How to plan for future pandemics

Q&A with UQ health economist Professor Stephen Birch

This is an illustration representing a doctor planning for a pandemic.

Image: Sompong Rattanakunchon/Getty Images

Image: Sompong Rattanakunchon/Getty Images

As the world continues to grapple with the magnitude of the COVID-19 outbreak, Contact takes a look at how much the coronavirus has affected Australia’s healthcare system, and whether the country is prepared if a second outbreak occurs.

Professor Stephen Birch is the Director of Australia’s only dedicated Centre for the Business and Economics of Health based at UQ. He is a leading expert in health economics – the economics of the prevention of illness and the production and restoration of health. Professor Birch sheds some light on how Australia could better plan for future pandemics.

This is an image of UQ health economist Professor Stephen Birch.

Professor Stephen Birch

Professor Stephen Birch

Q: How do you think Australia’s healthcare system has coped with the pandemic? What improvements could be made?

A: It appears to have coped very well with the pandemic thanks to the dedicated efforts of all those working in the system, whether they be involved in direct patient-care delivery, the healthcare providers, or responsible for the other aspects of ensuring our healthcare facilities run at a high level of effectiveness (management, catering, cleaning). Healthcare production relies on the contribution of all team members.

On the other hand, there have been substantial impacts on other areas of the healthcare system, in terms of waiting times for investigations and treatment for other conditions as a result of the priority given to COVID-19. We have essentially 'robbed Peter to pay Paul' by reducing access to care among other patients to deal with the COVID-19 patients.

There also appears to have been little integration between healthcare planning (making decisions based on what services need to be provided, where they are needed and how they are to be provided) and public health policy. Healthcare planning, in terms of the number of ICU beds and ventilators, has been based on ‘what is the worst that could happen’ when it comes to the spread of the virus, while public health policy has been doing everything it can (border closures, 14-day quarantines and social-distancing measures) to make sure that this worst-case scenario doesn’t happen. Ideally, these should be aligned. The challenge post-COVID-19 will be to ensure that the capacity of our healthcare system returns to reflecting the levels and geographical distribution of sickness and risks of illness in the Australian population (that is, population needs for care).

This an image of a hospital workers putting on gowns and gloves.

Image: Morsa Images/Getty Images

Image: Morsa Images/Getty Images

Q: With elevated hygiene standards and increased staffing, how has COVID-19 changed the cost model of hospitals and aged-care facilities around Australia?

A: I don’t think cost has been a consideration in much of the policy developments for the hospitals and care-home sectors. That is not to suggest that those facilities have not experienced challenges with meeting costs, but at the policy level, the general approach has been to seek the advice of medical experts and face the cost consequences.

The high-profile panel of 100 academics formed to advise the government has plenty of medical doctors and economists, but no one with expertise in health economics was included. Nothing can be done with money alone. Money can only be used to buy resources needed to deliver care to those in need. If we don’t have enough of those resources (doctors, nurses, care-home workers) then more money is not a solution.

As we emerge from this crisis, one important lesson is that the way we plan for our healthcare system must change in order to be responsive to the levels and severity of sickness and risks of illness in the population, as opposed to simply the number of people who live in Australia.

Remarkably, planning health care in Australia has not tended to use information on population needs.

In terms of moving forward post-COVID-19, economic realities will have to return to the healthcare system. We need to know whether the ‘elevated standards’ make a difference or were they part of a large package of initiatives funded in an emergency without evidence as to whether they made a difference or not. What it might do is place more emphasis on reducing the risk of hospital and care-home infections.  

Q: How will Australia’s healthcare system bounce back in comparison to other countries around the world?

A: Well that depends on whether decision-makers are prepared to adapt and update our healthcare planning to better meet the needs of the Australian population. The challenges are to measure population needs for care, identify the most effective services for addressing those needs, and develop the most efficient ways of delivering those services. What we did yesterday is not a prescription for what we do tomorrow. We need to learn from the past in order to understand the present and plan for the future.

This is an image of a doctor and nurse walking down the halls of a hospital.

Image: Thomas Barwick/Getty Images

Image: Thomas Barwick/Getty Images

Q: Is our healthcare system prepared if there is a second outbreak of COVID-19?

A: The system has the capacity to deal with a second outbreak and will be in a position to recommence screening in ways that would avoid the delays experienced in the first outbreak. But there would still be challenges around who gets priority for treatment and the impact that giving priority to COVID-19 cases has on the quality and timing of treatment for other patient groups.

Q: How will our hospitals and aged-care facilities sustain the costs associated with managing COVID-19, and other possible pandemics, in the future?

A: Those costs are unsustainable in the long term. Hospitals and aged-care facilities are dealing with the outcomes of policies and decisions that give rise to these emergencies. They have to deal with the consequences of cruise ships being allowed to disembark infected passengers or visitors being allowed to enter the country from infected areas. Good policy starts from avoiding incurring those costs by preventing the virus entering the population.

People were continuing to enter Australia from Italy without restriction well after Italy had implemented a lockdown on its own population. The number of COVID-19 cases occurring in people who haven’t entered Australia from overseas, or returned home from a cruise, is tiny. If we had been more vigilant earlier in the crisis, we might have reduced the number of cases in Australia to far fewer than what we have had.

It seems like the Australian Government’s response to COVID-19 was initially driven by economics (how do we protect our economy irrespective of health consequences?). Then, once the virus arrived in Australia, it switched to be driven by health (how do we protect our health, irrespective of the economy?). If consideration had been given to health economics at the first sign of the rapidly expanding crisis in China, it would have been clear that protecting the population's health at the outset would have helped to reduce the problems for the economy.

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