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Australian patients are going into hospital blind to health costs and quality. Meanwhile, USA and UK patients have high quality data

 

Vox magazine reports that most hospitals feel more comfortable giving advice on hospital parking, than they do at the price of hospital treatments. Patients usually find out about their health costs when they are handed their bill. Perhaps we should reduce the pay of hospital administrators to that of parking attendants. From several $250,000 a year, to $35,000 a year. That would cut the Australian health budget.

The same magazine article says that most Americans currently equate higher health costs with better quality of health services. Unfortunately, this is simply not true. In Australia as with so many problems in the USA private health system, both prices and quality are completely hidden from patients. You can’t shop around and get the cheapest quote for a hip replacement. The associated bills from pathology, radiology, surgeon, surgeons assistants, anaesthetist and hospitals are billed completely separately. The rebates (if any) from private heath funds change continuously and are not made public until the bill has been submitted. Even finding out what the item numbers for the various components of a hip replacement are impossible. Not to mention collating the charges, the government Medicare rebate, the health insurance payments and working out the patients out of pocket costs.
And how much of the USA health budget does nothing for American’s actual health? Approximately one third. Over servicing, excessive administrative costs and soaring executives salaries all play a part. Once again, just like Australia.

The recent Senate Enquiry into out of pocket medical costs has brought the issues of excessive health costs out into the open. The Royal Australasian College of Surgeons have just come out and said they are concerned about ‘exploitative and unethical high fees’ being charged by some surgeons. According to Stephen Duckett from the Gratten Institute, between 2007 and 2013, average out of pocket medical costs have increased by 25%. Almost 1/5 of Australian health spending comes from out of pocket costs, putting us third highest in the world, only behind the USA and Switzerland. And just like the USA, there is no link between higher fees and better quality care. Quite the reverse. Often the best quality medical treatments are delivered for free in public hospitals, where junior doctors, senior nurses and allied health workers work in a non-glamorous but effective ‘health team’ structure.

Despite these concerns, the AMA has rejected calls for fees disclosure. ‘It’s not possible for patients to shop around for a medical procedure in the same way that they do for a dishwasher proclaimed AMA president Brian Owler. Correct. Patients are deliberately kept in the dark by doctors, hospitals, health insurers, governments, medical device companies, pathology conglomerates and pharmaceutical multinationals. Secrecy means the opportunity to push prices up. The American experience shows us that. A series of articles by Elisabeth Rosenthal for the New York Times follows the secretive and excessive prices in American hospitals. These include charging $1,000 for a toothbrush and $100 for an aspirin.

Would the same be revealed if our politicians were brave enough to follow Barak Obama’s lead and force all Australian hospitals to reveal their full costs for 100 of the most common procedures? Probably.

In America, some patients have taken to social media to express their frustration about excessive fees and substandard care. The doctors (of course) have sued and won. But this unequal battle can’t continue forever. There are now 60 odd doctor review sites in the USA. Some also include some pricing, gleaned from a wide range of sources. The health industry, like the Catholic church have to face facts. The Middle Ages are over. Consumers have rights. And demanding accountability of authority figures does not result in eternal hell and damnation.

The problem is that the same doctor can practice completely different standards of care, depending on which hospital they happen to work in. Most patient care is carried out by nurses and allied health services. So what is really needed, is a hospital rating system.

So what can Australian’s do (besides being patronised and blamed by politicians who collect lifetime pensions and over-generous superannuation benefits)? What about putting our innovative streak to work, and designing a world first Trip Advisor site for hospitals, clinics and nursing homes? Consider the possibilities.

•    The facility name, address, google map and contact details
•    Public transport and private parking
•    Facilities including beds, specialities, offered, availabilities of doctors after hours and at weekends, nurse to patient ratios and allied health services.
•    Recorded complaints including Coroner’s reports, written complaints and comments from sites like Patient Opinion
•    A five-star rating based on clarity of pricing, cleanliness, timeless of care, discharge planning and follow-up care
•    A patient one paragraph commentary on the hospital, clinic or nursing home (kept free from personal abuse and silliness)
•    A five-star rating based on clinical standards, staffing issues and accountability
•    A clinician one paragraph commentary
•    A five-star rating based on the quality of computer systems, robust backup and networking
•    An IT professionals one paragraph commentary

References

Half of Americans thinks expensive healthcare is better. They are wrong. Vox. 2014
Australian Senate Inquiry into out of pocket costs – 2014
College raises concerns about extortionate fees of some surgeons – Sydney Morning Herald 2014
AMA rejects calls for more fees disclosure – Sydney Morning Herald – 2014
The problem with knowing how much your healthcare costs – The New Yorker 2013
DocAdvisor – patients around the world are starting to give doctors a piece of their mind. The Economist – 2014
Healthgrades USA site giving information on doctors and hospitals. Founded 1998.
Best Doctors. USA site that contracts with large employers to provide expert physician opinions to employees.
Best Hospitals National Ranking

Wikihospitals 2014