In health policy, it is rare to find an initiative that is universally blessed.
This is partly because health policy is frequently about finding the “least worst option”, there being few measures that don’t have some downside, and also reflects the “strife of interests” that so often drown out reasonable intentions.
So it’s not surprising that the new MyHospitals website — which enables us to compare waiting times for elective surgery and emergency department care at public hospitals and some private hospitals, and to source some other limited information — has drawn somewhat mixed reviews.
But it would be premature to consider these the final word; as health minister Nicola Roxon’s statement and the website itself make clear, MyHospitals should be seen as work in progress.
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In which case, a critical question seems to be, how should the website be evaluated? This is important if it is to be improved and made more useful.
Croakey today publishes suggestions from a range of experts. The consensus is that MyHospitals is but a baby step and needs a lot more work if it is to really make a difference.
Professor Philip Davies, Professor of Health Systems and Policy, University of Queensland, raises concerns about the lack of meaningful comparative data, and the site’s failure to offer any insights into Aboriginal and Torres Strait Islanders’ use or experience of hospital care.
“While it’s all too easy to criticise, MyHospitals should be acknowledged as a useful first step along the road to greater transparency and accountability in the health sector,” he says.
Professor Jeffrey Braithwaite, of the Australian Institute of Health Innovation at the University of NSW, says the site should be expanded to include comparative performance based on clinical indicators or other quality and safety measures.
In a similar vein, Professor David Penington, of the University of Melbourne, says the site is a “long way” from being really useful, even to GPs referring patients, because it lacks criteria related to safety and quality of care. “The website is no more than a start, bedevilled by COAG’s preoccupation with waiting lists and emergency room times as if these are all that matter. These are NOT indicators of quality,” Penington writes.
Dr Tim Woodruff, of the Doctors Reform Society, says the website “follows a pattern of good ideas badly implemented”, and is likely to lead to “gaming” of the system, rather than real improvements. Woodruff wants the data collection audited independently. “There is too much at stake for state hospital bureaucracies to be auditing results,” he says.
Dr Clare Skinner, Emergency Registrar, Hospital Reform Group, Sydney, argues that a health service has to be judged in the context of its resource base, local population needs and clinical service priorities. “The MyHospitals site, as it stands, maintains the federal government’s disappointing preoccupation with waiting lists and triage categories, rather than clinical excellence and patient (and staff) satisfaction,” she writes.
Dr David Briggs, editor of the Asia Pacific Journal of Health Management, says the main downside of the site is that it continues the focus on acute care rather than primary care and wellness. “I would like to have seen it called ‘My healthcare’ of which one subset is hospital performance data and the rest is devoted to primary health care access and listening to consumers’ narratives of the health service experiences, both positive and negative,” he says.
My own views are that the website could be considered a success if it:
- puts the spotlight on variations in access to and quality of care, and if it leads to incentives to tackle these
- puts a spotlight on the inequitable allocation of resources and leads to more funding and support for high need communities (beyond their hospitals)
- encourages innovation which improves outcomes for patients and the population’s health in a cost-effective way.
- And it will be a failure if it:
- encourages throughput with no regard to whether treatment is necessary, useful or cost-effective
- leads to more resources going to better off services and sectors, and the healthier, wealthier having even better access to better care
- results in more political pressure to increase funding to hospitals even more.
In case you didn’t see the latest AIHW report on health expenditure, released this week, spending on hospitals is booming, In real terms, expenditure on public and private hospitals grew at an average of 4.7% and 4.5% per year, respectively, between 1998–99 and 2008–09.
Meanwhile, expenditure on public health experienced negative growth (–3.1%) between 2007–08 and 2008–09.
To take David Briggs’s suggestion a step further, maybe we need a website called, MyCommunity’sHealth…
Now that could be a giant step forward.