Following the airing of the Four Corners report “Wasted” on 29th September, which featured commentary on the over diagnosis and over treatment of common health complaints including back pain, knee pain, chest pain and prostate testing, the conversation about inappropriate tests and procedures has gone well beyond the medical profession.
“Wasted” implied that doctors are not so eager to have conversations with patients and take the time to explain that the evidence relating to their condition simply doesn’t support doing a test or prescribing a drug, so they find it easier to do things quickly and prescribe or order a test. On the other hand, patients often need certainty regarding their condition, so they feel the need to see the image scanned or test figures instead of asking for evidence as to whether the procedures would really help them.
Four Corners reported that over diagnosis and over treatment are the largest drivers in the increase of health care costs. The next drivers are increases in the costs of technologies and the ageing of the population. Knee pain and back pain are two conditions that are only natural to happen in the ageing process, but last year, there were over 150,000 knee scans carried out in Australia, and it is estimated that at least 50% of them were unnecessary.
Analysis by Four Corners found billions of dollars being squandered and more than a hundred inappropriate tests and procedures receiving Medicare rebates. Following are the key findings of “Wasted”:
- Nearly one third of the almost $155 billion spent on health every year is being wasted – that is, about $46 billion
- Knee replacements cost up to $23,500 per procedure and last year cost the public and private health systems more than a billion dollars – about 20% of them may be unnecessary
- The cost of back pain imaging are about a billion dollars over the last ten years
- Spinal fusion operations, mostly performed in private hospitals, cost about $2.3 billion over the last ten years – it was estimated that 50% of this is needless
Exercise and Sport Science Australia (ESSA) entered the debate after “Wasted” aired. They recommend evidence-based, non-invasive and dramatically more cost effective clinical exercise prescription for various conditions featured. ESSA says that patients could be assisted to manage and decrease knee pain and lower back pain, prevent diabetes, lower blood pressure, improve blood flow and physical capacity in cases of stable angina and protect against prostate cancer.
The Consumers Health Forum of Australia (CHF) was quick to respond following the ABC’s airing of “Wasted” by calling on the Government to take urgent action to put the brakes on waste in health care. The CHF stated that consumers expect the best possible care for their taxes and out-of-pocket costs, and when so much of it being spent on procedures that are not supported by evidence, the system needs to be fixed.
The CHF also said that patients should be able to question their doctor about the necessity of proposed health interventions and be part of the decision on whether a test or procedure is right for them. They say that the Medical Benefits Schedule review should identify the most unwarranted and evidence-lacking items to be struck off the schedule.
Choosing Wisely Australia provides a forum for clinicians and consumers to improve conversations and decision making about unnecessary and potentially harmful healthcare. They guided by an advisory group comprising health professionals and consumers, including Associate Professor Adam Elshaug who featured on the Four Corners program.
Choosing Wisely Australia has partnered with 13 professional medical colleges and societies, including the Royal Australian and New Zealand College of Radiologists (RANZCR) and The Royal College of Pathologists of Australasia (RCPA). They have released twenty five recommendations along with five questions that consumers should ask their health professional.
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- The health industry’s reaction to the 2015 Federal Budget
- Revalidation of Doctors
- Optometrists’ opinions on new Medicare item numbers
- Advertising health services is about so much more than the AHPRA guidelines
Image: Graham Hellewell – flickr