health

Patients at risk and billions of dollars being wasted because of tests, scans and procedures that don't work.

Image via ABC.

When we are sick or in pain we do not realise that what is done, or not done, in the GP’s surgery can set us on a journey to a place we may not want to be.

We might be grateful to a doctor who takes the trouble to send us off for a scan, without realising that that seemingly simple and benign decision can have implications which last for years.

A special Four Corners investigation tonight reveals many of the treatments and tests we get are unnecessary, sometimes harmful and needlessly expensive, costing the health system billions of dollars every year.

Key points:

  • The annual health budget is almost $155bn. Four Corners has found that nearly one-third of that – about $46bn – is being wasted.
  • Many of us are receiving tests or treatments we don’t need, and some of these are harmful.
  • Since GPs were given permission to order MRI knee scans three years ago, the number of scans has gone from zero to over 150,000 in the past year. It’s estimated that at least half are unnecessary.
  • Knee replacements cost up to $23,500 per procedure and last year cost the public and private health systems more than $1 billion – not far short of 1 per cent of the national spend on health. About 20 per cent may be unnecessary.

Figures from the Australian Institute of Health and Welfare show Australia spends just under $155 billion on health each year, and it is estimated that one-third of that amount — about $46 billion — is being squandered.

This is total spending by federal and state governments, private health insurance and in hard cash from patients in gap fees.

Adam Elshaug, Associate Professor of Healthcare Policy at Sydney University, is an authority on what is called low-value care and has identified at least 150 unsafe, inappropriate or ineffective medical services that receive Medicare and health insurance rebates.

Since GPs were given permission to order MRI knee scans three years ago, the number of scans has gone from zero to over 150,000 in the past year. (Image via ABC)

He says the system is wasting precious health dollars and putting patients at risk.

"We know that patients are being harmed by receiving tests and treatments that they should never have received," he said.

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"There's a cost too, and that cost should also be counted because those are dollars that are wasted and could've been reallocated to other areas of medicine."

Most of us are unaware there is often little evidence supporting many of the medical services we receive, according to Professor Robyn Ward, chair of the Medical Services Advisory Committee.

The committee is responsible for reviewing the evidence behind proposals to add new items to the Medical Benefits Schedule (MBS) — the list of more than 5,700 services, tests and procedures for which Medicare will reimburse patients and doctors.

"There is not a great understanding among the average person that potentially these treatments or tests are offering very little in the way of outcomes, and are some times actually harming people and leading to a whole lot of other events, like other interventions, surgery even, that in itself has side effects," said Professor Ward, who is a leading cancer specialist and researcher.

To get a sense of how this much money is being wasted and how unnecessary treatments can send you on the wrong journey, take a look at what can happen when you go to your GP with a common health complaint: knee pain due to osteoarthritis.

What's going wrong?

So how is it that you can walk into your GP's office with knee pain and end up having had unnecessary and expensive surgery?

This scenario, as covered on Four Corners, repeats itself for low back pain, angina (chest pain on exertion which goes away when you rest) and testing for what is known as prostate-specific antigen (PSA) for prostate cancer.

The system is wasting precious health dollars and putting patients at risk. (Image via ABC)
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In part it is because of the way Medicare pays doctors for their services. Doctors are paid for doing things to patients. They are not paid or given incentives to give the best care. Few of the items on the MBS were assessed for evidence before they were added to the schedule.

"Most of the MBS was created at a time when evidence was not a prerequisite for reimbursement," Professor Ward said.

Over the years doctors have lobbied for their favourite tests and procedures, regardless of evidence. Once these items made their way onto the schedule, very few of them were reviewed, and only one or two removed.

Accepting uncertainty.

Jenny Doust, a GP and academic whose research focuses on evidence-based medicine, understands all too well why this situation can arise.
"Part of the problem is where GPs feel that they need to do more tests, refer patients on, and that's driven partly when GPs don't feel that they are clinically certain about what's going on and they're not willing to rest with that uncertainty," she said.

"Then sometimes it's also driven by patients expecting to be referred on or expecting tests to happen".

But "sometimes the best medicine is no medicine at all".

"Those conversations with patients take time to explain, that the evidence simply doesn't support doing a test or prescribing a drug [takes] long conversations ... and it's much easier in clinical practice to do things quickly and prescribe or order a test," Professor Ward said.

The Federal Government is reviewing the evidence for MBS items, but the question remains whether the interests of Australians will prevail over pressures from doctors and the medical industry.

But what are we, as patients, supposed to do?

Ask for the evidence, says Professor Harris.

"I think patients should be asking for the evidence. They should be asking for the evidence that they will be better if they follow course A or course B," he said.

Questions to ask before you get any treatment.

  1. What are my options (including doing nothing i.e. waiting and watching)?
  2. What are the risks and benefits of each option (including doing nothing i.e. waiting and watching)?
  3. What are the chances that these risks and benefits will apply to me?

(These questions were developed by Karen Carey, former chair of Consumers Health Forum and trialed by Heather Shepherd of the University of Sydney.)

This article was originally published on the ABC. Read the original article here.