AUSTRALIANS enjoy health care as good as anywhere in the world.
Our doctors are highly trained and hospitals are of the highest quality. If you’re sick, having a baby or hit by a bus you’d want it to be here.
However, as with all the other health-care systems around the world, ours isn’t free of imperfections.
Within the public health system people encounter long waiting times for many procedures and often just to see a GP or specialist.
More generally, our enormous reliance upon the public system and taxes to pay for it (public spending accounts for about 70per cent of our total national spend of $130billion) means eventually the whole show becomes unaffordable. You simply run out of sufficient working taxpayers to pay for an increasingly older, retired population.
But that’s a topic for another time.
During the week I observed that one of the weaknesses of our health-care system is the amount of medical treatment occurring which is of questionable clinical and economic value. That is, treatment that doesn’t really remedy the medical problem or treatment that is overly expensive compared to the benefit of other clinically acceptable options.
This risk of unnecessary treatment is of course by no means unique to Australia as a collection of studies worldwide demonstrate.
Given that health care accounts for an incredible 17per cent of the entire USA economy (we’re a bit over 9per cent) Americans have been very focused on ensuring medical treatment is not only effective in getting a good outcome for the patient, but also cost-efficient.
Numerous studies in the US have made this all the more compelling – studies which show that if you live in Santa Barbara (typically richer) you’re six times more likely to have surgery than if you live in The Bronx (typically poorer), studies that show faking knee surgery with just a scar was as effective in relieving patient-reported pain than actual and expensive arthroscopic surgery.
Last week Greg Ray (“Ensuring insurers pay”, Herald, 29/8) suggested my observations about the incidence of unnecessary care was a harbinger for NIB going down the path of the much-maligned “managed care” regime.
I’m not sure exactly how Greg actually defines managed care but if it’s about telling doctors, dentists or other clinicians how to do their job, then he’s wrong.
Our philosophy at NIB is that it’s not for us to interfere with clinical decisions. We’re simply not qualified to do that.
What we do want, however, is to play more of a role in helping people become more informed and better purchasers of health care. Providing them with more information about what the latest medical evidence is saying about their condition, actively assisting them manage their chronic condition, helping them choose a hospital, doctor, dentist or other clinician and creating payment schemes and incentives for better treatment outcomes, are all part of our vision.
Helping people access and afford health care when and where they want it is why NIB exists. And we will never compromise the need for quality of health care because of pure commercial considerations.
Mitigating unnecessary medical treatment just makes good sense. Apart from reducing costs and thereby premium pressures on consumers it also avoids the risk of medical complications that can sometimes flow from surgery.
Mark Fitzgibbon is chief executive officer of NIB Health Fund.