Norman Swan reported this story on Monday, September 28, 2015 08:06:01

MICHAEL BRISSENDEN: According to figures released last week, we as a nation spend just under $155 billion on healthcare. That's by governments, private health insurers and patients in out of pocket costs not covered by Medicare or insurance.



And while politicians like to say we have an unsustainable health care system, tonight's Four Corners as we've heard, argues there's plenty of money if we re-direct the 30 per cent, or $46 billion, that's wasted.



Norman Swan of RN's Health Report has the story.



NORMAN SWAN: There's waste everywhere you look in Australian healthcare. It occurs for many reasons, but often because of tests and treatments that are performed which are unnecessary, could have got the same benefit for less money or which are harmful.



ADAM ELSHAUG: We know that patients are being harmed by receiving tests and treatments that they should never have received, and yes there is a cost to that, and that cost should also be counted because those are dollars that are wasted and could have been reallocated to other areas of medicine.



NORMAN SWAN: Adam Elshaug of the University of Sydney is an international authority on what's called low value care. And there's a lot of it.



Tonight's Four Corners takes just four examples of low value care with the savings from one alone - unnecessary scans and xrays for lower back pain - could pay for a suicide prevention program that would save 1,000 lives a year. In all of these examples tonight there is the same pattern: a system which is designed to encourage unnecessary tests which lead to inappropriate and costly healthcare journeys where the beneficiaries aren't always the patients. Robyn Ward of the University of Queensland chairs the committee that decides what tests and procedures Medicare should pay for.



ROBYN WARD: If people knew that healthcare interventions were not going to deliver benefit I think they might make different choices. At the moment there is not a great understanding that potentially these tests are offering very little in the way of outcomes and are sometimes actually harming people.



NORMAN SWAN: What's often going on is a process called over-diagnosis. Professor Paul Glasziou of Bond University is a pioneer of evidence based health care.



PAUL GLASZIOU: It's that we tend to, with our powerful imaging techniques, the screening techniques that we're using and the definitions of diseases we're classing and detecting a lot more people as being diseased than we used to.



NORMAN SWAN: Surprisingly few medical conditions are clear cut. You'd think that you either have osteoperosis, cancer, diabetes or heart disease or not - but that's not necessarily the case. Doctors draw a line, say with blood pressure or blood sugar, above which they think the risk of a stroke or diabetic side affects is high enough to warrant treatment. And these decisions have often been influenced by industry and groups who stand to profit from the new market for drugs and tests.



PAUL GLASZIOU: The increase in health care costs has been driven a little bit by aging, a little bit by increases in the costs of technologies but the largest drive is our over-diagnosis and our over-treatment. That is going to get worse. So we're headed for a tsunami of over diagnosis. All that technology is not necessarily going into the right place. We're over-using it in the well and we're under-using it in the people who really need it. Medicine is now spending so much time worrying the well that we don't have time to take care of the sick.



MICHAEL BRISSENDEN: Professor Paul Glasziou and you can see more on that story on Four Corners tonight at half past eight on ABC TV.