As much as one third of Australia’s $155 billion yearly spend on health is being squandered on needless procedures and tests, according to an ABC Four Corners report sure to fan debate over the government’s Medicare benefits review.
A special investigation by Dr Norman Swan claimed some $46 billion was being wasted every year on expensive scans, tests, and surgeries such as arthroscopies and spinal fusions that lacked proof of efficacy or benefit.
Robyn Ward from the Medical Services Advisory Committee told Four Corners very few items on the Medicare Benefits Schedule were evidence-based.
“It’s really only been in the last few years, maybe five or six years, where a really rigorous evidence (base) has been put to the test, in terms of determining what goes onto the MBS,” said Ward.
“But that leaves five and a half thousand items without that evidence base.”
(Stephen Duckett has a nice piece on the MBS review over at The Drum that is worth reading).
Ward told Four Corners fee-for-service also encouraged “the wrong sort of clinician behaviour”, calling for disincentives to order imaging instead of the converse.
“A system I’m arguing for is one that actually pays for value and pays for health outcomes, rather than paying for activity or volume. And that means that we need to understand what value it is we want to buy, what health outcomes do we want to buy, and incentivise people to actually engage in behaviours that actually leads to improvements in health outcomes,” she said.
Sydney University’s Adam Elshaug said the MBS had ballooned from 300 items back in the 1960s to more than 5,700 at last count, and “we really now have to ask whether it’s fit for purpose in a modern-day healthcare system.”
The AMA was quick to condemn the report.
Lots of sweeping statements. V little balance on #4corners with a clear agenda
— AMA President (@amapresident) September 28, 2015
Clearly many things on MBS have not been through MSAC but has overwhelming evidence eg anaesthetic for surgery
— AMA President (@amapresident) September 28, 2015
AMA have supported review but not when just takes services away from patients without reinvestment — AMA President (@amapresident) September 28, 2015
Health Minister Sussan Ley also dropped in on the Twitter conversation.
Did you watch tonight’s @4corners? Tell us your views & ideas on how to deliver #BestMBS here: http://t.co/2UyCxkcP9Y #4Corners @normanswan
— Sussan Ley (@sussanley) September 28, 2015
GP Jenny Doust, from Bond University said part of the problem was the constant shifting of goalposts for management of conditions like hypertension, requiring lower and lower safe ranges and resulting in treatment of “lots of people who are actually very low risk”.
Paul Glasziou, director of Bond’s Centre for Research and Evidence-Based Practice, warned of a “tsunami of overdiagnosis”.
“The largest drivers are over diagnosis and over treatment, that is going to get worse as our imaging, bio-markers and genetic technologies get better. We’re going to keep labelling more and more people as having risk factors or diseases that we want to treat.”
Although billions of dollars were being spent on collecting data Ward said “we don’t go the extra step and actually use the data and feed it back to clinicians and feed it back to the patients and the public.”
Just to recap, some of the specific claims made on Four Corners tonight:
- $46 billion in health spending squandered on tests and procedures every year
- Most, or at least half of all knee MRIs unnecessary
- At least half of all knee arthroscopies unnecessary
- Around 20% of knee replacements inappropriate
- Majority of imaging for lower back pain “a complete waste”
- Up to 43% of invasive coronary angiograms unnecessary
#4Corners has found nearly one third of the almost $155 billion spent on health each year is wasted = $46 billion.
— 4corners (@4corners) September 28, 2015
For those asking, the estimate of 30+% waste is backed by Syd Uni Prof Bruce Robinson, who’s heading the MBS review #4Corners #health — Sally Neighbour (@neighbour_s) September 28, 2015
.@AElshaug on #4Corners… pic.twitter.com/oGLAhH2rq0
— 4corners (@4corners) September 28, 2015
Lots of excellent food for thought over at #4corners – a taster below:
