People seeking healthcare need to be given much better information about the performance of health services and health professionals, according to Professor Stephen Duckett, Director of the Health Program at the Grattan Institute.
In a lecture hosted by the Consumers Health Forum this morning, Professor Duckett also suggested that the fees charged by doctors for specific procedures should be published online to enable consumers to shop around.
He said his own healthcare experiences, even as a well-informed patient, showed the difficulties that individuals face in negotiating the healthcare system. Consumer advocacy must occur on a systemic level and should not focus on supporting individuals to act as their own advocates, he said.
A painful toe, a sore shoulder – and some ideas for healthcare improvement
Jennifer Doggett writes:
There are few people who can make a lecture about their big toe compelling. Attendees at the 4th Annual Lecture in Honour of Dr Christopher Newell AO found out today that Stephen Duckett is one of them.
The former Secretary of the Commonwealth Department of Health and current Director of the Health Program at the Grattan Institute focussed on his experience of seeking treatment for pain in one of his toes to outline some major potential areas of reform for the health system.
Professor Duckett described how his podiatric surgeon explained clearly the algorithm for making a decision on a treatment course, plus outlined his experience in performing the recommended surgery and his failure rate.
Duckett questioned why, given the data collected via Medicare and other sources, that this type of information was not conveyed to all consumers as a routine part of health care consultations.
In describing an ideal – but in his view achievable – standard of consumer access to data, he said that a 60 year old woman entering hospital for a hip replacement should be given data on the number of women of this age who had received hip replacements at the hospital over a defined period, their average length of stay, complication rate, overall outcome and performance of the surgeon.
Concerns about privacy of health data were, according to Professor Duckett, overrated, as individual identifying details could be omitted when providing the data in most cases.
He also made the point that the value of the data is at the population rather than the individual level and that researchers in areas relevant to health service improvement are rarely interested in the details of individuals.
He did, however, emphasise that safeguards do need to be in place to protect privacy in cases where individuals may not wish their data to be made available.
In emphasising the untapped potential of data currently being collected, Professor Duckett said that one of the greatest policy failures of our health system was the reluctance to use this data to inform health programs and services.
He also advocated for a greater consumer role in providing feedback and rating health services by comparing his experience of receiving health care with using an online service to book a restaurant.
He questioned why, if the booking service was able to follow-up his booking with a request a few days later for him to rate his dining experience, health services were not also able to proactively seek consumer feedback to inform both other consumers and the health services themselves about their performance.
Out-of-pocket costs were also highlighted by Duckett as a significant barrier to access for many consumers in the Australian health system. He argued from his experience in Canada that there was little evidence that co-payments are necessary to establish a sustainable health system.
Using evidence from the RAND Corporation study, he argued that moral hazard (i.e. people over-using health services because they are free) in health care is not a significant issue, and cited evidence that up-front payments can in fact prevent access to medically necessary services.
As a first step to addressing the issue of co-payments, Duckett suggested creating a joint MBS/PBS safety-net. He also recommended publishing the fees charged by doctors for specific procedures online so that consumers can be empowered to shop around for providers.
In describing another encounter with a surgeon in relation to shoulder pain, Professor Duckett described how, despite his extensive knowledge of the health system, he found himself unable to act as an effective advocate for himself when confronted with a surgeon whose advice he wished to question.
His insight from this experience was that consumer advocacy must occur on a systemic level and should not be focussed on supporting individuals to act as their own advocates.
The lecture concluded with Professor Duckett emphasising the importance of the consumer sector in driving health system changes, rather than relying on individuals, governments or providers to promote reforms.
The lecture was hosted by the Consumers Health Forum in conjunction with their Annual General Meeting and in honour of the late Dr Christopher Newell, a consumer health advocate and CHF Board member.
Professor Duckett’s lecture was preceded by a presentation by CHF’s current Chair Karen Carey on CHF’s achievements over the past 12 months. She highlighted the work done on informed consent and informed financial consent, saying that CHF was currently pursuing the development of a national standard for informed consent, which would be a ‘game changer’ for health care provision in Australia.
Disclaimer: Jennifer Doggett has provided consultancy services to the Consumers Health Forum on a number of issues, including informed consent and informed financial consent.
And here is Professor Duckett’s own summary of his talk