Stirling Griff (SA, Centre Alliance) Share this | Hansard source

Anyone who knows me knows that I am particularly passionate about medical transparency. By that, I mean providing consumers, the public, with all the information that they need to make an informed choice about a surgeon or provider; information that allows them to judge up-front the costs and risks before going under the knife. For example, how much will the surgeon cost? Are there any hidden fees? How often does a surgeon perform a particular procedure? Most importantly, what are their revision or, in other words, error rates? What about the hospital or clinic? What is its record of medical errors and patient readmission rates, and how does this compare with other hospitals and clinics? At the moment, consumers have almost none of this information at their disposal, unless, of course, they know someone on the inside. They take it on trust that hospitals, clinics and medical specialists will provide a good service and charge fair fees.

As consumers, we are often embarrassed to ask a surgeon about their fees. We're embarrassed to quiz them about their abilities and how often they have done a particular operation. We don't want to offend them because we are putting our health, and sometimes our lives, in their hands. If we want this information, we have to ask for it ourselves, always at a time when we are the most vulnerable. This information needs to be publicly available; in fact, it is in a number of countries around the world, most notably the UK, where you can review every specialist right down to their different procedures. And guess what? When it's all on the public record, the bar is lifted for everyone. Everyone wins; the public and the medical professionals.

People should be able to sit at their home computer, when they have had a moment to think, and research their surgeon before going under the knife. They need to know all costs beforehand and not be shocked by a bill that could potentially run into many thousands of dollars. Most importantly, they shouldn't find out after the fact that they've been operated on by a novice. Our medical system operates very much as a closed shop. If you are referred to a specialist, you ultimately have no idea of whether you've got a star performer or a dud.

This is not just about consumer information; better medical transparency and accountability will also blow the lid off the otherwise secretive world where the profession protects its own. Imagine if disgraced surgeon Jayant Patel's performance data had been publicly available all those years ago?

Perhaps then it wouldn't have taken a brave whistleblower to come forward and expose this deadly doctor, and perhaps his tragic reign at Bundaberg Base Hospital would have come to an end much quicker.

That's the thing about transparency: there is nowhere for dodgy doctors and deadly hospitals and clinics to hide. The concept is not a new one. In Australia, private health insurer Medibank publishes an annual Surgical variance report in conjunction with the Royal Australian College of Surgeons, which details a number of key indicators, including the rates of hospital-acquired complications, average surgeon out-of-pocket costs plus average total costs for a procedure, and the percentage of patients readmitted within 30 days. But this report misses a key component: disclosure of individual surgeons. We know from answers to questions that I put at estimates that the government is, at a snail's pace, also working to collect better mortality and morbidity data from public hospitals to publish on the MyHospitals website. Transparency of information can really only be a good thing, as it forces outliers to lift their game or get out.

If you want to know what a good system for medical transparency could look like, go to the My NHS website in the UK. It's not perfect but it's pretty damn good. You can look up your procedure by either hospital or individual surgeon to see how both perform. It is easy to navigate and breaks the information down in ways that make it easy to understand and compare. For instance, each hospital will show how many times a particular procedure has been carried out and the average demographic of patients treated for the same condition, and it will show for each hospital what percentage of patients had a greater risk of problems before or after surgery. It provides context and comparison. For surgeons, the data changes with the procedure. For instance, for cardiac surgeons, it provides the two most important pieces of information that you want to know as a patient: how often the surgeon has performed cardiac surgery and their patients' in-hospital survival rate—down to two decimal points.

This is all a far cry from what is publicly available in Australia. It means that as a patient you're not going blindly into surgery with fingers crossed, hoping you've made the best choice. You can take some control at a time in your life when you feel you have very little of it. Out-of-pocket costs are also a well-known problem, and that is why Centre Alliance last year initiated the Senate inquiry into the value and affordability of private health insurance and out-of-pocket medical costs. We are still waiting for the government's response on that report, but we were at least happy to see that the health minister is listening to our concerns and those of consumers and is trying to make headway with out-of-pocket costs by appointing an advisory committee to work with industry to make this information more transparent.

IVF is another area that needs a very bright spotlight shone on it. At the moment, couples can fork out almost $10,000 for each round of IVF treatment, with only half of that recouped through Medicare. All that these would-be parents have to go on is reputation, rumours and what the clinics themselves choose to say about their success rates. There is no standard set of information that clinics need to provide, yet the results for each can vary widely. In 2014, live birth rates between clinics varied from nine per cent and 24 per cent for fresh cycles. Two years earlier, live birth rates were as low as four per cent and as high as 31 per cent, depending on the clinic. Some clinics won't disclose their live birth rates, choosing to instead publish their clinical pregnancy rates, which of course are much higher.

The lack of transparency also poses a significant cost to government. In 2015 Richard Henshaw, a senior fertility expert with the Monash group of IVF clinics, told the ABC's AM program that the worst-performing IVF clinics actually cost taxpayers more than the best performers. He said that clinics in the top 25th percentile cost Medicare around $2 million to produce 100 live births, whereas clinics in the bottom 25th percentile soak up around $6 million to produce the same result. Taxpayers, through Medicare rebates, as well as parents are paying up to three times as much as they really need to, simply because they've had the misfortune to select a poor-performing clinic for their treatment.

One couple underwent 12 cycles of IVF over five years and spent $100,000 to get there. They did 10 cycles at a clinic recommended by their GP—with no success. Then they switched clinics and finally had a child. It doesn't have to be this way. The US and UK both publish individual clinic success rates—that is, the chances of a live birth—vital information for making one of the most important decisions in an infertile couple's life. We have these great examples we can model ourselves on, but somehow in Australia it's just too hard. 'It can't be done here,' this self-serving industry says.

There is every reason to move to a more transparent and accountable health system, and I implore the federal government to work with the states to do just that. I imagine there will be resistance from some medical colleges, but, frankly, we shouldn't try to shield poor performers from the embarrassment or loss of income that might result from such a system. It is, in the end, about more consumer choice, better public safety, better use of taxpayer money and better health outcomes. Who could argue against that?