Over-diagnosis and over-treatment biggest sources of waste in healthcare system



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Bond University Institute for Evidence-Based Healthcare Director, Professor Paul Glasziou, has said that the Australian healthcare system is riddled with over-diagnosis and over-treatment.

Speaking at a CEDA event in Brisbane he said that over-diagnosis was an invisible problem contributing to waste in the system.

“If you biopsy men my age you’d find 50 per cent have what appears to be prostate cancer,” he said.

“We found that at least 41 per cent of cases in Australia now are being over-diagnosed.

“They end up getting treated, getting their prostatectomy and suffer the adverse effects of that which can be impotence and incontinence.

“The surgery is an average of about $20,000 so it’s approximately $160 million per year that we’re spending actively to do something that is harming people who would have otherwise been asymptomatic most of their life and never would have suffered a problem from this condition.”

Professor Glasziou said this over-diagnosis is not limited to just prostate cancer, but all cancers such as thyroid, renal and breast, as well as lung cancer.

He said that other waste in the system stems from changes to definitions that occur.

He said that when diagnosing gestational diabetes there is only a 15 per cent overlap in definition between Australia and other countries such as the United States and United Kingdom.

“Who’s right?” he said.

“Quoting from a piece that one of our colleagues put in The Conversation recently about two women, one who lives in London, one who lives in Warwick and at 26 weeks they get tested for gestational diabetes and they have the same results.

“In the UK they would have been classed as normal, not having gestational diabetes, but if they lived in Warwick they would have been, by the Australian current definition, classed as having gestational diabetes.

“There’s been an increase in countries all around the world but the big change in Australia was an almost doubling since the change in definition occurred in 2012.

“There have been two Australian studies which have looked at the consequences of that for the baby and mothers and found no improvement in outcomes in that time, but increased numbers of women being treated having insulin.

“For the women in Warwick it would mean moving from there at a late stage in her pregnancy because she’d be classed as high risk and couldn’t deliver locally.

“We are screening and changing definitions for things all the time, some of which are appropriate and improve things but many of them have actually harmed people as well.

“I like this quote ‘medical science is making such remarkable progress that soon no one will be well’”.

He said that while it is difficult to know for sure, over-diagnosis and over-treatment rates are between 20 and 30 per cent and the largest areas of waste in the healthcare system.

MBS Review Taskforce Deputy Chair, Dr Steve Hambleton, said that overall Australian healthcare is one of the best systems in the world, but can do better with another area of waste being preventable hospitalisation for chronic disease.

“Every two to three minutes someone’s admitted that maybe didn’t need to be,” he said.

“We put about 250,000 people in hospital every year for medication errors, that’s not just a minor error, that’s not deaths but we put 250,000 people in hospital and that’s $1.4 billion.

“70 per cent of our Medicare schedule hasn’t been looked at.

“Chronic disease in Australia costs $27 billion, 30 per cent of the budget, but prevention, we’re spending one per cent of the budget, maybe we should be thinking about prevention.

“You see the tag line, we are actually really good at sick care, but we actually need to be better at healthcare and healthcare is about understanding the individual and prevention.

“People are anxious about engaging in e-health, not understanding the benefits that could potentially flow to the system with better engagement.

“The feeling of disempowerment, frustration and disengagement and even medical people when they get sick they feel this disengagement and disempowerment.

“What do providers think? They share some of these views, the red tape, the poor communication, lack of funding for innovative care and where’s the efficiency?”

Event presentations

Professor Paul Glasziou, Bond University MP3 | PDF

Dr Steve Hambleton, MBS Review Taskforce MP3 | PDF

Moderated discussion MP3

Delegate handout PDF

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