Christopher Joye has an excellent piece in the ABC’s Drum website about the ‘economics’ of the NBN. I would recommend you read it in full. He makes the new point that the addition to the nation’s debt is in fact very substantial and that the opportunity cost of this initiative is extremely high when consideration is given to the initiatives foregone.
Now the Prime Minister is spruiking the benefits of the NBN by reference to its ability to facilitate medical consultations and promising a special Medicare rebate for broadband consultations. It’s hard to know from whom she is receiving her advice, but the reality is that the scope for broadband medical consultations is very limited indeed.
Just think about – why don’t all us suburbanites receive our medical consultations using broadband conferencing – which is feasible at the moment – if it were such a good idea. Think of the efficiency gains. But face-to-face consultations are either technically required – hard to feel that tummy over the internet – or overwhelmingly preferred as doctors pick up various cues from being in the physical presence of their patients. (And I am leaving aside the emotional side of the doctor-patient relationship – the comforting pat, for instance.) And of course, anything procedural requires contiguity between patient and doctor/health care provider.
There is also an assumption in the Prime Minister’s proposal that there is a standing army of specialists able and willing to sit in front of screens to ‘consult’ patients located elsewhere. This is an heroic assumption at this stage and for quite some time into the future.
Now internet-enabled consultations can play some limited role in some limited circumstances – opthamology, radiology, psychiatry (although empathy over the wire might be a bit of stretch) are possibilities. But to use this example as something that justifies $42 billion of taxpayer money is a ridiculous.
And I have made the point before, that proper evaluations need to be undertaken of the various call centre health initiatives, such as Nurse On-Call, before extending them. Understandably driven by strict protocols and attempts to minimise risk, it is unclear whether the value of these services – say, by reducing the flow of patients to Emergency Departments – is greater than the costs.