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Monday, May 11, 2009

What Should Be in the Budget for E-Health? - Vital Read!

The Commonwealth Budget is to be released at 7:30 pm tomorrow. What is to be hoped is that within the document is some substantial boost for the Health Sector given that it has largely been ignored in the first and second stimulus packages.

I do fear we may be disappointed. As the Brain and Mind Institute executive director Professor Ian Hickie wrote in the estimable publication crikey.com.au today:

“At this stage, the Federal Government’s management of the health portfolio has focused largely on managing the politics rather than driving reform.”

I have to say I agree with that broad assessment. I would also suggest that thus far the politics – and the communities frustration with the present state of the Health Sector – has not been all that well managed.

What is needed in e-Health? Essentially the funds to get on with the implementation of the National E-Health Strategy developed by Deloittes. The following comes from a very well informed source.

The recommended funding to implement this Strategy (sadly not released in the summary report made public almost six months ago) are as follows (over 5 and 10 years respectively):

1. Foundational Activities Workstream

E-Health Standards $100M $160M

Unique Health Identifier (UHI) Solution $190M $400M

National Authentication Service for Health (NASH) $80M $200M

Total $370M $760M

2. E-Health Solutions Workstream

National E-Health solutions investment fund $500M $800M

E-Health compliance function $50M $120M

Consumer and Care Provider Health Knowledge Portals $20M $30M

National Prescription Service $60M $90M

Total $630M $1040M

3. E-Health Change and Adoption Workstream

National Awareness Campaigns $60M $100M

Care Provider Incentives $400M $600M

Professional Accreditation and Training Changes $10M $20M

Total $470M $720M

4. E-Health Governance Workstream

National E-Health Entity and Governing Board $20M $40M

National E-Health Regulatory Function $10M $20M

Total $30M $60M

Thus, in summary, the funds required are as follows (quoting the full report):

The total indicative estimated cost of the implementation of the national E-Health Strategy is A$1.5 billion over five years or A$2.6 billion over ten years. This represents a relatively modest investment program when scaled against total annual recurrent spending on health (approximately A$90 billion) and the total annual recurrent spending on health by all levels of government (approximately A$60 billion).

The major variable component of this figure is the discretionary amount to be allocated to funding high priority E-Health solution developments and providing financial incentives to private sector providers. In both cases the magnitude of these investments should be proportional to the size of projected benefits and should be sufficient to drive meaningful progress towards the achievement of national E-Health outcomes.

A description of the details of each of the workstreams can be found here:

http://www.nehta.gov.au/component/docman/doc_download/626-national-e-health-strategy-summary-dec08

See pages 10-18.

I would note these costs are remarkably modest when compared with the current and planned investments in the US, UK and Europe.

As a balance to these costs the estimated benefits are cited as follows:

There are significant challenges associated with attempting to quantify benefits associated with E-Health, not least of which is the paucity of quality data on Australian health care system costs, activities and outcomes. Despite these limitations, it is possible to develop indicative estimates based on analysis of local and international literature. This analysis shows that the tangible benefits associated with implementation of the Australian E-Health Strategy are estimated to be in the order of A$5.7 billion in net present value terms over ten years. The annual savings associated with a fully implemented E-Health Strategy are estimated to be approximately A$2.6 billion in 2008-09 dollar terms.

What I will be looking for is a commitment to an investment of this sort of scale over some reasonable period to start gathering those benefits. Three hundred million per annum is really small beer in the 90 billion plus of the health budget nationally, especially since some of the early funding is already committed – e.g. a good deal of the Foundational workstream.

The financial information (both costs and benefits) contained in the full Deloittes report has been available within all the State Governments and the Commonwealth for over six months and it is quite wrong in my view that the public does not get a chance to debate the merits of the suggested investments so that some action can be taken if that is the expert and community consensus.

All we have had so far are motherhood statements of support for the suggested directions and then total silence as to how implementation is to be achieved. Given the crucial place of e-Health in any Health Reform Agenda this really is a joke.

If we don’t get some, at least starter funding, to begin investment of this nature and scale then we will all be able to form a view as to the chances of e-Health in Australia ever getting support from this Government.

David.

3 comments:

Anonymous said...

What is the "National E-Health solutions investment fund $500M $800M" for? How is it intended to be spent?

Dr David More MB, PhD, FACHI said...

For details of what is proposed that the funds be spent on see the Summary National E-Health Strategy Document that is linked to in the main text of this post.

David.

Paul Fitzgerald said...

Hi David, this is an interesting "wish list", however do any of really believe that the Politicians will want to spend this sort of money on IT with the economy in recession, and the need for more nurses/doctors etc (pick your favourite flavour!) I agree entirely that we need to get on and do this stuff, however we need to ensure that we take along the aged and community sectors with us. To dream of an EHR in our lifetime will require the full continuum, not just acute and primary care.
cheers,
Paul