Australians love to deride the American health system but it may have a few lessons for us.
In New York City this week, public hospitals have taken an historic step forward. They are publicly releasing data about the safety and quality of their patients’ care, in the expectation that this will drive improvements.
According to the New York Times, information about the overall death rate at each hospital, the rate of deaths after heart attacks, preventable bloodstream infections and pneumonia cases will be posted on the internet.
While the move is part of a broader trend in the US to mandate hospital performance reporting (the New York State Health Department plans to issue hospital “report cards” next year), the article also notes that some hospitals have begun to voluntarily release such information.
Meanwhile, in another sign the US is getting serious about improving health care safety, the Bush administration recently announced that Medicare would no longer pay the extra costs of treating preventable errors and conditions.
Cut to Australia, where the NSW health minister and her state colleagues have just fended off a federal proposal to publish hospital performance data.
Bob Wells, Director of the Menzies Centre for Health Policy at the ANU and a former senior federal health bureaucrat, is hoping the Commonwealth sticks to its guns, for the sake of improving accountability and helping patients to make more informed choices about their care.
“The reasons for withholding basic information about how taxpayers’ dollars are spent across the public hospital system are of the Sir Humphrey Appleby variety,” he says.
“For example, it is argued that some hospitals and staff will cheat and ‘game’ the system; privacy might be breached; the data are unreliable and cannot be compared from hospital to hospital; there will be a heavy administrative burden; and the public would not understand the data anyway.”
Wells has drawn up a list of information that he would like to see published by public and private hospitals, and would be happy to provide these to any interested parties.
Meanwhile, health policy consultant Jennifer Doggett is similarly dismissive of arguments against public reporting.
“There is good international evidence that making performance data public can encourage hospitals to improve quality of care,” she says.
“A recently published analysis of 45 studies in this area concluded that while there remained gaps in the research, the ‘evidence suggests that publicly releasing performance data stimulates quality improvement activity at the hospital level’.”
Doggett argues that releasing hospital performance data can also increase the health system’s efficiency by steering patients towards the hospital that will best meet their needs, and help identify and address problems in individual hospitals early, before they become more serious.
“This would be a marked improvement on our current system where all too often we only learn about problems within a hospital when patients are seriously harmed or when a hospital employee risks their reputation and career by becoming a whistleblower,” she says.
Indeed. At a recent seminar in Sydney on health reform, one senior public hospital specialist deplored the lack of information available to guide patients and their referring doctors.
“I do what everyone else in this room would do: ask a colleague,” he said.
“It’s quite a poor way of trying to measure what is a good doctor/hospital/health system.”
Let’s hope his Health Minister is listening.
Tomorrow: Why governments and the health professions like to keep debate about health care safety behind closed doors