The Future of Healthcare in Australia
Saving Lives and Protecting Lives
Author: Prof. Hon Greg Hunt
Former Australian Minister for Health
Introduction
Professor Hunt was appointed Honorary Enterprise Professor in the Faculty of Medicine, Dentistry and Health Services and the Faculty of Business and Economics at the University of Melbourne in December 2022.
Greg is also the inaugural Chair of the Advisory Council for the Turner Institute for Brain and Mental Health at Monash University. He advises a wide range of businesses and not for profits in the areas of innovation, leadership, strategic planning, health and the environment.
Greg is a highly experienced former Cabinet Minister in the Australian Government, having served as Australia’s Minister for the Environment, Innovation and Health across three major portfolios over almost nine years.
As Minister for Industry, Innovation and Science, he led the establishment of the Australian Space Agency, laying a critical foundation for Australia’s role in the global space sector.
As Minister for the Environment, he introduced key environmental initiatives, including the Emissions Reduction Fund, the Green Army, and the $1 billion Reef Trust. He also played a leading role in Australia’s negotiations for the Montreal Protocol update and the Paris Climate Change Accord.
In recognition of his achievements as Environment Minister, he was named Best Minister in the World at the World Government Summit in 2016.
As Minister for Health from 2017 to 2022, he led significant reforms and strategic initiatives across Australia’s health sector. He oversaw the nation’s response to the global COVID-19 pandemic and established telehealth as a permanent and universal component of Medicare.
Key achievements included:
Reforming private health insurance to improve affordability and access.
Developing comprehensive, long-term strategies for mental health, aged care, medical research, and primary care.
Facilitating the listing of over 2,000 new and amended medicines on the Pharmaceutical Benefits Scheme.
He was responsible for managing an annual budget of $132 billion, providing oversight to 17 portfolio agencies, and leading a workforce of 7,000 staff.
Greg is the longest serving Federal Member for Flinders (over 20 years), and is a Fulbright Scholar with a Masters from Yale University and First Class Honours in Law from the University of Melbourne.
The last 50 years have seen unimaginable progress in both global and Australian healthcare and clinical outcomes. Advances in vaccines, pathology, radiology and chronic disease management such as immunotherapy have saved and protected millions of lives globally.
The next decade is set to see a further revolution in healthcare, arguably of comparable scale to the last, based on the 4 great pillars of;
Genomics
Stem cell therapies
Digital health and robotics
Remote sensing
Taken together, these 4 trends will usher in the age of precision health as a service (PHAAS). Against that background, Australia is well placed both to benefit from the health outcomes that will save numerous lives going forwards.
Indeed, given the strength of our fundamental research and development capabilities, we are in fact exceptionally well placed to help lead or contribute to each of these trends and to help generate economic outcomes for Australia as well as health outcomes for individuals both within Australia and abroad.
Why.
Ellie’s Story
Not long after I became Health Minister, I visited the Sydney Children’s Hospital Oncology ward to talk with researchers, doctors, nurses and parents about the Zero Childhood Cancer Program. The program was just starting and would sequence the tumours of some of these very ill children.
Led by brilliant clinician researchers such as Professors Michelle Haber and Tracey O’Brien, the program aimed to provide molecular level insights into childhood cancers which in turn would allow for precision treatment. It was and remains based on cutting edge genomics research both here in Australia and abroad.
While I was at the Hospital, I met a beautiful young 12-month old girl Ellie and her parents.
Ellie was suffering from a potentially catastrophic thoracic cancer which had meant she was placed on life support to assist her breathing 1. Conventional treatments had failed and her parents were being prepared for the worst.
Ellie was then enrolled as one of the first patients in the Zero Childhood Cancer Program. Her tumour was sequenced and a rare genetic mutation was identified as the likely cause 2. In turn a US based company agreed to provide a prospective medicine on compassionate grounds.
Within 6 weeks Ellie was released from ICU after the tumour responded to the new treatment.
Today she is a healthy young girl and one of the faces of the Zero Program 3.
Ellie’s story is about why we do what we do.
It is also about how fundamental research, genomic sequencing, policy programs, collaboration and brilliant medical leaders can come together to deliver better health and economic outcomes for Australia and Australians over the coming decade.
The Australian Healthcare System.
While Ellie’s story is about why we do what we do, it is only possible because of a broader integrated national health system. The Australian Health System is comprised of Commonwealth Investment, State investment and private investment.
At the Commonwealth level, our projections in my last health Budget as at May 2022 were that overall Commonwealth health investment will have increased from $75 bn in 2012/13 to $140 bn in 2025/26. In turn Medicare will have grown from $19-$36bn, Aged Care investment from $13 to $35 bn and Hospital investment from $13 to $33bn.
Over the coming decade, total annual Health expenditure is likely to grow to close to $400bn.
Hence from a national perspective, getting the best outcomes for the invested capital and recurrent expenditure is vital, and from a business and investor perspective there will continue to be enormous growth in both health services but in particular Precision Health as a Service (PHAAS).
All of this translates to better health outcomes and more opportunities to help young children such as Ellie – and indeed people of all ages – lead long, healthy lives.
As the Australian Institute for Health and Welfare has noted:
“In 2020–21, an estimated $220.9 billion was spent on health goods and services in Australia. This equated to an average of approximately $8,617 per person and comprised 10.7% of overall economic activity.”
Precision Health as a Service.
The 4 Pillars
Genomics
The first pillar of the precision health revolution is genomics.
Genomics is about the ability to make individual diagnoses at the molecular level, in turn to treat conditions with better targeted medicines and in time to individually tailor the composition of some of the treatments themselves.
At its best, genomics is about prevention and early detection.
Perhaps one of the best examples of genomic prevention is Mackenzie’s Mission which was an almost 10,000 couple screening program to detect couples at risk of having a child with one of 1300 autosomal or recessive genes that could seriously impact quality of life or life expectancy.
Of the participating couples, almost 4% were found or confirmed to be at high risk of having a child with a genetic condition of concern.
In turn this gave couples choice as to whether to undertake IVF with pre implantation genetic testing (PIGT) to screen for the specific conditions. The first phase of Mackenzie’s Mission moves from a Trial Program to a standard of care test for Cystic Fibrosis, Fragile X or Spinal Muscular Atrophy as a Medicare funded Service on 1 November of this year.
Coupled with access to PIGT this makes Australia a world leader in genomic testing for prevention of birth related debilitating conditions.
World leading Australian research centres such as the Murdoch Children’s Research Institute and companies such as myDNA are already at the forefront of these emerging services with more such as Myrio TX and others evolving into high potential DNA services of the future.
Over the course of the next decade, there will be a snowball effect as the $500m Medical Research Future Fund Genomics Mission helps create a stronger research, legal and ethical foundation for further growth in platform capabilities, new tests and new treatments based on genetic detection.
While the potential for better health outcomes is profound, equally there is enormous potential in growth opportunities for Australian firms and investors.
Stem Cell Therapy
The second pillar of Precision Health as a Service will be stem cell therapy. Again, Australia is already strong in this area.
The peak Australian research body Stem Cells Australia summarises the science as:
“Stem cells are a special type of cell that have the remarkable ability to make copies of themselves, as well as create more specialised cells found in the body.”
Stem Cells Australia already identifies 21 broad conditions including heart disease, lung disease, MND and in time Alzheimer’s Disease, where stem cell diagnosis and treatment may have the potential to help.
In essence, the science offers the capacity to repair or mitigate damage from many degenerative or other conditions.
Perhaps one of the best examples is Zolgensma, which was recently listed on the Pharmaceutical Benefits Scheme at a cost approaching $2m for one off treatment for patients with Spinal Muscular Atrophy. While Zolgensma does not repair the initial damage, it effectively creates an alternative pathway, and if administered sufficiently early to infants offers the prospect of a life with minimal impacts. This offers a dramatic transformation in the otherwise usually grim and catastrophic future awaiting families who have a child diagnosed with the more severe forms of SMA.
Again the $150m Australian Stem Cell mission will help provide a strong scientific, legal and ethical base for the emerging research and commercialisation in Australia.
In turn this will help provide the foundation for institutes such as the Centre for Eye Research Australia and their emerging spin out Mirugen who together are working on stem cell based treatments for retinal disease.
Digital Health
The third pillar of Precision Health is digital health.
Australia now has an almost unique platform with an over 90% participation in the lifetime My Health Record, universal access to Telehealth and availability of e-scripts.
Subject to patient confidentiality, this changes both the data landscape for public health analysis, and the capacity for individuals to receive healthcare at home, the office and in rural and remote settings. It particularly supports health equity for many of the disadvantaged with mobility or access issues such as older Australians, Australians with disabilities or indigenous Australians.
Against this background we are already seeing a revolution in Telehealth and screening access through emerging Australian companies such as CU Health, Akkadian Health and Heathscreen.
At the broader level, the size of the Australian telehealth market is projected to grow from approximately $700m in 2022 to over $3b by 2020, at a compound annual growth rate of over 19%.
Again, patient need, technology and economic growth come together to help reshape healthcare.
Robotics & Remote Sensing
The fourth pillar of Precision Health as a Service is the emerging field of robotics, AI and remote diagnostics.
Surgical robotics and AI are coming together to allow emerging Australian companies such as Akunah Medical to preplan and visualise orthopaedic surgery.
This in turn is combined with 3D printed device capabilities such as those being advanced by the Aikenhead Institute and Anatomics to help create a tailored surgical outcome for patients.
Individually tailored planning, surgery and prostheses or devices is then supported by new remote sensing or continuous diagnostic monitoring.
We already have Continuous Glucose Monitoring but emerging Australian companies such as Nutromics and Wear Optimo are world leaders in developing in hospital, in home or wearable sensors for a range of conditions.
Real time continuous monitoring will lead to better understanding of baseline health, more effectively targeted modulation of medication such as the antibiotic Vancomycin and better monitoring of hydration levels in aged care.
Conclusion.
Against this evolution in precision health, two underpinning organisational themes are expected to grow.
First, we are likely to see greater use of transitional care as a step down from hospitals, coupled with increased care at home in both aged care and general convalescence. Remote diagnostics coupled with precision monitoring means the emergence of companies and service such as KNG Health who run the Gold Coast medihotels program and Axe Health who will offer supported in-home monitoring.
Second, there is likely to be a greater need for bespoke, shared and co work laboratories as well as tailored health project management services. Traditional laboratory suppliers such as Westlab for eg, are evolving into fully integrated health project managers through their Connected Service which offers concept development, design, construction and project management.
All of these trends come together to facilitate the move to Precision health as a Service. This is the third wave of medicine not just within Australia, but also globally.
The first was the development of basic surgery and medical treatments including antibiotics.
Second, we have had 50 years of diagnostic and more effective treatments through pathology, radiology and vaccine development.
Now we move to the world of precision health.
The Precision Health as a Service age will undoubtedly and inevitably provide historic opportunities for private health to partner with public health in developing and providing individually tailored diagnoses, treatments and services to our patients. It won’t transform everything. It won’t cure every ailment.
But it will mean that more people have better treatment, better outcomes and more children such as Elie have a better shot at a full healthy life.