1
Nov
2019

Remembering George Palmer, academic health policy advocate

by Stephen Duckett


This eulogy was delivered by Stephen Duckett at a commemorative service for George Palmer in Brisbane on 1 November 2019. Stephen Duckett was a student and colleague of George Palmer’s in the 1970s and ’80s, and collaborated with George on the introduction of case-mix into Australia. Dr Duckett is now Grattan’s Health Program Director.

George Palmer shaped health service management and policy in Australia from the 1970s until the end of the 20th century. As Professor of Health Administration and head of school at the University of New South Wales during that period, he taught generations of students in what was then the only university program for health service managers in the country. He was Australia’s leading health policy academic throughout this period, and shaped policy in seen and unseen ways.

Most of his students in the School were midcareer and so the insights he gave them – both about the Australian healthcare system and the use of statistics to monitor health system performance –could be directly translated into practice. He also shaped thinking beyond the University through his scholarly book with Stephanie Short that went into five editions (Palmer and Short 2014) .

He brought his academic insights, and practical orientation, into health policy in Australia during the Whitlam years when he was appointed a commissioner of the National Health and Hospitals Commission. This body was responsible for creating and funding the community health program in Australia.

George’s international reputation and legacy here in Australia rests on his influential research on case-mix measures (Palmer 1986, 1989, 1991, 1996). I think this work reveals something about his approach and his successes.

It was on one of his regular visits to the United States (Turner and Short 1999) that George first came across the Yale University team led by Bob Fetter and his work on measuring the performance of hospitals (Fetter et al. 1991). George immediately appreciated what a breakthrough it was. Before Fetter’s work, we did not have a robust way of describing the work of hospitals; after the Yale work, we did. What Fetter’s team at Yale had done was to break through the impasse about whether we compared cost per patient day or cost per patient treated. Fetter’s work developed a standardised way of describing the patients that hospitals treat.

But that work was in the United States, a country with a very peculiar health system, and so a lot of work was needed to transform Fetter’s idea into the Australian context. George approached me with a proposal to work with him and Bob Fetter to test an application in Australia.

I had been a student and colleague of George’s at the University of New South Wales for more than a decade – he supervised my PhD among other things – and when he proposed the case-mix project I was in a senior role in the Health Commission of Victoria.

We gave George and Bob Fetter access to hospital data, including costing data, and the rest, as they say, is history. Until then, I thought use of Diagnosis Related Groups required a massive infrastructure; George showed it didn’t.

George led a small team, including Beth Reid, which mapped Australian coding and grouped Victorian data to Diagnosis Related Groups, the measure of inpatient activity, now familiarly known as DRGs (Palmer et al. 1986). Meanwhile Bob Fetter led the work which identified the costs of each DRG in Victoria’s largest hospitals.

I had been a DRG sceptic before George convinced me to the contrary (Duckett 1985). This began a very productive collaboration with George where his team produced annual reports showing Victorian length of hospital stay compared to United States length of stay and thus helped us to identify targets for productivity improvement. He engaged in what today we would call knowledge transfer, to build our skills in the Health Commission so that we could do inter-hospital comparative work ourselves.

Following a pilot where we used DRGs for paying for compensable patients – and this involved another two other leading health economists, Dick Scotton and Helen Owens, in 1993 Victoria adopted DRGs for paying for public hospitals (Duckett 1995). This was followed 20-or-so years later with implementation nationally.

George Palmer leaves a legacy of academic leadership and public service. George was data driven. George was interested in improving the performance of the whole health system. George was committed to the public sector and making sure that it was efficient so that it could address equity issues. George worked in teams. George knew a good idea when he saw one. George will be remembered not only for his policy contributions, but also in terms of his many students and colleagues who benefited from discussions with him and the insights he gave us.

 

Duckett, Stephen (1985), ‘If DRGs are the solution, what is the problem?’, Australian Health Review, 8 (1), 25-31.

— (1995), ‘Hospital payment arrangements to encourage efficiency:  The case of Victoria, Australia.’, Health Policy, 34, 113-34.

Fetter, R.B., Brand, D.A., and Gamache, D. (eds.) (1991), DRGs: Their design and development (First edn., Ann Arbor: Health Administration Press) 341.

Palmer, G.R. (1986), ‘Economics and financing of hospitals in Australia’, The Australian Economic Review, 3rd Quarter, 60-74.

— (1989), ‘The funding of hospitals using Dignosis Related Groups: problems and soultions’, in C Selby Smith (ed.), Economics and health 1989: Proceedings of the Eleventh Australian Conference of Health Economists (Clayton: Public Sector Management Institute).

— (1991), ‘The use of DRGs in the management and planning of hospital services’, The Australian Economic Review,  (1st quarter), 62-70.

— (1996), ‘Casemix funding of hospitals: Objectives and objections’, Health Care Analysis, 4, 185-93.

Palmer, G.R. and Short, S. (2014), Health care and public policy: An Australian analysis (Third edn.; South Yarra: Palgrave Macmillan).

Palmer, G.R., et al. (1986), ‘The validity of Diagnosis Related Groups for use in Victorian public hospitals: Report to the Departments of Health, and of Management and Budget, Victoria’, (Sydney: School of Health Administration, University of New South Wales).

Turner, L. and Short, S.D. (1999), ‘George Rupert Palmer – DRG carrier and champion’, Australian Health Review, 22 (2), 86-102.