Aboriginal and Torres Strait Islander communities will benefit from their increasing connection to technology based health platforms.

1. ICT as an enabler of Health Care
to Indigenous Communities
https://sites.google.com/site/crauchlethesis/documents/MDCD2012presentation%20outline.pptx?attredirects=0&d=1
Slide 1 of 15
Student: Christopher Rauchle
Supervisor: Stephen Cassidy
Snum: 41958209

2. Past Promises of ICT to Indigenous
Communities
Telephone – Most Indigenous
Population was more than 40km
from the main road. This was
Telstra’s cutoff (when they were the
Post Master General’s Dept)
Aussat –A gold plated system that was
supposed to provide telephone and
television to remote Australia.
One of the key drivers of the system
was Indigneous and outback access
and telehealth – did cause the
Indigenous media movement in
remote (but not very remote) areas
but was not a big telehealth success
Radio – simple two way radios have
been used world wide to
communicate between distant
remote regions

3. Current ICT uses in Indigenous Health
Regular PSTN with a service such as
Skype
Telephone consultations, prescriptions
High quality x-rays, MRI and CT scans
being sent as images
Live linking to remote x-rays and sensors
(ultrasound etc)
Checking eye health with remote
examinations
Checking Blood Sugar, blood pressure
Decision support in the GP office, Health
department
Queensland telehealth,
Royal Children’s Hospital
Brisbane(8)

4. Service Innovations allowing eHealth
Government payments for
eHealth consultations
Allowing consultations without
physical attendance
iPad field records of community
consultations with uploads
back in the office or when in
range of a mobile service
area (and much cheaper and
faster than paper or film
records)
Medicare payments – where
there is a chemist it is usually
linked via satellite if there is
no telephone line

5. Future ICT Health platforms
Intel ‘Shimmer’ platform of wearable
monitors to tell if the elderly have
stopped moving or are moving
abnormally in their homes – very useful
for an aging Indigenous population1
More integrated e-health systems
Full robotic surgery (already a reality
where fibre is available) means
specialist surgeons can ‘teleport’ all
over the regional parts of Australia
without having to travel hours or days
to operate. This surgery, using smaller
instruments means faster operations,
faster healing, fewer complications
with specialists in some surgeries
‘working’ only from a few large city
hosptials.2

6. Problems with the basics
Communications links are never
good enough – mobile service in
particular has been quickly
overwhelmed by usage
Satellite bandwidth is insufficient for
the number of users – this is a
problem worldwide and most
satellite downloads are limited to
around 10Gb/month
NBN is required to deliver similar
experience in remote and very
remote areas and no matter what
party is in power, the NBN
satellites will be deployed to
provide internet access in very
remote areas

7. Baumol’s Cost Disease and Health
Certain tasks cannot be sped up by IT – concerts
still take several hours to be performed. Health
care exams still take several minutes of face to
face time. Surgery still requires several hours.
Lecturing to students is still done in hour
blocks.
Service roles that cannot be done in anything
other than human time are ‘stagnant services’
and even if the salaries of the people doing
them do not increase over time they get more
expensive relative to the cost of other services
that are not ‘stagnant’ – Teaching is increasing
in cost faster than healthcare.
Even if the cost of a doctor visit doesn’t rise its
cost relative to other, non-stagnant services,
does
Cato Institute – Price trends for stagnant services9

8. Baumol’s Cost Disease and Health
IT’s role in reducing cost disease is to compress
the time taken by health workers to process
workers and if possible increase the
consultation and decision making process
eHealth records, networked CAT scans and MRIs,
computers on the doctors desk instead of index
card files are all evidence of technology
designed to mitigate cost disease.
No surprise that IBM’s Watson is being employed
on Health problems now…this is a long shot that
health decisions can be made in a clinical
setting with IT, which is not subject to cost
disease
Increasing reliance on internet based services
such as webMD and even Google threaten the
health care professional in stagnant services.

9. Jevons Paradox in Health
This should be good news then? Cost disease
can be mitigated so more people can be
served more cheaply.
There is a second Paradox involved to do with
the coal industry.
Jevons was hired to research coal
consumption by the coal industry. The theory
was that coal consumption would fall because
new, efficient, steam engines meant that much
less coal was going to be burned for the same
work output – coal industry feared a price
collapse
The opposite is true…cheaper energy meant
more steam engines and coal consumption
skyrocketed

10. Jevons Paradox and IT Health Care
IT is the same. Faster processes/processors
using chips that consume fewer resources
does not result in fewer computers to do the
same job. These more efficient systems are
able to address markets that had previously
been too expensive for IT – IT processors
proliferate and service to those markets
skyrockets.
Where it was formerly too expensive to offer
service to an area, with cheaper IT, more
people can be visited and areas that once had
a cost to serve that was too high are opened
up.
Also, when treatment becomes possible through
this effect it replaces non-treatment for a new
population of sick people. Therefore something
that used to be free now costs something.
Productivity - 1990 v 2040 from Baumol

11. Can Health Care ever fall in price
Although new treatments almost always
cost more than the ones they replace,
the amount spent on Health care per
capita seems to be falling
internationally.
It may be because everyone is using
more and more IT to compress or
eliminate the various tasks involved in
the process
It may be due to superior treatments that
are being developed, often with the aid
of massive research projects driven by
super computers that develop and
simulate drugs such as
immunosuppressants, anti-viral and
anti-cancer drugs and therapies.

12. Indigenous Specific Commonwealth
expenditure
Indigenous expenditure as
a percentage of GDP has
remained static at one third
of a percent of GDP.
Even in periods of budget
surplus, spending on
Indigenous programs
remained static with
funding redistributed to
other govt programs during
the GFC
4

13. Cost to serve Indigenous clients
2011 – $123B total health care with $4.5B
spent on Indigenous Health (5% for the
2%)
2012 - Government Health care costs for
Indigenous people are twice as high per
capita as for non-Indigenous people
($8190/Indigenous v $4054/Non)3
The cost to deliver health care to remote
and very remote Indigenous Australians
can be four times the cost to deliver to a
non-Indigenous Urban client.
Government costs to deliver health care
to a very remote Indigenous family of four
could therefore cost $64,000 so anything
that can reduce the cost to serve is
welcome
5
Since Urban Indigenous people
access the same Health Services as
non Indigenous people, with most
going to remote and very remote
clients

14. Market attractiveness
Delivering services is not profitable but policing
the delivery of services, administering the
delivery of services and planning the delivery
of services is.
Well people are not as lucrative as sick people
needing complex medical procedures and
assistance with chronic illnesses but
Indigenous Health programs are well funded
and so this segment is attractive.
Most expenditure on Indigenous Health remains
in the planning areas of government
departments with a tiny proportion making its
way to the front line.
Attempts to control expenditure result in more
planning and oversight which perpetuates
the problem.

15. Social Media
Research institutes have begun to use
social media to distribute their
materials.
NACHO – National Aboritingal
Community Controlled Health
Organisation is on twitter and
reports their documents are
downloaded more now.
“Just for a Chat” social media
campaign in the Torres Strait to deal
with sexual health (funded by
Queensland Health)
No Smokes campaign by the Menzies
School

16. Telehhealth
Flying Doctor transformation from a physical delivery
service to IT delivered one – 85,000 telehealth
consultations per year including video calls – one
third of their patients are Indigenous7
Patient e-records – sometimes patients can’t
remember when they were treated for things and
in an Itinerant population it is valuable for any
doctor or chemist to be able to look these up
Closing the Gap program – making it easier to make
claims without medicare documentation
E-Health system relies on MyAccount with fed.gov.
This system has already changed since last year. I
cannot log into the account I created and I cannot
reset it without talking to a call centre. Not the sort
of UX a very remote Indigenous person would be
able to use.

17. Conclusions
Indigenous Health consistently fails to hit its KPIs and Millenium
Development Goals for improving health outcomes.
Australia has rates of glaucoma, trachomoa and hearing loss related
illnesses that aren’t seen outside of Sub-Saharan Africa – when sight,
breathing and hearing are affected it causes ‘disease burden’
External cause (injuries) are up to three times higher for Indigenous
males between 25 and 44 years of age. Endocrine, metabolic and
nutritional mortality 6 to 7 times higher than non-Indigenous rates.6
Much of the money and time devoted to Indigenous Health is in
administration and rather than focusing on high tech solutions in the
field, cheaper solutions based around social networks would be more
effective.

18. References
1 http://www.ted.com/talks/eric_dishman_take_health_care_off_the_mainframe.html
2 Monte Malach • William J. Baumol, Opportunities for Cost Reduction of Medical Care: Part 3, p891
3 2012 Indigenous Expenditure Report, Indigenous expenditure in all states, http://www.pc.gov.au/__data/assets/pdf_file/0017/119303/01-ier-2012-factsheet-allstates.pdf
4 Commonwealth Indigenous-specific expenditure 1968–2012, 28/9/2012, p10
5 Commonwealth Indigenous-specific expenditure 1968–2012, 28/9/2012, p43
6 http://www.aihw.gov.au/indigenous-observatory-health-and-welfare/
7 http://yourhealth.flyingdoctor.org.au/health-services/telehealth/
8 http://www.uq.edu.au/coh/telepaediatrics
9 http://www.cato.org/blog/cost-government