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Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010–2014)
  1. Kelsey Chalmers1,2,
  2. Sallie-Anne Pearson3,
  3. Tim Badgery-Parker1,2,
  4. Jonathan Brett3,
  5. Ian A Scott4,5,
  6. Adam G Elshaug1
  1. 1 Menzies Centre for Health Policy, University of Sydney School of Public Health, Sydney, New South Wales, Australia
  2. 2 Health Market Quality Program, Capital Markets CRC Ltd, Sydney, New South Wales, Australia
  3. 3 Medicines Policy Research Unit, University of New South Wales, UNSW, New South Wales, Australia
  4. 4 Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
  5. 5 Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
  1. Correspondence to Professor Adam G Elshaug; elshaug{at}sydney.edu.au

Abstract

Objective To examine the prevalence, costs and trends (2010–2014) for 21 low-value inpatient procedures in a privately insured Australian patient cohort.

Design We developed indicators for 21 low-value procedures from evidence-based lists such as Choosing Wisely, and applied them to a claims data set of hospital admissions. We used narrow and broad indicators where multiple low-value procedure definitions exist.

Setting and participants A cohort of 376 354 patients who claimed for an inpatient service from any of 13 insurance funds in calendar years 2010–2014; approximately 7% of the privately insured Australian population.

Main outcome measures Counts and proportions of low-value procedures in 2014, and relative change between 2010 and 2014. We also report both the Medicare (Australian government) and the private insurance financial contributions to these low-value admissions.

Results Of the 14 662 patients with admissions for at least 1 of the 21 procedures in 2014, 20.8%–32.0% were low-value using the narrow and broad indicators, respectively. Of the 21 procedures, admissions for knee arthroscopy were highest in both the volume and the proportion that were low-value (1607–2956; 44.4%–81.7%).

Seven low-value procedures decreased in use between 2010 and 2014, while admissions for low-value percutaneous coronary interventions and inpatient intravitreal injections increased (51% and 8%, respectively).

For this sample, we estimated 2014 Medicare contributions for admissions with low-value procedures to be between $A1.8 and $A2.9 million, and total charges between $A12.4 and $A22.7 million.

Conclusions The Australian federal government is currently reviewing low-value healthcare covered by Medicare and private health insurers. Estimates from this study can provide crucial baseline data and inform design and assessment of policy strategies within the Australian private healthcare sector aimed at curtailing the high volume and/or proportions of low-value procedures.

  • inappropriate care
  • low-value care
  • quality in health care
  • choosing wisely

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Footnotes

  • Contributors KC designed the study, conducted the data analysis and interpretation, and drafted the article. KC and TB-P developed the low-value procedure indicators with contributions from JB and IAS. S-AP and AGE had input into the study design and critical revision of the article. All authors had final approval of the article.

  • Funding This work was supported by the National Health and Medical Research Council (grant number 1109626); the Capital Markets Cooperative Research Centre under the Health Market Quality Program and their partners Hospital and Medical Benefits Systems and the New South Wales Ministry of Health; and the HCF Research Foundation. JB is funded by an NHMRC Postgraduate Scholarship (APPID: 1094304). AGE receives salary support as the HCF Research Foundation Professorial Fellow. KC and TB-P receive salary support via a doctoral scholarship from the Capital Markets Cooperative Research Centre-Health Market Quality Program. KC also receives support from an Australian Government Research Training Program Scholarship, and TB-P through a University Postgraduate Award from the University of Sydney.

  • Competing interests KC receives salary support via a doctoral scholarship from the Capital Markets Cooperative Research Centre-Health Market Quality Program, and consulting fees from Queensland Health Department. TB-P receives salary support via a doctoral scholarship from the Capital Markets Cooperative Research Centre-Health Market Quality Program, and consulting fees from Queensland Health Department. AGE receives salary support as the HCF Research Foundation Professorial Research Fellow and is a Ministerial appointee to the Australian Medicare Benefits (MBS) Review Taskforce, receives consulting sitting fees from Cancer Australia, the Capital Markets Cooperative Research Centre-Health Quality Program, NPS MedicineWise (facilitator of Choosing Wisely Australia), The Royal Australasian College of Physicians (facilitator of the EVOLVE programme) and the Australian Commission on Safety and Quality in Health Care, and Queensland Health (state department of health), and is on the advisory board of the NSW Bureau of Health Information; S-AP is a member of the Drug Utilisation Sub-Committee of the Pharmaceutical Benefits Advisory Committee (PBAC) and receives consulting fees from NPS MedicineWise.

  • Ethics approval The University of Sydney Human Research Ethics Committee (project ID 2015/662) approved the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The code used in this study is commercial-in-confidence. The data in this study are available from Hospital and Medical Benefits Systems, which were used under licence for the current study, and is not publicly available. Data are available from the authors on reasonable request and with permission from Hospital and Medical Benefits Systems.

  • Patient consent for publication Not required.

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