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Monday, July 07, 2008

Still in the dark on hospital and doctor performance

The Sydney Morning Herald reported last week that NSW Department of Health continues to hold the line against publication of information about the professional performance of hospitals and doctors, but the Feds are showing no sign of backing off their insistence that more transparency has to be part of the away forward on reform of the health system.

The Herald quoted a publicly available audit, Review Of Implantation Procedures For Permanent Pacemakers In NSW Public Hospitals 2007, stating there "appeared to be no difference in complication rates between … where the procedure was performed." However the report showed complication rates varied from 8.5 per cent for the best-performing hospital to 17 per cent for the worst, and neither the report nor the Department identified the hospitals concerned.

A cardiologist told the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals recently that there was a "strong case" for public report cards on surgeons who implanted pacemakers because some had higher infection rates and "signature mistakes". And the director of the Centre for Human Bioethics at Monash University, Justin Oakley, said if patients were not told of differences between hospitals "there has been a failure in informed consent".

So good to see the Federal Government keeps pushing:

"NSW hospitals would be forced to publish their mortality rates or risk losing federal funding, the federal Health Minister, Nicola Roxon, said this week. The Prime Minister, Kevin Rudd, was "adamant" such criteria were made public in his plan to make states more accountable for public hospital performance, she said.

We lag many systems around the world in this area, but it is still a hot issue, for example in California where a bill before the legislature also seeks to ensure public disclosure of medical outcomes and other information about health care safety, quality and cost. One of the supporters says the potential cost savings are enormous and that public disclosure of safety and quality information, such as mortality rates by hospital, has been shown to lead to improved performance.

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