Linking research, policy and practice

1. Linking research, policy and practice presented by S.J. Duckett Professor of Health Policy La Trobe University to National Symposium on Ageing Research Canberra 23-25 September 2003

2. Translating research into practice – examples • Casemix funding of hospitals (+) • The value of the private health insurance rebate (-, ?) • Case fatality rates (-)

3. Casemix funding of hospitals • U.S. development work by Fetter 1970s • DRGs (Diagnosis Related Groups) as a way of describing hospital activity • 1983 DRGs as a way of paying for hospital activity in an uncapped, market-oriented system • 1993 DRGS in capped system (Victoria)

4. Influences on implementation of casemix funding in Victoria • Health Policy Context • New government • Purchaser orientation • 10% budget cut • Technical Context • Long history of DRG • involvement • Previous publication of • comparative data • Clinical costing system • development • Development of AN-DRGs • Victorian resource weights • Path of Entry • Bureaucratic Introduction of Casemix Funding in Victoria • Effectiveness of Champions • Minister • Secretary • Director of Acute Health Services • Roles of Key Constituents • Political support • Victorian Hospitals Association support • Support from leading clinicians • Internal and External Networks of Support • Informal support from Commonwealth officers • Ability to mobilise work of public services • Role of advisory committees

5. What has happened to private health insurance?

6. Did the rebate reduce pressure on public hospitals? • Answer: Yes • At a cost of 2-3b per annum

7. What is the current age profile of the insured population?

8. Is current health insurance policy sustainable? • Despite life time cover policy, insured population is older than the uninsured • Younger people are leaving insurance, worsening the profile and increasing premiums in real terms • To keep average age constant in 2010, 75% of (then) 30-39 year olds will need to be insured

9. What has happened to utilisation? • Separation (discharges, transfers, deaths) both sectors typically increase 100,000 or so p.a. • 200,000 people who might otherwise have been treated in public hospitals were treated in private hospitals in 1999-2000. • This effect does not appear to be sustained

10. The value of the private health insurance rebate • Highly political • Will research change current government policy? • No • Will research change future government policy • ?

11. Case fatality rates • ‘Practice makes perfect’ • Experience with procedures is associated with reduced hospital care fatality rate • Action: 0

12. Conclusion • Research which influence policy process has different attributes from other research • Has advocates in policy process • Is relevant to the time • Is salient to the decision making process • Research does not need to be TRANSLATED it needs to be TRANSFORMED

13. Contemporary paradigm (stripped bare) • Bright academics with ideas and “results” • Dumb policy makers

14. Proposed model Academics With policy focus Bright Policy makers

15. Types of research funding • Investigator initiated • Outside policy process • “Policy relevance” is not assured • ?possible to transform • Priority driven • Closer to policy process • Projects may or may not be relevant • ? Criteria as above or as below • Policy maker commissioned • Targetted to specific policy question

16. Criteria for evaluating research • “Good science” • “Good investigator” • Policy relevant • In a different system • To a different political party

17. What is the tradeoff? Hi Scientific quality Investigation initiated Fundable threshold? Priority research Lo Lo Hi Policy quality

18. How can more policy relevant research be done? • Do the research then transform? • Participatory priority setting process? (risk: only addresses contemporary issues)

19. The research funding continuum • Investigator initiated • Priority driven • Investigator declared (II) • Broad call for proposals (II) • NIH Study Group (JC) • CRC (JC) • Policy maker commissioned