should consider the well-being of health system<figure><img src="https://images.theconversation.com/files/16609/original/d5xv989c-1350432254.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We need to research the health of the health system for the sake of sustainability.</span> <span class="attribution"><span class="source">Greg Boege</span></span></figcaption></figure><p>The <a href="http://www.mckeonreview.org.au/10857/Consultation_Paper/">consultation paper</a> by the panel of the <a href="http://www.mckeonreview.org.au/">McKeon Review</a> is available and open for public comment now, so it’s worth examining whether this review (the latest of many into health and medical research) is different from those that have come before. </p>
<p>We can also now assess whether the current recommendations will meet what McKeon has called “the overarching message” of the review - that Australia needs a “stronger connection between health and medical research, and the delivery of health-care services”.</p>
<p>Although this is a summary document (the detailed paper is expected to be released in the next week or so), in general, the recommendations are familiar. Since at least the 1960s, reviews of Australian health and medical research have called for greater investment in health services and systems research to meet the challenge of maintaining a sustainable health-care system. </p>
<p>It’s gratifying to see recognition of the need for health systems research and health economics. Although its not new, the emphasis in this review is stronger than other recent reports. But it fails to grasp the breadth of research required in this area.</p>
<p>As well as informing delivery of services, research also needs to inform “big picture” health policy. While some aspects of health care provision, such as efficacy, quality and safety will benefit from research evidence produced at the level of service delivery, we also need evidence about how efficient, accessible and equitable the health system is.</p>
<h2>A better way</h2>
<p>Unlike many other Australian government policy areas, the <a href="http://www.health.gov.au/">Department of Health and Ageing</a> doesn’t have its own internal research capacity or funding; it relies on the National Health and Medical Research Council (<a href="http://www.nhmrc.gov.au/">NHMRC</a>) to fulfil this role. This may be appropriate for biomedical and clinical research, but it doesn’t work for health services, health policy and health economics research. </p>
<p>We’re disappointed that the report has recommended that the management and leadership of health services research be left with the NHMRC, given the organisation’s poor track record in supporting this type of research. We believe that to truly achieve evidence–based policies, the review should recommend a similar approach to the United Kingdom, where the <a href="http://www.dh.gov.uk/en/index.htm">department of health</a> has its own policy research program and the <a href="http://www.nhs.uk/Pages/HomePage.aspx">National Health Service</a> (NHS) has the <a href="http://www.nihr.ac.uk/Pages/default.aspx">National Institute of Health Research</a>, in addition to the separate <a href="http://www.mrc.ac.uk/index.htm">Medical Research Council</a>. </p>
<p>A new Australian institute of health systems research would be the recipient of quarantined funding for health systems and health services research. This would fall in line with the review’s recommendation that at least 3% of Australian and state and territory government health expenditure (an additional A$2bn to A$3bn per year by mid-2023) be set aside to drive research activity within the health system as an embedded component of the Australian government’s health reforms. </p>
<p>The second important task for such an institute would be to set priorities for health systems research. While the review supports priority setting for research with earmarked funds, many researchers have been less than satisfied with previous priority setting processes in this type of research. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/16608/original/9kjydtxy-1350431946.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><span class="source">marsmet521/Flickr</span></span>
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<p>Over the past 15 years, we have seen a diverse range of attempts at health system and services research, including ones based on national health priorities, national research priorities, a priority-based collaboration between the states and the commonwealth, partnership projects and now partnership centres. </p>
<p>While consultations were undertaken prior to each new scheme, no independent evaluation has assessed the success or otherwise of these schemes. And most have come and gone so fast that, in practice, the individual research projects they supported resembled poorly-funded commissioned projects.</p>
<h2>Building research capacity</h2>
<p>Implementing a new national institute would require research capacity. When a similar need to build research and research capacity was identified in primary care, the response was the <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/pcd-programs-phcred">Primary Health Care Research Evaluation and Development Strategy</a> and the funding of an institute to provide leadership, and support centres of research excellence alongside, not instead of, access to NHMRC funding. </p>
<p>While the review recognises the importance of building research capacity, it fails to understand that this requires more than providing training, funding and time for health-care professionals to undertake research. Health services researchers come from many non-clinical disciplines and need to be sustained along a career path. </p>
<p>Access to high-quality data is also an essential part of the infrastructure required for health services research. Clinical trials are only one, and an increasingly expensive, way to deliver evidence on what works. We also need to know what works when new treatments are made available to all patients. We need to know what works for so-called rare diseases, where the patient population is not large enough to enable powerful trials, but where the prevalence is increasing, and many people are living with ongoing severe conditions. There’s an urgent need for support for better collections of observational data (such as registries and longitudinal data). </p>
<p>And we need to have the means to link data from various sources. In particular, we need to be able to link data on inputs (health professionals, hospitals and GP practices, for instance) to outputs and outcomes (volume of services provided, performance indicators, and health outcomes). </p>
<p>So far, the data linkage process has focused on linking patients’ data (linking individuals’ in-patient and emergency data with data from cancer registries, for instance). While this is important, there’s very little linkage of patients’ data to data on the health-care providers who treated them. Hospital data don’t indicate who referred patients, for instance, so there’s no link to primary care services. This is a major omission in data linkage given the importance of primary care in reducing hospital expenditures. </p>
<p>There are currently significant barriers to accessing linked data because the extraction process is costly and time consuming. And one-off data extractions that a researcher must keep confidential runs contrary to others reproducing and testing results of a study.</p>
<p>The <a href="http://www.who.int/en/">World Health Organization</a> calls health systems research the “brains of the health system”, and <a href="http://www.who.int/rpc/publications/scaling_up_research.pdf">argues for increased investment</a> in this field of research. If the Australian health-care system is not to be left without brains, the final report of the McKeon review will need make health systems research a part of the future of the our system.</p><img src="https://counter.theconversation.com/content/10145/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Hall receives funding from the ARC, NHMRC and APHCRI. Professor Hall is a health systems researcher. </span></em></p><p class="fine-print"><em><span>Marion Haas does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The consultation paper by the panel of the McKeon Review is available and open for public comment now, so it’s worth examining whether this review (the latest of many into health and medical research…Marion Haas, Professor of Health Economics, Deputy Director of CHERE, University of Technology SydneyJane Hall, Professor of Health Economics and Director, Centre for Health Economics Research and Evaluation, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/79702012-07-04T04:45:33Z2012-07-04T04:45:33ZMedical research needs new body to champion healthy ageing<figure><img src="https://images.theconversation.com/files/12417/original/d9y8fg6s-1340952335.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cognitive training is one way to keep your brain healthy.</span> <span class="attribution"><span class="source">Regenerative Neuroscience Group</span></span></figcaption></figure><p>Australian medical research is undergoing its most important and comprehensive review in more than ten years. Led by the 2011 Australian of Year, the <a href="http://www.mckeonreview.org.au/">McKeon Review</a> couldn’t have happened soon enough because the sector, like our society, is at a crossroads. </p>
<p>Over the next 30 to 40 years, we face one of the most profound demographic changes in our history: the greying of a large part of the population. Prevention and better management of age-related disease will become one of the great medical challenge of our time. </p>
<p>Consider the 2009 International Monetary Fund <a href="http://www.economist.com/node/13888045/">analysis</a> that concluded developed countries will need to spend approximately nine times more on age-related issues over the next four decades than they had spent on responding to the 2009 global financial crisis. That’s an equivalent of a GFC every six to seven years. </p>
<p>National forecasts indicate dementia will become Australia’s leading cause of death and the single most costly disorder within one generation. Numbers of affected individuals will rise from approximately 254,000 to 1.1 million by 2050. Continuing the status quo would mean that, in 2062, spending on dementia-related care alone would be approximately A$82bn. </p>
<p>This will pose an unbearable strain on not only the health budget but the nation’s finances as a whole. Policymakers face the prospect of diabolical health decisions about quality of care and patient prioritisation. </p>
<p>A new “national healthy ageing research council” may be part of the solution – a body that puts the promotion and maintenance of good health well into our later years at the top of the national agenda. </p>
<p>Creation of a new institution to champion healthy ageing recognises the increasing scientific knowledge about <a href="http://rng.org.au/wp-content/uploads/2012/05/Brain-and-heart-targets-for-better-dementia-prevention-Medicine-Today.pdf">modifiable risk factors for dementia</a> and other age-related disorders. These are factors that we have a degree of control over. It would also provide a chance to lower our risk and help avoid these disastrous outcomes. </p>
<p>Virtually every cardiac risk factor that has been studied, for instance, also increases dementia risk. Hypertension (high blood pressure) in one’s 40s and 50s increases the risk for dementia in one’s 60s and 70s by two-and-half times. Similar long-term increases in risk have been found for obesity, diabetes and smoking.</p>
<p>What we do with our brains after <a href="http://theconversation.com/brain-power-why-using-it-helps-stop-losing-it-6531">retirement</a> also seems to be as important as the state of our physical health. The brain is an exquisitely sensitive organ and, like a muscle, responds quickly to changes in activity and stimulation. New learning can trigger a cascade of neuroplastic mechanisms beneficial to cognitive function that, over time, are likely to delay or help prevent dementia. New models of retirement will be needed because switching off mentally is arguably one of the worst options. </p>
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<img alt="" src="https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/12345/original/743shsxy-1340860089.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">National forecasts indicate dementia will become our leading cause of death and single most costly disorder within one generation.</span>
<span class="attribution"><span class="source">Adam Jones/Flickr</span></span>
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<p>But the greatest challenge of all is turning this knowledge into action. Ever worsening <a href="https://theconversation.com/mapping-australias-collective-weight-gain-7816">obesity trends</a> are a sobering reminder; we all know what needs to be done, we just don’t do it. In order to truly save Australia from its own lifespan success, a whole-of-government, whole-of-society effort is needed. </p>
<p>We need to think beyond simplistic community education campaigns. These messages will need reinforcement by innovations in technology, architecture, urban design, legislation and even possibly <a href="http://psych.med.unsw.edu.au/PSYCHWeb.nsf/resources/Media/$file/uniken_mayjune_2010_M+Valenzuela_.pdf">taxation reform</a>. </p>
<p>We also need to recognise that there’s still much we don’t understand when it comes to changing long-term risks for dementia and other age-related health issues. The establishment of a national healthy ageing research council to fund projects dedicated to the promotion of healthy ageing and disease prevention is therefore a key part of the puzzle. </p>
<p>Some of the best researchers in this field are right here on our shores, but private and public financial support needs a quantum shift in order to rise to the challenge. In fact, international events suggest an inter-generational investment in medical research could help position Australia as a world leader.</p>
<p>Australia’s future will be determined as much by how we plan for age-related demographic change as by how we respond to the mining boom. In fact, it seems sensible for even a small fraction of the latter to be used to help set up the former for success. But dollars will not be enough. </p>
<p>To make a real dent in forecast increases in dementia and other chronic diseases, both individuals and society at large need to commit to real and lasting action, starting now.</p><img src="https://counter.theconversation.com/content/7970/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Valenzuela receives funding from NHMRC and several small philanthropic organisations. He is a medical researcher.</span></em></p>Australian medical research is undergoing its most important and comprehensive review in more than ten years. Led by the 2011 Australian of Year, the McKeon Review couldn’t have happened soon enough because…Michael Valenzuela, Associate Professor & Leader of Regenerative Neuroscience Group, Brain & Mind Research Institute, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/65972012-04-26T04:35:35Z2012-04-26T04:35:35ZTaking to the streets to protect medical research funding<figure><img src="https://images.theconversation.com/files/9959/original/bt5cjzyt-1335413832.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A rally of white-coated scientists and lab technicians rally against cuts to research funding in Perth, April 14, 2011.</span> <span class="attribution"><span class="source">AAP Image/Lloyd Jones</span></span></figcaption></figure><p>Australia’s usually mild-mannered medical researchers marched in the streets a year ago to protest mooted government budget cuts. In the face of widespread outcry, the government chose to maintain the $746 million of funding to the <a href="http://www.nhmrc.gov.au/">National Health and Medical Research Council (NHMRC)</a> it had threatened to cut. </p>
<p>While this was a welcome outcome, Australia’s health and medical research community remains wary that its funding may be under threat in the longer term. There’s no doubt the Government is looking under every rock for savings as it aims to return the budget to surplus. But we shouldn’t have to march in the streets to protect funding for a sector that delivers so much to the country’s economy and the future health of our citizens.</p>
<p>It’s worth noting that in the last year alone, Australian researchers have announced huge advances in medical and health science. We’ve made breakthroughs in the development of new malaria drugs and vaccines, discovered a potential future treatment for prostate cancer, and made progress in the treatment of aggressive melanoma skin cancers. </p>
<p>These are just a few among a host of equally important discoveries that aren’t as simple to communicate but may be the foundations to defeating the big health threats of tomorrow. What’s more, such medical advances don’t just benefit Australians – these are discoveries of global significance. Malaria, for example, kills nearly a <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960034-8/fulltext">million</a> people each year. </p>
<p>Australia’s medical advances would not have been possible without the funding that our researchers marched in the street to protect. The challenges facing the health system can only be solved by investing in generating new knowledge and applying it – be it health economics, understanding how to stem obesity, or the next revolutionary treatment for cancer.</p>
<p>The Australian Government’s investment in health and medical research is lower than both the United States and other countries in the <a href="http://www.oecd.org/home/0,2987,en_2649_201185_1_1_1_1_1,00.html">OECD</a>. In the US, the government invests <a href="http://www.oecd-ilibrary.org/sites/sti_scoreboard-2011-en/04/02/index.html;jsessionid=3lps35bod6tkd.epsilon?contentType=&itemId=/content/chapter/sti_scoreboard-2011-35-en&containerItemId=/content/serial/20725345&accessItemIds=/content/book/sti_scoreboard-2011-en&mimeType=text/html">0.31%</a> of gross domestic product (GDP) in medical research; in the OECD the figure is <a href="http://www.oecd-ilibrary.org/sites/sti_scoreboard-2011-en/04/02/index.html;jsessionid=3lps35bod6tkd.epsilon?contentType=&itemId=/content/chapter/sti_scoreboard-2011-35-en&containerItemId=/content/serial/20725345&accessItemIds=/content/book/sti_scoreboard-2011-en&mimeType=text/html">0.11%</a> of GDP. <a href="http://www.oecd-ilibrary.org/sites/sti_scoreboard-2011-en/04/02/index.html;jsessionid=3lps35bod6tkd.epsilon?contentType=&itemId=/content/chapter/sti_scoreboard-2011-35-en&containerItemId=/content/serial/20725345&accessItemIds=/content/book/sti_scoreboard-2011-en&mimeType=text/html">In Australia</a>, the government invests only 0.09% of GDP in the sector (18% less than the OECD average). This figure that will see us going backwards over time as we compete with the strong research commitment we are seeing in other countries, such as <a href="http://www.oecd-ilibrary.org/sites/sti_scoreboard-2011-en/04/01/index.html?contentType=&itemId=/content/chapter/sti_scoreboard-2011-34-en&containerItemId=/content/serial/20725345&accessItemIds=/content/book/sti_scoreboard-2011-en&mimeType=text/html">China</a> and <a href="http://www.oecd-ilibrary.org/sites/sti_scoreboard-2011-en/04/01/index.html?contentType=&itemId=/content/chapter/sti_scoreboard-2011-34-en&containerItemId=/content/serial/20725345&accessItemIds=/content/book/sti_scoreboard-2011-en&mimeType=text/html">Korea</a>.</p>
<p>There’s no doubt that research can be expensive, but the alternative is more so. And under-investment is clearly short sighted. The work of our health and medical researchers ultimately keeps more people out of hospital, and brings new efficiencies to our health system. It reduces the ever-increasing drain on government funds. </p>
<p>Every dollar invested in health and medical research is estimated to return on average <a href="http://www.asmr.org.au/ExceptII08.pdf">$2.17 in health benefits</a>, ultimately helping us tackle our booming health costs and minimising the future burden on the community. </p>
<p>Research also delivers strong economic dividends – our medicines industry is our most valuable high-technology exporter and alone is worth almost <a href="http://www.abs.gov.au/ausstats/meisubs.NSF/log?openagent&5368012a.xls&5368.0&Time%20Series%20Spreadsheet&7DBC8F041F7AD2D7CA2579D50016ABD8&0&Feb%202012&04.04.2012&Latest">$4 billion</a> in exports annually. </p>
<p>As Treasury finalises the budget it should consider our nation’s current strength in this sector as a tool to sustain our economy beyond the mining-led boom.</p>
<p>In the face of last year’s protests about potential budget cuts, the government announced the independent <a href="http://www.mckeonreview.org.au/9903/Home/">McKeon Review</a> of health and medical research. The review will recommend a ten-year plan for the sector. This is an important opportunity for everyone involved to contribute to shaping our investment in the future health of the Australian community and I encourage everyone with an interest in the country’s future health to <a href="http://www.mckeonreview.org.au/9884/Public_Consultation/">contribute</a>. </p>
<p>And while we await the review recommendations, I also urge the government to look to the long term in setting the budget for 2012-2013. Rather than having to march in the streets to protect medical research funding, let researchers use their energy working towards a road map for a more efficient and effective health system, and a healthier Australia.</p><img src="https://counter.theconversation.com/content/6597/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Campbell receives project grant funding from the NHMRC and in the past has received grant funding from the ARC.</span></em></p>Australia’s usually mild-mannered medical researchers marched in the streets a year ago to protest mooted government budget cuts. In the face of widespread outcry, the government chose to maintain the…Julie Campbell, Director, Wesley Research InstituteLicensed as Creative Commons – attribution, no derivatives.