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Wednesday, February 11, 2009

If We Are to Have A Stimulus Let’s Have One that Makes a Difference!

I have prepared this for the next issue of Pulse + IT.

Opinion – Dr David More

Like many others I have found it quite disappointing that the scope of the Rudd Financial Stimulus Package has essentially ignored the Health Sector (among a large number of others it must be said).

What we have seen from the Rudd Government is a one of hand out combined with major investment in essentially four areas – school education, road black spots, home construction and roof insulation.

This is to be contrasted with the package which is working its way through the US Congress. The most recent draft of this bill in the US Senate shows a different and what I have to say is what I see as a preferred approach.

The draft legislation – Senate Version – is available online here:

http://online.wsj.com/public/resources/documents/stimbil2009.pdf

Among the major differences are:

First the stimulus is spread over all arms of government (Health, Education, Road Infrastructure, Agriculture, Housing, Defence etc)

Second there is a very considerable ‘High Tech’ component to the spending. (Research in a wide range of areas from ocean fisheries, information technology to climate change and rural broadband)

Third there are targeted low-income tax cuts of modest size per family – not the rather generous amounts coming in a single lump to families and workers making under $100,000 (which is really getting well into middle class welfare again).

However the biggest difference (from my perspective) between Australia and the US is the planned investment by the Obama Administration in Health IT. Although the numbers are not yet finalised it seems the scale of the planned investment is between $15 and $25 Billion US Dollars over 3-4 years.

Not surprisingly this very large planned investment has attracted a lot on comment, some favourable and some a little more cautionary. In general the overall flavour of the reaction has had the following broad points.

First it is universally agreed that the US health care system is overly expensive, financially inefficient, worryingly unsafe and needing to provide greater patient accessibility.

Secondly it is largely agreed, except by the most extreme sceptics, that moving to a digital health care can contribute to both efficiency and safety of the health system.

Third it is also generally agreed that the issues of information security and privacy need to be carefully considered in any major initiative.

Where there are a range of views the difference seem to centre around the pace with which implementation should be conducted, what the private / public sector involvement split should be, what role open-source software should be mandated to play and what technology / architectural approaches should be adopted to ensure that following the investment there is a largely interoperable National Health Information Network.

It is also of note that the US Congress has been working on bi-partisan Health IT legislation for the last few years. This has meant that the various peripheral issues (such as security, privacy and incentives) have all been debated and discussed in considerable detail.

A very recent example of these considerations can be discussed here:

http://aushealthit.blogspot.com/2009/02/press-release-on-health-information.html

As noted in that posting the privacy provisions that are planned for the Bill (termed the American Recovery and Reinvestment Act of 2009) seem to me pretty sound.

The bill's privacy provisions include the following:

  • Stronger protections against the use of personal heath information for marketing purposes;
  • Accountability for all entities that handle personal health information;
  • A federal, individual right to be notified in the event of a breach of identifiable health information;
  • Prohibitions on the sale of valuable patient-identifiable data for inappropriate purposes;
  • Development and implementation of federal privacy and security protections for personal health records;
  • Easy access by patients to electronic copies of their records; and
  • Strengthened enforcement of health privacy rules.

We could sure do with a single federal act of parliament in Australia that provided similar and consistent legislative provisions for the management of health information,

Reporting of the Obama package has also considered the employment implications of the planned Health IT initiative.

The following report is indicative of what is being said.

Study: Spending on health IT would generate 212,105 jobs

A $10 billion investment in health information technology as part of a planned economic recovery package would create or retain 212,105 jobs in one year, a Washington think tank has determined.

The Information Technology and Innovation Foundation (ITIF) endorsed health IT spending, along with spending on broadband networks and a smart power grid, as components of a larger economic stimulus package Congress is expected to introduce soon.

ITIF President Robert Atkinson said the organization does not necessarily advocate the amounts of spending that it analyzed — $10 billion for each IT component or a total of $30 billion. He said the analysis of the job-creation effects could be extrapolated to a larger or smaller amount of spending.

“I think this is a once-in-a-generation opportunity for our country” to position itself for greater competitiveness in a future global economy in which IT will be a major element, Atkinson said.

The full article is found here:

http://govhealthit.com/articles/2009/01/07/spending-on-health-it-would-generate-212105-jobs.aspx

Additionally, the overall Health IT initiative, as it is planned also includes funds for telemedicine grants and loans, enhanced I.T. for Indian Health Service facilities, and improved interoperability for first responders. All in all covering all the bases.

Lastly we have Rush Limbaugh (the right wing US ‘Shock Jock’) opposing the Health IT initiative – so it must be right! See:

http://thinkprogress.org/2009/02/09/rush-heath-it/

So what we have with the Obama package is an already considered thought out Health IT investment plan that will create jobs and provide adoption incentives while addressing privacy and security and what we have from Mr Rudd is the issue being ignored despite the obvious business case for investment in the area and treatment of Health IT as an infrastructure worth investing in for the long term.

This is pretty poor I believe. What is more I am sure there are many similar ‘high tech’ initiatives that could be identified and brought on line reasonably quickly to make a difference both in the short and long term. I just don’t think the planned package has been given enough future orientated thought.

David.

6 comments:

Anonymous said...

I don't think we should be using what America does as a model for what Australia should do. What is there about the American health system that is so good we want to emulate it? How much money has America spent on RHIO's, heaps, and how many have failed, most, and the others have yet to prove they have achieved anything of value. America has a habit of throwing money and more money and more money at anything that moves and is seen to be a problem in the hope that lots of money will fix the problem. Wise investment is different from reactionary investment. What we are seeing at the moment in healthIT in the US is reactionary and opportunistic. Let me also extend that thought to the UK's national health IT project - look at how much they have spent and what have they got in return? Not a lot it so it would seem. So let us not follow the UK model either.

We should not do what America does, we should not do what the UK does, we should do what needs to be done in Australia, for Australia.

Aus HIT Man said...

You seem to be missing my point. I think the Australian package is too narrow - and some senators seem to agree - and think we should have Health IT as part of the package, among a broader range of initiatives. Health IT should not be done as it being done in the US but as Deloittes recommended for OZ.

David.

Anonymous said...

Thanks for the clarification. It is so easy for the real message to get mangled and buried in amongst all the references to what is happening in the US.

It is reassuring to learn that some of our Senators seem to "agree that we should have HealthIT as part of the package". Are you aware of any public statements to that effect?

It's hard to make an informed judgment regarding Deloitte with only a skimpy summary to go by.

Aus HIT Man said...

Sorry, another clarification. As I read what the cross bench senators are saying they want a broader scope for the package (Murray Basin, Unemployment, Green Technology) - as at least in part in the US. No one has been specific about Health IT that I know of - as opposed to the US. The Deloittes study suggests an extra $150M or so for 2-3 years - in the context of $42 Billion - not all that much. Much less than is needed to help the Murray!

David.

Anonymous said...

From the year 1867 here's another perspective on the world in which we live:

"Owners of capital will stimulate the working class to buy more and more of expensive goods, houses and technology, pushing them to take more and more expensive credits, until their debt becomes unbearable. The unpaid debt will lead to bankruptcy of banks, which will have to be nationalised, and the State will have to take the road which will eventually lead to communism"

Karl Marx, Das Kapital, 1867

Aus HIT Man said...

2 Comments.

1. We are still waiting for communism to happen some 140 years later.

2. The figure for the Deloittes additional costs is about $250M p.a. over each of 10 years. Given we are talking of a 12-18 month stimulus - still not much in the scheme of things. (I had it a bit low initially)

David.