beyond pt 0 23/1

in ways which bypass local clinical and ethical scrutiny. The aggregation
of consumer presence in a ‘health portal’ site, with the referral of patients
to medical practitioners on payment of a referral fee, opens up a major
structural change in the industry at least as disruptive to the accepted
institutional structure as the rise of the hospital was to the medical
profession in the last century.
Models for rationalisation and consolidation of health
The globalisation of biomedical publishing and the development of the
health super sites funded by US venture capital pose a considerable threat
to Australia’s health infrastructure.
At present it seems unlikely that the necessary coalition of healthcare
providers will form to keep control of the information infrastructure of
their industry. One possible scenario is the dominance of the Australian
health information management market by the big players—HealthEon/
WebMD, Medscape and the like. Indeed it will probably be attractive to
some health information providers to form such alliances.
Such a development is likely to retard the development of widespread
e-commerce in health in Australia. There is widespread evidence that health
information systems do not transfer well in different national contexts.
It also seems unlikely that a public sector led model of health e-commerce
can be successful. There are too many fiscal and institutional barriers in
the existing roles of Commonwealth and State/Territory Governments
to permit the speed, flexibility and scale required if Australia is to
have a native health information management system and associated
e-commerce capabilities.
The most likely outcome is therefore a systematic sub-optimal
implementation of e-commerce in Australian health care.
Key points
Greater use of e-commerce could drive considerable change in health services.
Significant efficiencies stand to be made in areas of health, such as pharmaceutical
supply chains. Furthermore, e-commerce might change the way that these services
are delivered, particularly through the potential for servers to coordinate and
integrate services by multiple providers. Essentially, the change would result in
better management of information and therefore better health outcomes.
Similar to other sectors, a key change would be to introduce more convenient service
delivery channels, as well as introducing the potential for new services, or extending
access to existing services (via distance health for example).
While there are quantified estimates about cost savings and other potential
economic impacts, it was not feasible to include these into the modelling conducted
in this pilot study. The main problem is that many of the changes foreshadowed rely
on policy changes in public systems. These follow different trajectories to
commercial outcomes that the rest of the study has focused upon.
Rather than merely estimating the impact of e-commerce in this sector, a separate
study about what could be achieved if certain barriers were removed is called for.
131