If you had a well-funded system, but if it’s completely publicly funded, then who decides what sort of funded system. If you have times of austerity, you’ve just tighten the belt, and that’s what people have to do. And we’ve seen the consequences of that in the UK with sort of increasing pressure on the NHS and worse health outcomes. I think that’s why there’s a lot of reticence in Australia to go down that path because being completely reliant on the continued goodwill of whatever government, whatever economic circumstances, has proven hard.
– A/Prof Michael Wright. 13 January 2026

Earlier in the year, I had the great pleasure of interviewing A/Prof Michael Wright, the President of the Royal Australian College of General Practitioners (RACGP) in Sydney over a game of chess, and prior to dinner at the famous XOPP by Golden Century restaurant.

The interview took place in one of the free (thank you Sydney City Council!) meeting rooms at the Darling Square Public Library, which is just upstairs of the restaurant in the spectacularly designed building, The Exchange.

I’d wrangled a commitment from Michael last year when we were mutually at a conference in Busan, South Korea, that he’ll appear on an episode of Blitz Chess Chats, and the quid pro quo was that I would show him some of the best Cantonese food in Sydney! We’d had abalone in Busan (quite inexpensive there) and it was the first time Michael had experienced it cooked well. At XOPP by Golden Century, we had braised abalone in the Cantonese style, slowed cooked in oyster sauce (delicious!), as well as their signature pipis in XO sauce (hence the restaurant name!).

The interview is the sixth episode of my “Blitz Chess Chats” series on my chess YouTube channel. We start off with a brisk game of of blitz chess as an interview ice-breaker. Michael and I discuss three main topics:

1. AI, LLMs, and technology in health and general practice
2. Michael’s doctoral studies on continuity of care
3. Health system funding

You can watch the entire thing, or dive straight to the interview with the interview-only cut! 😊

Game + Interview

Interview only

Interview transcript

Adj A/Prof Michael Tam

So, you were talking a little bit about, I suppose, some of the things you’ve been working on over the past year. And you mentioned one of the things I’ve discussed, I think, with a previous interviewee that is a hot topic, artificial intelligence (AI) in health. I know that you’ve been – I’ve seen some of your photos, I follow you on Facebook – on some of the Hackathons I think that the college has been involved in. So, tell me a little bit about that, where you see the college’s role or potentially where is that going to go?

A/Prof Michael Wright

It’s a good question. I mean I think as we’re surrounded by increasing technology and I’m really keen to make sure that GPs understand it but also use it safely to help our patients – so we access care.

I mean, there’s a lot of discussion about AI replacing all of our jobs. But increasingly, I think that AI will assist us to make better decisions. But we need to understand it to get that assistance, because if we don’t know what we’re doing, we really are just handing everything over to the AI.

But actually, I think AI can be a really great support for helping us make better decisions.

Adj A/Prof Michael Tam

Yeah, like the way I see it, I don’t doubt at some point in the distant future, we will have, nominally, artificial general intelligence. I actually don’t think that’s going anytime soon, to be honest.

And the enthusiasm, I think, for the large language models is based on a lot of anthropomorphised… how would you call it? It’s not delusional, but I think it’s a serious misunderstanding of what the models are actually doing.

I actually recently gave an analogy; I gave a talk to UNSW from the perspective of chess. All the frontier models cannot play chess. And it’s a simple game insofar as that the rules are very simple. A child can learn the rules and play it consistently. And it’s concrete. You follow a set of rules. You go by first principles. Ostensibly, you can call that reasoning if you wanted to. And none of the frontier models can do it. They will either cheat, which is hallucinations, or they’ll be easily beaten by a 1970s algorithm.

So, when it can’t do that, you can’t tell me it’s looking into people’s records, looking into literature, and actually from first principles doing reasoning. What it’s doing is the appearance of reasoning… and that’s fine. That’s actually really good. It’s actually amazing! But it’s not actually reasoning.

A/Prof Michael Wright

And as you say, it’s that whole that it’s predicting what it thinks the next likely thing will be.

Adj A/Prof Michael Tam

Exactly.

A/Prof Michael Wright

Even if that makes complete nonsense.

Adj A/Prof Michael Tam

That’s right.

A/Prof Michael Wright

That’s right.

A/Prof Michael Wright

And that’s interesting to know what it thinks the next most likely thing will be. But… does that inform our health decisions? Unless that’s the question that we’re asking, is what is the next most likely thing that this will be?

Adj A/Prof Michael Tam

That’s right. The LLMs are extremely good at approximating a response. And so when that response, where an approximation… where it looks good enough, is actually good enough, that’s perfectly fine. If I want to format a document in a particular way, it could be done a million different ways. As long as it’s readable and it is cogent, that’s fine. It doesn’t have to be a particular way.

While often in certain domains of reasoning, there actually is a correct answer and it’s a very narrow correct answer. And so approximately is what we just call bullshit! It’s not the right answer.

A/Prof Michael Wright

It’s not just good enough. Particularly if it has to come to an answer and the answer is incorrect, the incorrect answer is more damaging than not having an answer at all. Because in general practice, one of the things is we work with is uncertainty. Lots of people don’t have a diagnosis yet, and that diagnosis will come out over months or years. If an AI predictive model says, oh, I think it’s this, it does certainly colour everyone’s actions after that. Then it’s almost like removing that diagnosis before you can actually get to the true diagnosis in some cases.

Adj A/Prof Michael Tam

The LLMs obviously are extremely good at manipulating language. So, I think for summarisation, it’s actually very, very good – particularly if it’s something you as the human user can immediately verify. So even for something, I know it’s a little bit controversial, let’s say, consultation summarisation, note-taking. Because you are literally there – you can verify whether it’s accurate or not.

The problem is aspects you can’t verify. And so, if you’re looking at somebody else’s notes as written by AI, how can you know whether it’s correct or not? You weren’t there. So, the trust becomes an issue. But clearly, when used in a certain manner, it can be safe and can be very, very good.

Adj A/Prof Michael Tam

From the perspective, okay, I’m not going to ask you to take the college’s stance, but from your perspective… let’s say moving forward, we’re into just the beginning of 2026, let’s say 2027 to 2030. Where do you think, what do you think, you know, general practice in 2030, what might it look like in terms of technology use?

A/Prof Michael Wright

I think already we’re seeing the rapid uptake of the consultation scribes, so the scribes to support us to write our consultation notes. Now, I think that will continue, but there’ll be a ceiling. Not everyone will want to use it. It’s a bit like when computers first appeared on GPs’ desks, let’s say 30 years ago. There were some early adopters, then the majority of us sort of came along, particularly when there was benefit to our workflow; things like not needing to write on a prescription pad, but being able to do electronic prescriptions.

And potentially there are some real administrative bugbears in our work, which you probably know: writing prescription and having to call telephone lines to get approval, filling in forms that don’t integrate with our medical software. Now, if AI is going to help us get through around those sort of things, I think that will help the uptake. And I think it’s got great capacity to do that. It’s just trying to work out what are the cases… the examples, where AI will actually be a solution.

So, I think that’ll be helpful. You see practices already that have things where there’s a device where you come into the surgery and you can put in your arm, and your blood pressure and you can have that done. I think that kind of technology is getting a lot cheaper. It’s impersonal though, so I’m not saying that’s a better thing, but for some people they may want to have that data.

I think also people will have more data from home. So, whether it’s on our iPhone or our Android devices, that a lot of people are bringing in apps to me and saying, this is what my app says. Now, the challenge with that is there’s a lot of noise. There’s a lot of information there, and how much of it’s useful? On some of the devices people have got, [it’ll detect] if they develop an irregular heartbeat and that might make you more likely to have strokes. and things like that can be helpful information. And other people come in and talk about their sleep cycle, and some of it’s about more on the health lifestyle optimisation rather than the disease-seeking. I think, potentially that’s going to be one of the challenges for us, as a medical professional, as a GP, is working out… obviously I’m trying to help people to live their best life and more of this is about healthy lifestyle as well as treating their disease.

Maybe we will get a shift more towards lifestyle management, but we still have to do the other things. That’s the challenge: do we have the capacity to do it all?

Adj A/Prof Michael Tam

Yeah, and I suppose, it’s a more philosophical question. Really, more for society, I think: is this what we even mean by the good life?

Like now there’s this quantification of biometrics because – I suspect you as well – I’ve seen patients, they’re bringing their devices and their wearables and sometimes, you think maybe it’s useful? Like is this data real? Maybe it is. Is it interpretable? Don’t know. And you can do the pretence it’s interpretable and if the patient finds meaning in making behaviour change, [perhaps it] doesn’t matter.

But then clearly there are times where I’ve seen someone where effectively they’ve developed an anxiety disorder around minor abnormalities on their, for example, in their heart rate. And so, they keep measuring it a hundred times a day, and actually, the measure is driving the anxiety. The anxiety is what’s causing the tachycardia. They just need to detox; in fact, they need to stop using the device and they’ll be fine.

And I wonder, how much, you mentioned it has noise… One could believe, I think it’s plausible that some of these measures are potentially predictive of… something.

A/Prof Michael Wright

Yeah.

Adj A/Prof Michael Tam

We don’t know of what, because we’ve never… no one’s ever done any research on that. Like, let’s say you find minor arrhythmias on a device that measures a pulse rate, but basically 24-7, 365 days: do they mean anything if they’re asymptomatic? We don’t know what rate of those are actually just within normality.

A/Prof Michael Wright

What’s significant? And I suppose even what’s the usefulness of measuring all this data when maybe if we turn it off, people might have a happier life, particularly for the people who do get anxious. But maybe that’s what we do as GPs. I feel like that is our kind of our role is to work with people to understand the data that they have and hopefully reassure appropriately when something does seem within normal range.

But that’s one of the things I think we do as GPs is by seeing people multiple times over a longer period, that we tend to get a sense with our patients of what’s normal for them. And maybe, and I do think that we perhaps jump off less quickly, when you know someone and you’ve seen them, “well, I think this might be my perception of what these symptoms means. Let’s go down that path.” But also knowing that if I’m wrong, we’ll be able to follow this up in the near future. So, you’re not letting someone slip through the cracks. Because we see people on multiple times and we expect to see them again, we can work out the success or otherwise of a particular treatment or not treatment, if we observe people and say, look, I think we can just watch this for a week or two. And that’s something that I don’t think technology particularly allows us to do. I don’t know that you see that many technological solution where it says, “don’t worry about this, we’re not sure what it is, but it’ll probably go away.”  The uncertainty doesn’t come much through with technology.

Adj A/Prof Michael Tam

Well, that’s the thing that doesn’t come with ChatGPT. Where you ask it a question and it goes, “well, look, I actually just don’t really know.” And perhaps when they talk about guardrails and things like that, part of the challenge is that ChatGPT and most of the LLM chatbots will be extremely unusable; would be practically useless if they actually presented their answers in the genuine language of the uncertainty that exists. They’ll say, “look, I’m not really sure, but maybe it exists.” Why did I even ask this as opposed to just googling the answer directly?!

A/Prof Michael Wright

Because I think even with the LLMs, they do predict the most likely response. If that response is 51%, okay, but maybe it’s 30% and there are 10 others, it’s still only less than one in three would pick that response. There’s a lot of other alternatives.

Adj A/Prof Michael Tam

Yeah, and it’s predicting the most expected response from the perspective of its training data. And of course, the further away the phenomenon is from something that could exist in training data, the more likely it’s actually just saying a bias. It’s not saying what’s real, it’s saying a bias because that is what you would expect to see in the training data, but it’s not real.

Adj A/Prof Michael Tam

Now, Michael, you’re someone who has a PhD. I remember when you first became president, I think, at the college conference, not last year, but in 2024. And you and Mark Butler, the Health Minister, were on stage and he sort of noted, you both kind of look a little bit similar! But, noted that you’re also a health economist and you’ve got a PhD in health economics from UTS (University of Technology Sydney)… which is actually just a couple of hundred metres away!

A/Prof Michael Wright

I did a lot of my PhD study just up the road.

Adj A/Prof Michael Tam

So, can you tell me a little bit about your doctoral studies? What did you study and what did you find?

A/Prof Michael Wright

I was very interested in continuity of care. So, this idea that if you have care from the same GP or the same practice over time, do you get better health outcomes? There’s some international evidence to suggest that, but I hadn’t found any Australian evidence. So, I thought this is something that I want to quantify. As a GP, I like seeing people who I’ve seen before. I think I do a better job, but I didn’t know: is it better for them?

Adj A/Prof Michael Tam

That’s right. The lived intuition is surely it must…

A/Prof Michael Wright

It’s probably a good thing, yeah. And you feel like people don’t have to go explain the whole history every time, and probably that’s better for them. But then I thought, well, maybe it’s not better. Maybe having multiple people involved, you get different sets of eyes, so it’s better? But I thought I wanted to quantify it.

I did my PhD at the business school at UTS in health economics, looking at if you could quantify what is the impact of having continuity of care. I did a number of studies, but the main one was looking at cancer screening: using a large data set, looking at women. It’s called the Australian Longitudinal Study of Women’s Health, where we’re asking women for 20 years: had you had your regular breast screening and had you had your regular cervical cancer screening (so regular pap tests). And trying to work out, was there any pattern between women who said that they had the same GP, or went to the same practice but saw different GPs, and whether they had that cancer screening compared to people who went to multiple practices.

And essentially what we found is that women who had all their care compared with women who saw multiple practices, women who went to one practice were more likely to have appropriate cancer screening.

And also, women who had all their care from one GP were also more likely to have appropriate cancer screening than women who saw multiple GPs within a practice. But the main difference was between the multiple practice and the single practice attendance.

So potentially, that continuity from information from having all the shared record, that has a benefit. But there was also an additional benefit, although smaller but still significant, that if you had all your care from one GP, potentially that relationship where you’ve got all your care, potentially we both sort of have this shared responsibility to one another that I would say, look, I think it’s time for your test, and that potentially you might say, oh, okay, yep, I’m due. There’s, so trying to, as I said, trying to understand the value of that. That was what the PhD was about.

Adj A/Prof Michael Tam

Sure, and was the result, did that seem to be maintained when accounting for, let’s say, people from different socioeconomic groups.

A/Prof Michael Wright

We accounted for… there were a lot of variables that we controlled for, including income status, education. We did look at age, we looked at state of location, medication use. I’m trying to think… yeah, there were about 15 of them, but just tried to control all the other variables.

So potentially, people who are wealthier can afford to go and see the same GP all the time, whereas people who have less resources might have to shop around for whatever. But even when we controlled all of that, the significant differences were maintained.

Adj A/Prof Michael Tam

Yeah, so that result seemed to be robust across that. I’m really pleased that there’s that result because I suppose it sort of meets my expectation of what we should find. I suppose a concern in particular is… I’ve historically worked in South Western Sydney, which is a relatively low-income area. In fact, one of the lowest income areas across Australia. One of the things that we have observed before; because one of the things people say, “oh, you know, people from the South West, they don’t go to see a GP, so they go to emergency departments.” That’s actually false. When you actually look at the data, I think the median number of general practice visits is in fact higher in South Western Sydney than other parts of the country. Not grossly higher, it is a little bit higher.

But one of the things is that there’s also a higher number of individual GPs seen across a unit period of time as well. So, there’s less of that continuity. One of my concerns is that some of the health reforms to try to improve access have largely focused on… access, insofar as seeing anybody, as opposed to supporting continuity. And in fact, some of the changes may in fact be impairing or could damage continuity, hypothetically. What are your thoughts about that?

A/Prof Michael Wright

The evidence is that trying to encourage people to get care from their same GP, from the same practice, would actually be beneficial. think if we set up the incentives to encourage patients to seek care from their preferred GP, that would be ideal.

And I know what you’re saying. If we all open up alternative pathways where you can go and see a GP, or you can go to an urgent care centre, or you can go and see a pharmacist, or you can go, in Queensland they’ve got satellite hospital… you know, all those people. It really does fragment care. It adds extra people, and particularly if people aren’t sharing a single health record, there’s very little accountability. The international evidence shows that you get worse health outcomes.

Yes, so I think it’s an important point you make. That actually trying to support people and providing incentives that encourage people to go to the same practice definitely would encourage that continuity of care and reduce that fragmentation. Some of the measures have been designed to do that, like MyMedicare. The idea has been that encourages people to go to the regular GP. But, without incentives for patients and the GPs to provide that care, then it’s a little bit hard to see how successful it will be.

Adj A/Prof Michael Tam

So, you were mentioning sort of a couple of dimensions – different types of continuity. So informational continuity and also relational continuity. And so, in my naive sense, both seem to be enhanced by, or maybe even be required, for there to be local teams for it to really work well. So for instance, if I’m working in a local clinic, if my medical records aren’t quite up to snuff that has an impact on my colleagues, it has impact on my patients, it’s likely I will get feedback from other people within the health system.

I would imagine, even though it could potentially work, that for people outside, if everything was external, you’re much less likely to have that work quite as well. So, what are your thoughts about the mechanisms of how we make that work?

A/Prof Michael Wright

I know you mentioned relational and informational continuity. The other one we often talk about is management continuity, which is where there’s some consistency in how we care for things. So, it might be like, if you come and see me with… pneumonia. I’m likely to give you certain treatment, and if you go down the road and see someone else, they’ll going to provide you [with the same]. So, there’s some continuity there. There are some benefits from that predictability of us doing similar things.

But I think you’re very right in that the informational continuity can help. If someone’s travelling interstate and they’ve got access to the same record that I’ve got, then that will help them even if they don’t know the person. But they’re still trying to operate within a certain team. And as I said, for general practice, the core of what we do is providing care over time repeatedly. So just everyone doing something and adding it to the record isn’t really helpful, particularly if people haven’t looked at what’s in the record, and no one’s actually learning from what’s being put in the record. That’s a challenge.

And then, and I think locally, increasingly we’re talking about in general practice working more in multi-disciplinary teams. So, you’ve got a GP, but you might have a nurse, you might have a pharmacist working in the practice, or a psychologist. All of those people need to work together, and having a shared record is fundamental to that. But also knowing each other and understanding what each other’s roles is critical to that too.

Adj A/Prof Michael Tam

Yeah, so as you know, I’ve worked largely within mental health. Multidisciplinary care is, I suppose, part of the model of care for people living with severe mental illness in that specialised mental health scene. Certainly, things like team meetings are not replaceable just by medical records. And so, actually having humans talking to other humans, where it’s important and salient; and I can certainly agree that in community practice it may not be quite as important all the time. But the record doesn’t replace that. And just like my personal knowledge and memory of seeing and speaking to one of my patients over time cannot possibly be replicated in the record. Because even if you wrote down an entire transcript – you know, there’ll be hundreds of pages – as another human reading it, you’re not going to be able to absorb that lived experience, and it wouldn’t be reasonable to do so anyway.

So, there is, I think, something about the fact that our interactions are fundamentally with humans. Our patients are humans. And so, to me the continuity, that relational element, that local, actual, face-to-face interactional element, sort of demands, I think, a certain respect for locally based teams.

A/Prof Michael Wright

And I think, as GPs, that’s what I feel like for a long time we’ve got. I think this is what we do that’s valuable, that having that relationship, understanding our patients, and treating them more than a series of entries in a record is the sort of difference that we have. That’s when people say that, my GP understands them and they say that’s the most valuable thing that they’ve got. I think that’s where that comes from.

Adj A/Prof Michael Tam

Yeah, the patient is not an object in a medical record system. That’s a certain description that enables care, but that’s not them.

A/Prof Michael Wright

And that record can facilitate to keep some information that might be useful in the future, but it doesn’t replace the person in front of you.

Adj A/Prof Michael Tam

Now I’m going to change tack a little bit. Because you’re at a senior leadership level within the College of General Practitioners and also from your health services, health economics perspective; imagine you have a magic wand, and you can reconstruct the health system as you choose. So, you’re god! So, not constrained by what’s happened in history and exigencies of what can be voted in and what won’t be voted in.

If you could magically change it to a way that you think would be optimal, what would the Australian health system look like?

A/Prof Michael Wright

It’s a fun one to think about. I mean, I do think fundamentally we don’t place enough focus in Australia on prevention and health promotion and keeping people well in the community. So, if I was to redesign it, I would shift resources and focus towards more prevention, promotion, primary care. So basically, design and keeping people well in the community rather than waiting for them to get sick at the hospital.

One of the challenges we do have in Australia is we have a federated health system where the states control the hospitals, the federal government controls community care, for want of a better word, although the federal government does pay almost half of the hospital budget as well. And so that challenge is that there’s a great resistance there. So, changing that. I mean, we’ve talked a couple of times in our history of ending the blame game. If one side of politics, if one arm of government were to agree that there was to be a single oversight, potentially that would create some greater efficiencies.

But it potentially then just creates a single system; some of the tension between states and the federal government does create innovation, and also the balance of having a public system as well as with an element of private creates this. Although they create more complexity that tension between those different models may actually be in our long-term benefit.

When you look at other countries who have, the UK has a single publicly funded system, which is under great pressure, but due to underfunding over decades. Whereas in the US, there’s a large private component and a high insurance level. And if you are insured, you get really good care, but there’s a large proportion of the population who don’t have access to care. In Australia, we do currently have a – I’m not going to call it a happy medium – but in between those is probably the way we want to be.

Adj A/Prof Michael Tam

It’s an interesting thing. It’s kind of like a prisoner’s dilemma, right? Because you can certainly design a centralised… Let’s say, a government-run health system that was well-funded, if it was pretty efficient, you can design the quality and the service level that’s agreed by the population, if you live in democracy. And similarly, in a purely privatised system, if you want more, you pay more. If you want less, you have less. From the perspective of, let’s say, car insurance, that’s all privatised with a certain degree of regulatory oversight.

But what we have seen worldwide is with those models, they tend to have corrosive elements: they become very efficient at not being very good, and they get a bit stuck. And what you’re saying is our mix of private and public maybe stops some of that settlement?

A/Prof Michael Wright

And exactly, as you said. If you had a well-funded system, but if it’s completely publicly funded, then who decides what sort of funded system. If you have times of austerity, you’ve just tighten the belt, and that’s what people have to do. And we’ve seen the consequences of that in the UK with sort of increasing pressure on the NHS and worse health outcomes.

I think that’s why there’s a lot of reticence in Australia to go down that path because being completely reliant on the continued goodwill of whatever government, whatever economic circumstances, has proven hard.

Adj A/Prof Michael Tam

From a macro perspective, and again, from the perspective you can wave magic wand, how much, what proportion of health funding (if you’re the health system god) should go to, let’s say, primary care, as opposed to secondary, tertiary care, public health, and population health? Where do you think that is, in terms of ballpark funding?

A/Prof Michael Wright

I mean, some of the research which I’ve been doing has been looking at the percentage of the health budget that goes into primary care. And by primary care, I mean high quality, first contact, comprehensive, long-term care, like you get from a GP in Australia. In other places, you might go to a family medicine doctor. The percentage of the health budget that’s been going to providing that care has been dropping year on year for most of the last decade. So, we were close to 8% back in about 2013-14. I think in the most recent figures it’s less than 6%. Essentially the funding that’s been going into general practices has been pretty static; it’s around $400 per person per year, but hospital expenditure has been going up. The amount spent on hospital, per patient on public hospitals has gone from around $2,500 to over $3,000.

So, a relatively small increase in investment in general practice, I think would have a big impact. If we go back to 10%, that would be a reasonable starting point. I mean, if we get to 20%, that would be miraculous. But also, if you ask patients… There’s a survey that a colleague ran asking patients how much of the health budget do you think goes to general practice. And the average person thought about 30% should be going into GP services. It’s actually, as I say, probably less than 6%. So maybe asking patients what they want is something that also could we do to inform the mix?

Adj A/Prof Michael Tam

Yeah, I do find it interesting when people say that Medicare is unaffordable, where these are, in my view anyway – I’m not in government, so obviously it’s more difficult and more complicated than what I’m saying – that these are choices because the total quantum that goes to general practice (Medicare is more than general practice), but the total quantum that goes to general practice is actually pretty small.

A/Prof Michael Wright

If you’ve got the pie, yeah, I mean, it’s a very small piece of the pie that does go to support general practice. And we provide over 170 million visits a year. So nearly 90% of the population goes to see a GP; there’s high levels of contact, high levels of access. The stats which I saw last year, which I thought was really interesting: where 99% of people, when you ask them, “could you see a GP when they needed to?”, said “yes”. Now, some people had to pay for it, some people had to wait longer, but 99% could see a GP. That’s pretty spectacular access, and I do think it’s something we should be proud of.

So even when you say, you know, the whole idea of waving the magic wand and starting again, we’re probably starting at a better place than most people. So, I probably don’t think we need to throw everything out and start again. There are some real features of our system that are positive that do act as checks and balances.

Adj A/Prof Michael Tam

Yeah. I think fundamentally part of it is just quantum of funding. I don’t strongly, I suppose, believe in one model over another model. But I do have, a personal problem when… I get concerned when health reform is shuffling deck chairs, like moving money from one pie, from one model to another model, but the total quantum hasn’t changed.

And as far as I can tell, community medicine is actually quite efficient overall. There’s bits of leakage here and there, of course. But it’s actually pretty good. And Australian hospitals, they’re overall probably fairly efficient in terms of what they do as well. So, the issue is perhaps configuration and what money goes where. In Australia, as you know, we don’t put a lot of funding into population health and preventive health, especially compared to, let’s say, the pharmaceutical budget. It’s not difficult for new pharmaceuticals to be effectively funded for a good fraction of a billion dollars, and that’s an annual rolling budget, while something, let’s say, trying to improve access to dietetic services or improving exercise services available for the community, group exercise – that’s basically impossible.

A/Prof Michael Wright

I think you’re right. I mean, you’ve seen the new drugs, the new weight loss drugs that are very expensive, effective, but they will get on the PBS and they will be subsidised. But you’ve got a lot of other measures, like group weight loss, group exercise, you know, other things that will actually impact health and weight long-term as well. But they’re not as, perhaps they’re not as easily quantifiable. And so, because of that, they just less attractive to funders because they’re less certain.

Adj A/Prof Michael Tam

Yeah, and it’s a funny thing, there’s this issue about certainty because, like some of it is a matter of, it’s almost a matter of belief. It’s like asking what’s the evidence for primary school education. There’s no good evidence for it, from the perspective of clinical trials. But you just have to believe that that is the case. There’s a very strong theory on why.

A/Prof Michael Wright

Although there is a strong economic school that talks about the return on education. And I think that’s a good point. And that’s one of the reasons why I’ve actually have found studying economics quite interesting, because it does talk about the return on different types of investment, but those investments can be education, you know, as well as financial tools.

And so, and maybe that’s something that we don’t… we do look at clinical trials for these sort of hard health outcomes, when there could be additional [analysis on] education, group consultations, you know, a number of other interventions we could do beyond medications, but which they’re just not viewed as highly. And which they should be.

Adj A/Prof Michael Tam

Look, thank you very much. It was a stimulating discussion!

A good game. I think we didn’t use the clock quite properly. I hadn’t used it for a while!

A/Prof Michael Wright

Sorry, first time for me to use the clock. So sorry!

Adj A/Prof Michael Tam

No, that’s all right. I don’t normally use the clock.

A/Prof Michael Wright

I was sort of waiting for a bell that goes off every 10 seconds to say that you’re taking too long!

Adj A/Prof Michael Tam

No worries! This is a copy of my book for you.

A/Prof Michael Wright

Thank you so much! I feel like I’ve got a lot to learn, so thank you.

Adj A/Prof Michael Tam

Look, you played the game reasonably well. I can tell you’re a beginner.

A/Prof Michael Wright

As I said, I haven’t played a game of chess since school, I think, so yeah, it’s quite refreshing to start again. Probably more of a checkers guy to start with!

Adj A/Prof Michael Tam

Not at all, not at all. Look, if you do decide play, my interest in chess is particularly with what we call the Romantic style, which is less rigorous, but more based on tactics and sacrifices, and just basically, chaotic chess for fun.

All right, thanks very much again and I’ll catch you around.

A/Prof Michael Wright

Okay, thanks a lot. Thanks.