Implementing value for money in health care services

In this news article from PHCRIS Professor Nick Graves,  who is convening the 2017 HSRAANZ Conference to be held on the Gold Coast, talks about the need for a systems overhaul to achieve better value for money in health care services in Australia and how he hope to develop these ideas at the conference.


A Professor of Health Economics at the Queensland University of Technology (QUT) says if better value for money is to be achieved for health care services in Australia; it will take a systems overhaul to achieve it.

Professor Nick Graves leads two centres at QUT—the Australian Centre for Health Services Innovation and the Centre of Research Excellence in Reducing Healthcare Associated Infections—which both explore ways to implement cost effective health care.

“I have a background in health care economics and have worked in London, New Zealand and Australia on research projects aiming to improve the value for money of health care services,” he said.

“In my previous work I thought generating research studies and evidence was going to be sufficient to make changes.

“However, I have found out it is more complicated than that and people don’t necessarily have the time, skills or motivation to gather the evidence and implement changes.

“People are also not particularly rational, so even if they see evidence to show that something can be done better they tend not to change what has been practiced for years.”

Professor Graves believes generating economic evidence is an important first step, but demonstrating how evidence can be implemented and identifying the barriers and challenges, as well as people’s motivations, is just as important.

“At the University we have our own research group, we do our own studies and collect data from health services, but we also encourage health care professionals to lead studies so doctors, nurses and allied health care workers can generate their own knowledge and evidence.”

Professor Graves identified the payment and incentive system as a challenge and barrier to delivering value for money in health care, saying the current system “can sometimes reward people for doing the wrong thing”.

“Surgeons and doctors can be reimbursed for low value care; we also have a poor approach to prevention in Australia, tending to deal with health problems when they become acute, and we don’t have strong strategies for end of life care,” he said. “These are all expensive issues.”

Professor Graves identified low value health care happening when we over-diagnose and over-treat diseases, with breast cancer screening, and PSA testing for prostate cancer within elderly males, two examples.

Examples of high value care are the prevention of diabetes, good medical management of hypertension, screening for bowel cancer and falls prevention programs.

“If value for money were improved it would assist the community by generating greater health care benefits from Australia’s health care budget.”

Professor Graves said change would have to come through new legislation from the Federal and State Governments, prioritising high value care and removing the incentives to deliver low value care.

He hopes to promote these ideas at the 2017 HSRAANZ Conference held on the Gold Coast, in which he is part of the organising team.

“We are in the early stages of planning, but we want to make it fun and interesting, with presentations from international keynote speakers and research leaders,” he said.

A new idea Professor Graves would like to bring to the conference is to use the format of television show The Shark Tank, where four senior health service executives would pose as ‘the investors’ with researchers “pitching” their ideas for innovation or improving health care services.

“I would like the health service executives to be honest because there are a lot of bad ideas being proposed without evidence,” he said.

“I think it would be an ideal opportunity to convince these four investors of novel health care innovations.

“Hopefully we can pull it off”.

This news item was featured in This Week in PHC Issue: 25 February 2016.