Focus on Unwanted Variations in Care

AHIA is concerned to make sure that members get the best possible care. Figures show large variations in care across states.  For example, why is it that not enough hip replacements are done in some states whilst in others too many are performed?

Surgical procedures performed in the private hospitals around Australia represent a high cost to private health insurance industry.  In 2009-2010, the cost for surgical procedures was estimated at around 48% of total benefits paid to public, private and free standing private day surgery for the treatment of privately insured patients. Of this, 80.5% was paid towards top 20 most expensive surgical procedures.

Among them are low-volume, high cost procedures. Its high cost is usually associated with expensive prosthesis. Hip and knee replacement and Interventional Cardiology procedures with pacemaker and defibrillator will fall into this category. 

The second group includes high-volume and low–cost procedures and is represented by cataract extractions, caesarean sections and general surgery especially treatment of hernia.

In the quest of searching for variations the AHIA's Clinical performance Research Unit regularly performs analysis of the most costly procedures. The data is analysed state by state with a focus on differences in number of performed  procedures shown as rates per 100 000 of population,  average cost to private insurance industry, length of stay as overnight and same day hospitalisation, readmission rates and surgeries with and without complications.

The latest reports focus on Hip and Knee Replacements (Aug 2011)

Tags: costs, CPRU, episodes, hip replacement, knee replacement, safety and quality, variations in care,