The key findings of the report were that:
- Nearly one third of the almost $155 billion spent on health every year is being wasted - about $46 billion
- 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 last year. It's estimated that at least 50% of them are unnecessary.
- Knee replacements cost up to $23,500 per procedure and last year cost the public and private health systems more than a billion dollars - not far short of an astounding 1% of the national spend on health. About 20% of them may be unnecessary.
- The costs of back pain imaging are extraordinary - about a billion dollars over the last ten years. That doesn't include the costs from public hospitals, but most are done in the private sector.
- At least half of all back scans and X-rays are of no value - that's half a billion dollars that could have been saved in the last 10 years. That could buy a regionally delivered suicide prevention programme, which could save a thousand lives a year.
- Spinal fusion operations, mostly performed in private hospitals, cost about $2.3 billion over the last ten years. It's estimated that 50% of this is needless.
The transcript of the program is here.
A related article by Dr Norman Swan and Claudine Ryan ("Patients at risk and billions of dollars being wasted because of tests, scans and procedures that don't work") is published on the ABC website here.
A response by Dr Evan Ackermann, chair of the RACGP National Standing Committee for Quality Care, has been published in Australian Doctor: "The programme was factual, and told a complex story of overtreatment and overdiagnosis and its contribution to wasteful health spending. It looked at orthopaedic procedures like knee arthroscopy; it looked at the treatment of cardiac hypertension, the impact of lowering thresholds for the diagnoses of diabetes. And it looked at PSA screening, as well as the ordering by GPs of imaging for lower back pain. They were good subjects. The discussion on GPs as the trigger point for the waste in spending could have been done better. And there was too much focus on fee-for-service being a major contributing factor for driving doctors’ behaviour. To me, these are minor criticisms because the show was a good introduction for the wider Australian community to a hugely important debate...Four Corners paid little attention to the GP environment — the medicolegal risks, the corporate environment, the very real pressures from patients themselves for interventions. And the program ignored the fact that for several years now, GPs, through the RACGP, have been leading the debate on overdiagnosis, overtreatment and waste."
Stephen Duckett, director of the Health Program at the Grattan Institute, has written on The Drum, "What should happen when there is evidence of over-use? Simply de-listing - taking the test or treatment off the schedule - is not the right approach. Instead, what is needed is to try to get the treatment or test more tightly targeted...Doctors should receive clear guidance from an independent body about what is appropriate and when. Second, this guidance might be reinforced with financial incentives in the fee schedule - for example, the rebate might only be available if clear diagnostic criteria are met. Third, doctors and hospitals that perform the procedures should be given feedback about their rates of referrals for diagnostic tests or procedures. If doctors persist with high rates, they should be required to justify their decisions through a clinical review."
Ray Moynihan, a health and investigative journalist and Newcastle University academic, has pointed out on The Conversation that, "One criticism of the Four Corners program is that almost all the interviewees shared the view Australia is doing too many tests and treatments, and urgently needs to wind them back. We didn’t hear anyone take the view we need more medicine not less..." and "One of the key claims in the Four Corners program was that almost a third of the money being spent on health care is “squandered”. If you include everything we spend, that’s potentially A$46 billion a year wasted. While this may well be the case in Australia, it’s perhaps worth pointing out that this estimate arises from studies in the United States. A key paper in the Journal of the American Medical Association in 2012 estimated that total health-care waste in the US – including overtreatment, fraud, administrative complexity and other flaws – accounted for between 20% and 50% of the total cost of health care – with the midpoint estimate being 34%. Hence the one-third figure. To my knowledge, there are as yet no similarly rigorous estimates of waste in Australian health care."
The response to this by Dr Norman Swan is that, "...the estimate used was based on international experts such as Professor Don Berwick, who argued the range of wastage was 20 to 40 per cent, with the US at the high end. He said Professor Adam Elshaug, who is an international authority in this area, thinks it is 30 per cent for Australia."