Mrs Leslie Martin
Executive General Manger
Commonwealth Bank

You might wonder what a nice bank like ours is doing in a place like this. We are here because these issues are important to our customers. Our customers, of course, are consumers, the patients, the Government, the health funds, doctors, specialists and hospitals. We are also here because of the cost to the community. This cost has two forms: Actual levels of cost and the opportunity cost associated with a less-than-optimal allocation of resources.

The banking industry brings quite a lot to the party:
Network capability
Payments skill & scale
Skills & tools in fraud management
Authorisation and authentication frameworks and mechanisms
A dose of infrastructure engineering capability

We've heard comment today about the relevance of the banking industry's changes to the challenge faced by the medical community. The banking industry does bring real experience and "scar tissue" in the kinds of transformational change that technology makes possible.

The banking system, broadly, brings tremendous reach, particularly when compared to the Medicare network:
Banks have 4888 branches; Non banks have 1239
Australia Post has 3078 of 4474 post offices enabled with Giro Post
There are 24,173 ATMs in Australia
There are 518,532 EFTPOS terminals across Australia

Medicare has 234 offices across Australia. Medicare makes 226 million payments to the value of $7.8 billion a year. The banking industry makes:
1,223,863,158 credit card payments for a value of $150,715,219,000
976,590,478 debit card payments for a value of $64,624,054,000
1,641 million direct entry payments for a value of $7,882 billion
23,081 RTGS payments per day for a value of $136 billion

The banking industry:
Processes 506 million cheques per year for a value of $1,679 billion
Supports a cash pool of approximately $15-17 billion

As such, the Medicare payments are a drop in the ocean, compared to the banking system. We would argue that Medicare should leave the business of paying and claiming rebates to the banking system, rather than trying to establish its own capability. Not only are banks skilled in moving money and servicing customers but they also have skills in security and fraud control - sophisticated neural networks for detecting abnormal behaviour.

Just as we have heard at this conference about the need for the organised medical profession to go into bat for consumers when changes are being made which could impact on privacy, banks have the same role in ensuring that customer interests and privacy are not eroded by well intentioned and necessary measures to combat crime and taxation fraud. We also have to work to protect our customers' interests

The third area of contribution to the e-health debate from the banking sector is the lessons we have learned during the painful journey from handwritten passbooks to the internet banking world - a journey that most of us over 45 years old have experienced as customers.

Firstly banking has put the customer at the centre of our systems - it is now possible to get all the information about the bank's dealings with one customer together on one screen, regardless of which part of the bank has been involved. Customers can access banking services in many more ways than previously.

In 1974 the banks got together to develop standards for moving information electronically between banks - the SWIFT system. This meant putting aside competitive issues and agreeing on what we had to do in common. The development of standards has been lead by the industry with encouragement from the regulators.

Clearly the banking industry is not the same as the health industry and some of the comparisons are rather unfairly targeting the slow progress of e-health uptake. We have decided what information needs to be available online and what doesn't. We have a good idea what will benefit our customers and are acceptable.

In addition to bringing network reach and payments execution and control capability, the banking industry brings some perspective on engineering change. There are a few key principles to share:

Keep it simple and don't boil the ocean: Break things in to do-able "chunks" to get the benefit that is available, then move on to the next chunk
Separate the money from the medicine, because you can, and it lets you focus on what needs doing with health records
Leverage other people's skills and resources so you can focus on what you do best and what is most important: Hitch your wagon to those who have a long term, vested interest in investing in capability, where you don't.
"Nail" the "transaction" as close to the point of service as you possibly can: Payments at the time of the visit can reduce cost and bureaucracy and improve everyone's cash flow.

So, in closing, I'd like to leave you with three thoughts:
The banking system can and should be leveraged because it offers: Convenience, ubiquity, scale, frameworks and tools, scar tissue and war stories
Change management disciplines should underpin everything
Banks compete and collaborate all the time. It just takes some getting used to….

Once again thanks for the opportunity to be here and participate in a forum which we hope will help see a way forward for e-health and also for more active involvement of the banking industry.