You can review an airline, so why not a hospital? It’s time for health sector scorecards

by Stephen Duckett

Published by the ABC, Thursday 21 November

When you’re looking to book a flight, it’s not hard to find websites that will tell you which airline is offering the cheapest prices or what previous passengers thought about their experience.

From seat comfort and layover times to safety ratings, whatever your qualm, the internet is at your disposal.

So why don’t we have something like TripAdvisor when it comes to healthcare in Australia?

Despite long waiting lists and high rates of complications (a statistic that affects one in four people who stay in hospital overnight), the health sector continues to lag behind other industries in providing public information about its performance.

Progress on public reporting has been glacial — in fact, it’s been a decade since the National Health and Hospital Reforms Commission recommended there be a nationally consistent framework for hospital outcomes.

It is high time governments, both state and federal, lift their game and produce easy-to-use hospital and medical specialist scorecards to drive improved outcomes.

When this lack of progress is raised, we hear the standard platitudes as politicians and bureaucrats read from their cue cards:

Excuse 1: we are working on this, it takes time.
Excuse 2: it is very complex, we have to get the measures right.
Excuse 2a: it is so complex will never get the measure right so we shouldn’t do it.
Excuse 3: this data is commercial-in-confidence, supplied to us by private hospitals and private doctors, therefore we can’t publish it.
Excuse 4: it is not in the public’s interest to publish the data because doctors or hospitals might game the system by no longer admitting the sickest patients.

Our politicians are sitting comfortably on their hands

All these excuses are lame and just that — excuses.

They appear to be designed to deflect media attention, so politicians and bureaucrats can sit comfortably on their hands.

Australians should not stand for this. Other countries have overcome the “technical issues” that our politicians and bureaucrats hide behind.

Queensland has even published the risk adjustment process it’s used for more than a decade to ensure fair comparisons of hospital performance.

Way back in 2011, the federal and state governments agreed to establish a National Health Performance Authority to be responsible for the transparency agenda.

It published a few reports — on public hospital efficiency, infection rates, and waiting times, for example — but was closed down as part of the Abbott/Hockey 2014 Budget.

And guess what? There has been virtually no progress since.

Here’s what needs to be done

Governments should make three commitments, to ensure Australians know a lot more about the performance of their hospitals and medical specialists:

Start with private reporting to the provider:

Governments should provide all hospitals and private specialists with comparative data, so that they can understand how they are performing on key metrics.

For hospitals, this would include detailed data on waiting times, quality and safety of care, and efficiency.

For private specialists, this would include information on clinical outcomes such as complication rates.

This would help hospitals and specialists to learn from the best performers in their field.

Private health insurers also have a part to play — they should make it easier for their members to know which private hospitals and specialists have lower complication rates.

Then, make all that data public within two years:

Outcomes data should not be secret surgeons’ business for ever, though.

Some delay in moving from private to public reporting is warranted, to give hospitals and specialists time to fix any data errors and address areas where they are performing worse than expected.

Two years would allow for four data cycles, assuming data were provided every six months.

Make it impervious to political whims:

Governments should release all the data on a specific date every six months.

That way, there can be no cover-ups, and that data release is not subject to political or bureaucratic whims.

The lame excuses need to stop

Public reporting in the health sector has been directly linked to an overall improvement in performance.

It’s been a fact of life in the United States for decades, and the evidence shows that while the current generation may not use the data to make choices about where they want to be treated, doctors and hospitals take notice nonetheless.

That could be out of embarrassment, or perhaps a fear of losing some of their market share.

Transparency would surely provide the same benefits for Australians.

The lame excuses should stop. Further delays would be unconscionable.

It’s time for doctor and hospital scorecards.