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In Australia, most healthcare expenditure occurs at the local level, this includes individual local health districts, hospitals, and primary health (e.g., general practitioner visits). Not only is local level expenditure the largest, but it is also the fastest growing; in a ten-year period from 2006-2016 hospital spending rose by 7.5% and primary care by 6.5%. But increasing spending does not guarantee better outcomes. In fact, unchecked expenditure can threaten health system sustainability as governments cannot afford to fund increasingly expensive care.

Regular, embedded, and routine evaluation is needed to ensure return on healthcare investments – yet evaluation is rarely carried out at the local level where most spending occurs. Previous research has suggested that this is because local health services may not have evaluation skill sets and appropriate staff.

The solution: the embedded Economist program

The embedded Economist program aims to increase awareness of the value of economic evaluation, develop health service staff knowledge and capacity to apply economic evaluation, and to facilitate the routine application of economic evaluation principles in decision making. To achieve these objectives the program has two components 1) an economist in residence, and 2) health service staff education.

As with any new program, the embedded Economist program needs to be evaluated to determine if it works as intended. In the recently published article, Embedding an economist in regional and rural health services to add value and reduce waste by improving local-level decision making: protocol for the ‘embedded Economist program’ and evaluation in BMC Health Services Research, PCHSS’ Professor Jon Karnon and colleagues describe the design, implementation, and evaluation of the embedded Economist program.

The article co-authored by Professor Karnon details that the economist in residence will be on site at the healthcare service 2-3 days a week for corridor consultations and meetings and that staff education will be delivered through an online learning community and a university course. Throughout the program, health service staff members can connect with the embedded economist through planned in-person workshops and presentations, through interactions with the online community, or by enrolling in economics and finance courses in a university to build their health economics skills. The economist is also available to assist with the coproduction of interventions.

The embedded Economist program is now underway.

In the March PCHSS webinar, Improving health system performance through economic planning and post-implementation evaluation of health services, Professor Karnon discussed preliminary findings from their current projects. His presentation highlighted the potential broader system impacts the program could have on health system sustainability. For example, a local evaluation of extended physiotherapy practice in emergency departments resulted in a 50% reduction in inpatient admissions and reduced wait times. Professor Karnon hypothesised that at this stage in the evaluation it seems as though extended physiotherapy practice in emergency departments is cost effective.

Evaluations conducted as part of the embedded Economist program could influence decision making, such as the scaling up of successful programs such as this or the de-implementation of wasteful programs. Nationally, a 1% reduction in medical waste could save AU$128 million each year.

Nationally, a 1% reduction in medical waste could save AU$128 million each year.

The evaluation of the embedded Economist is also underway

The embedded Economist program itself will be evaluated to assess its impact on knowledge generation, policy, clinical practice, health services or population health, and economic benefits. The evaluation plan outlined in BMC Health Service Research details pre, during, and post evaluation using a range of methods including surveys, observations, documentary analysis, interviews, and field diaries. The evaluation of the embedded Economist program is novel as it will be among the first to assess the embedding of a health economist into a health service, and the nature of relationships and interactions that form. If this program is proven to be of benefit, it could be extended to other areas, such as epidemiology, public health, and study design and contribute to minimising the divide between health professionals and health system researchers.