Evidence-based initiatives improve patient care


Evidence-based initiatives are key to improving the safety and quality of patient care, writes APHA chief executive Michael Roff.

I recently read a very pertinent and thought-provoking article in the Medical Journal of Australia.

It was entitled ‘Non-reimbursement for preventable health care-acquired conditions’ and the author, Christopher Davis, put forth a compelling argument as to why managing health care risk must be evidence-based and not harm patients or compromise the common good.

Dr Davis’ credentials are readily available; he is a former Queensland assistant health minister and is now the director of geriatrics at Prince Charles Hospital in Brisbane.

Dr Davis’ argument centred on Medibank Private’s contentious decision to not reimburse hospitals for 165 hospital-acquired complications that the insurer deems preventable. The list includes events such as falls in hospitals and readmission to hospital as a result of a wound infection.

The stated objective of the policy is to improve patient care and thereby contain costs.

The approach is similar to the one taken by Medicare and Medicaid in the United States in 2008. Both organisations refused to pay for selected potentially preventable hospital-acquired conditions, arguing that it would improve hospitalised patient safety.

In his article, Dr Davis cited a 2012 study of Medicare and Medicaid’s policy, which found no evidence that financial disincentives reduced infection rates and no situations where patients appeared to benefit from the implementation of the policy.

Dr Davis argued that, given the similarities between Medibank’s policy and the one implemented by its American counterparts, Medibank’s approach is unlikely to significantly contribute to the stated objective of patient safety.

Many others held this view when Medibank announced the policy last July, as the list did not appear to be evidence-based. The insurer duly came under intense scrutiny and the Australian Private Hospitals Association (APHA) was particularly scathing of Medibank’s approach.

APHA was worried that it could result in private hospitals reviewing their service mix – albeit reluctantly – and not offering services for complex cases, which could lead to more complex patients and those with chronic conditions being forced to rely on the public system.

That’s when Medibank saw the error of its ways.

The insurer introduced an independent clinical review process, acknowledging that the only way to improve safety and quality in health care is by collaborating with hospitals, doctors and experts to correctly define the highly preventable adverse events.

At a time when public hospitals, in an attempt to boost their coffers, are flagrantly coercing policy holders into using their private health insurance in the public system, patients need to be able to trust the private sector.

Serving patients’ long-term interests with evidence-based initiatives is key to earning that trust and APHA will continue to undertake research that adds to the private sector’s solid evidence base.


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