The Embedded Economist

What is the problem?

Health budgets are under strain. For NSW currently the Health Expenses Budget is 28.6% of total NSW Government expenditure (2018-2019 – $25.1 billion). Health expenditure is projected to grow at 6% per annum and could grow to 38% by 2055. Dan Hunter, Ministry of Health Chief Financial Officer, has called for ‘innovative thinking about our long-term service strategies and models of care.’ Australia spent about $170 billion on healthcare in 2017 and a conservative estimate is that about 20% of this expenditure is waste. Most of Australia’s health spending occurs at the ‘local level’ in health districts, hospitals and primary health care. This is also where the least evaluation occurs.

About the research translation program

The Embedded Economist intervention has two components that should be integrated together, although both are capable of separate delivery. The components are: a) education and b) an economist in residence program.

The education intervention will consist of a curriculum of stackable learning modules in economic evaluation, statistical modelling, simulation modelling, qualitative evaluation and decision-making in healthcare. The learning module will be a mix of professional development short courses (that can be amalgamated into a graduate certificate subject), graduate certificate subjects, and placements. The education intervention will be a collaboration between the University of Newcastle (as education providers) and HMRI (as content experts).

The economist in residence program will be based on the placement of an economist within health services. On activation of the project, a seminar will be delivered to health service managers to outline the spectrum of potential help provided by health economists and the factors to consider when deciding how best to in involve them in healthcare research. This information will be used to co-design a program of placement work that will be undertaken over a 4-month period.

The intervention will be evaluated using a mixed methods approach and be informed by multiple data sources for triangulation. In terms of the theoretical approach to the research, actor-network (ANT) theory is proposed as the dominant lens for analysis of the individual longitudinal case studies created at each health service.

What will be the impact?

This study aims to positively influence the knowledge and attitudes of health service staff toward the use of evidence in decision making. It also seeks to increase the likelihood that health services decisions are based on the best possible evidence. Evidence-based decision-making has been demonstrated to improve the quality of care provided by services, with subsequent improvement in clinical outcomes for patients and reduced waste of healthcare resources. By investment in improving local level evaluation of technologies and models of care, it has been estimated that a 1% reduction in waste could be accomplished, saving Australia $128 million per year.

For more information, contact Donella Piper at donella.piper@health.nsw.gov.au