A rapid rise in telehealth and the overuse of keyhole surgery on patients with no prospect of benefit are among the findings of new research into healthcare performance in NSW released today.
The Bureau of Health Information’s annual Healthcare in Focus 2016 report compares NSW’s performance to the health systems of 11 countries and other Australian states and territories, and found that technology can be a benefit and a burden.
“The ageing population and accompanying rise in chronic disease, advances in technology and increasing consumer expectation are among the drivers of increasing healthcare utilisation,” the report says.
The fast uptake of telehealth is improving access to care for those in more remote parts of the state with shortages of healthcare workers.
“The use of telehealth has been rapidly growing in NSW healthcare. It may contribute to decreasing health disparities between rural and urban populations, and improving rural medical workforce recruitment and retention by providing professional development opportunities. The use of such technology to help people self-manage chronic disease at home has been shown to reduce healthcare costs, hospital admission and length of stay and mortality,” according to the report.
Video consultations between patients and specialists — including those with additional in-person clinical support — have increased six-fold since 2011–12.
But despite improvements in access to care provided by technology, the inappropriate use of procedures such as keyhole surgery persists.
About 70 per cent of knee arthroscopies were performed on patients with osteoarthritis degenerative knee conditions aged 50 years and over despite no prospect of benefit.
“A total of 18,384 knee arthroscopies were performed in NSW hospitals during 2014–15. More than three-quarters of these were in private hospitals,” the report says.
Healthcare in Focus 2016 also finds additional “important areas for improvement”:
Median waiting times for cataract surgery, and hip and knee replacements are substantially longer than many other health systems, particularly among patients from lower socioeconomic areas. In 2014, the median waiting time for cataract extraction was 222 days, placing NSW 15th out of 16 health systems.
NSW patients experience relatively high rates of post-surgical complications, with 15 per cent experiencing a complication of care.
Only 73 per cent of patients had hip fracture surgery within the clinically recommended time frame of two days, and NSW was outperformed by all eight comparator countries that publish data for the measure.
About 2.5 per cent of NSW patients who underwent hip and knee replacements suffered a venous thromboembolism, and about 2.5 per cent of abdominal surgery patients developed sepsis, which are relatively high rates internationally.
Meanwhile the state is contending with a growing pressure on the health system that outstrips population growth.
Compared with other Australian states and territories, NSW has the highest number of GP visits per capita, increasing by 11 per cent between 2010–11 and 2015–16. The state’s population grew by 7 per cent.
Emergency department visits are relatively high, with 15,767 presentations per 100,000 population in the most urgent triage categories 1–3 last year.
Among the 2.6 million presentations to public hospital emergency departments in NSW in 2015–16, 6 per cent were followed by another emergency presentation within two days, and 10 per cent within seven days.
“An important set of effectiveness measures focus on unplanned patient returns to care. Such returns are not always avoidable, however they can reflect shortcomings in the initial healthcare encounter – in follow-up arrangements, integration of care or the adequacy of discharge planning,” according to the report.
The annual Healthcare in Focus draws on data from the OECD, 2016 Commonwealth Fund International Health Policy Survey of Adults, Australian Bureau of Statistics, Australian Institute of Health and Welfare, NSW Patient Survey Program and NSW Ministry of Health datasets, including analyses of administrative and medical records.
Bureau of Health Information Acting Chief Executive Dr Kim Sutherland said despite areas for improvement the state largely matches or outperforms comparable systems around the world.
“New South Wales performs consistently well when aspects of our healthcare system are measured against those in comparator countries. The report finds that no country had lower spending and better health than NSW,” Sutherland said.
“Deaths from heart attack and stroke in NSW have fallen sharply over the past decade. Healthcare is accessible to most people in NSW and patients generally receive it in a timely and safe way.”