Doctors prescribe fewer drugs and do fewer operations when they know they’re being watched, an Irish organisation has found. Here’s why.
Doctors in South Africa and abroad cause thousands of avoidable deaths each year by ordering unnecessary tests, surgeries and hospital admissions for their patients. That’s according to Louisine Alpern, co-founder of the Irish medical services organisation Medical Reviews International, or MedRev.
Alpern was speaking at the annual conference of the Board of Healthcare Funders of Southern Africa (BHF) in Cape Town this week.
“It’s an epidemic of overtreatment,” she warned.
Physicians who overuse medical services have more to do, and are also more likely to make mistakes, Alpern explained. In the US alone, medical errors cause a quarter of a million unnecessary deaths each year, according to a 2016 paper published in the British Journal of Medicine.
At the conference, Chris Adams from the South Africa health fund risk management firm Verirad, which verifies radiology and pathology claims for medical schemes, revealed that in one case, a lack of coordination between doctors forced a 64-year-old diabetic patient to undergo the same blood tests twice in the space of three days. And a 59-year-old woman was sent for the same blood tests by her general practitioner, physician, and surgeon during her three-week hospital stay.
Unnecessary procedures are conducted around the world. A 2010 BioMed Central Musculoskeletal Disorders study showed that in Spain, for example, a quarter of knee and hip replacements in 2005 were uncalled for.
Adams explains: “We need to communicate with each other. We’re losing money, and harming patients.”
Over and over: SA patients stuck in repeat treatment
It’s not just operations that happen unnecessarily — needless medication is dished out too. A 2014 study in the journal, The Lancet Infectious Diseases, found that the world’s use of antibiotics shot up by more than a third between 2000 and 2010.
South Africa, along with four other countries including India and China, was responsible for three-quarters of the increase.
A four-year investigation by South Africa’s Competition Commission revealed that a lack of competition in the country’s private healthcare sector is also driving overtreatment. The inquiry found that many patients were using medical treatments just because the drugs and procedures were available, and not because they needed medical help. This phenomenon is called “supply-induced demand”.
Alpern explains: “We need a new paradigm in medicine. We must do better by doing less.”
Big brother’s sway: You’re safer when your doctor knows (s)he’s being watched
In Ireland, where MedRev is based, Alpern and her colleagues have figured out what stops doctors from overusing medical services: knowing that they’re being watched.
The organisation helps medical schemes save money and cut medical overuse through an online review process that evaluates whether the treatments doctors order for their patients were necessary.
The reviews are conducted by independent specialists, who weigh the claims against the best available evidence, and then contact overzealous doctors with a full clinical report that includes advice on how to streamline their treatments.
But even the watchers need to be watched, Alpern says. “We wanted to be sure the doctors are getting consistent advice.”
As a result, the specialists’ advice is monitored, and the amount they are paid for their expertise is not linked to how many claims they deny.
When MedRev first gets involved at a scheme, the number of claims that are rejected is sky high. But once doctors realise their work is under scrutiny, Alpen says, they start to submit fewer and fewer claims to medical schemes.
For example, after MedRev had worked with a UK company for two years, the number of claims for unnecessary oral surgeries dropped by 30%, saving the scheme thousands.
The organisation’s records also reveal shocking overtreatment in a Swedish scheme, with three-quarters of spinal procedures that were claimed for done for no reason. Half of knee, hip and shoulder surgeries were also unnecessary.
In Ireland, MedRev found that 70% of hospital admissions were not medically necessary — in some cases, these surgeries were ordered without the scans needed to make a proper diagnosis.
Alpern warns: ”This kind of overtreatment takes a human toll. Overly aggressive treatment causes pain and suffering for patients.”