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Healthy ageing

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Healthy ageingThe work by Professor Segal on priority setting and associated research and health system reform is integral to support for healthy ageing. This research is designed to determine the optimal mix of health services; across modalities, disease stages and health delivery settings that will maximize health and well-being and how systems can be modified to support desirable resource shifts.

Professor Segal developed a new model for priority setting to guide decisions about the allocation of health care resources. Hers was the first model (published in 1994, to take a population wide approach which put all interventions - across disease stages, modalities and health delivery settings on a ‘level playing field’. This research saw the first published economic evaluation of the prevention of Type 2 diabetes (in 1998), which recommended funding of interventions to prevent T2 diabetes, a recommendation recently taken up by governments.

Professor Segal has undertaken extensive analysis of the role of prevention, including preparation of an issues paper for Victorian Treasury. An evidence-based approach is recommended, in which all interventions compete equally as the means to maximise health gain for resource applied.

Not all investment in prevention represents ‘good value’, while management can represent excellent value (eg hip replacement surgery). Simple generalisations such as ‘resources need to be redirected towards prevention’ are unlikely to maximise health and wellbeing. This conclusion is supported by a recent analysis by Professor Segal, funded through an ARC Discovery grant, of the cost-effectiveness of 250 interventions.

Analysis of health system incentives/Distortions imposed by funding arrangements

Professor Leonie Segal has completed a large body of work on health funding and delivery arrangements for the Commonwealth Department of Health and Ageing and through an ARC Discovery Grant. An analysis of health funding arrangements in Australia has identified distorted incentives that are undermining efficiency by favouring pharmaceuticals and medical services over other modalities, in situations of equivalent cost-effectiveness and quality of evidence.

The cost of these distortions is substantial. For example, allocating $1million to a drug that costs $50,000 to gain a life year (as is typical), instead of a more cost-effective intervention (such as dietary advice for persons who have had a heart attack), at $5,000/life year gain means a loss of 180 life years. There are several ways that an ‘even playing field’ could be achieved, such as the adoption of a single fundholding needs adjusted capitation model, or modification to the choice of comparator underpinning the PBAC system.

Health Insurance

Professor Leonie Segal has published widely on health insurance, including a critique of Australia’s mixed public/private health insurance system. This analysis demonstrates that a universal health system, funded through taxation, with access to services based on clinical need is the most efficient and equitable means of funding heath care. Subsidising private health insurance, necessarily increases costs of care and distorts access to care, reducing equity of access and undermining outcomes. Overseas evidence supports this conclusion.

Health workforce planning

One of the structural factors impinging on access to high quality health care is the health workforce. Professor Segal has developed a health workforce planning model – the only published evidenced-based model for determining the optimal level and mix of health services. It is based on population health status and an understanding of optimal approaches to health care. This model is currently being applied in South Australia to the primary health care workforce needs of persons with Type 2 Diabetes.

Economic evaluation

Professor Leonie Segal has conducted well over 200 public sector interventions, across all areas of public policy, and over 100 in the health sector. This experience covers both complex system initiatives; such as the Coordinated Care Trials and more simple health interventions. This work includes the largest published body of work evaluating 29 life style interventions to reduce burden from physical inactivity, poor nutrition, alcohol abuse and smoking.

Professor Adrian Esterman has a long standing interest in the area of health ageing dating back to the 1980’s. Examples of his research projects include: