Which way to best health care?

episode

Health Report 28 min 3 speakers 8 chapters transcribed 4 days ago

▲ 0

Transcript

jump: chapters · speakers · find in transcript

Transcript

Transcript generated automatically by AI and may contain errors.

What court case revealed inefficiencies in the private medical‑device market?

Dr. Norman Swan 0:00

Hello and welcome to the Health Report with me, Norman Swan. This week, a fascinating court case which has revealed just how inefficient the private sector market is for medical devices. The latest on a condition that maybe one in ten of us suffer from, including pain or burning in the upper abdomen, and or feeling full early on in a meal. And none of the tests the doctor does turns up anything. If that's you or someone you know, don't go away. And a huge report released last week which showed astounding variations in diagnostics, prescribing, and surgery across Australia. For example, a 75-fold difference in the prescribing rates for ADHD, attention deficit, hyperactivity disorder medications for children.

Dr. Norman Swan 0:40

If that prescribing is in fact merited, there are some communities in New South Wales where ADHD must be in pandemic proportions. Is it a national childhood emergency? Or is it really that some pediatricians are incontinent with the script pad? Also, big differences in antidepressants, antibiotics, dangerous medications in the elderly, addictive painkillers, cataract surgery, knee surgery, and so the list goes on. The report The report is called the Australian Atlas of Healthcare Variation. The person who chaired the group which supervised the development of the Atlas on behalf of the Australian Commission for Safety and Quality in Healthcare was Professor Anne Duggan of the University of Newcastle, and Anne is in our Newcastle studio now.

Dr. Norman Swan 1:20

Welcome to the Health Report.

Anne Duggan 1:22

Thank you, Newman.

Dr. Norman Swan 1:23

So this is th we've had you on the Health Sport a couple of times before, prefacing this over the last year or two. Now it's now it's out.

Anne Duggan 1:30

Yes, and I think I agree with you, it's a really important report and a the basis for m some important work to move forward on.

Dr. Norman Swan 1:38

Now uh each of the last two occasions I've had you on and talking about this, you've kind of avoided saying, well, this is outrageous, um, you know, uh unacceptable variation and you've sort of qualified it.

What does the Australian Atlas of Healthcare Variation show about prescribing and surgery rates?

Dr. Norman Swan 1:50

Let's just walk through some of the results. So antibiotics, thirty million scripts a year. Um if you take the uncorrected, you know, the outliers on either side, the high prescribers and the low prescribers, There's sixteen times the difference in antibiotics that doctors really shouldn't be prescribing unless they absolutely have to. And if you take out the tops and the lo bottoms and average it out, it's about threefold difference. I mean, that's big differences. And it takes a doctor to write out a script. I mean

Anne Duggan 2:23

Norman, I agree with you, that is phenomenally high. Thirty million prescriptions dispensed. And that excludes the ones that were actually prescribed and were never taken up. There's no doubt that we are very high by world standards in antibiotic prescribing and uh dispensing and i.e. people filling their script. We exceed Canada, we exceed the US, and I think that this is an emergency because we are at risk of developing at bugs that are resistant to our antibiotics. Irrespective of the variation, I think we need to actually learn. The lessons of other places around the world and reduce our overall prescribing of antibiotics. But I take issue with the point that it is purely a clinician that does it.

Anne Duggan 3:06

We actually a a consultation is a discussion between a clinician And a patient. And in the background is society and what's the message of society are saying about antibiotics. So there's a lot of work to be done. Not just with clinicians and script pads.

Dr. Norman Swan 3:24

On this morning's big ideas on ABC television, I interviewed Don Berwick, one of the giants of safety and quality in healthcare. And he said there's never been demand in healthcare that hasn't been generated by doctors. You know, th they're the ones who do it. So we can talk about the the two way thing, but essentially it's a it's a doctor driven demand. He's quite strong on that.

Anne Duggan 3:44

I would d disagree with him because I think there's a number of issues here. One is that we are as a society becoming more aware of what we think we need and we don't necessarily inform the community very well all the time about the evidence for things.