Delia Scales, a former nurse whose personal experience of cancer treatment made her acutely aware of health system failings, is on a mission to create greater transparency and accountability in healthcare.
• An easy-to-understand overview of best practice clinical guidelines by disease, an overview of errors that occur, and health IT startups that may be helpful.
• Suggestions for pathology services, hospitals, clinics and nursing homes, based on the lowest cost, highest quality and current location of the user.
• A chance to give accurate feedback on the cost and quality of health care received.
• A way to share personal healthcare experiences via social networks.
Delia Scales writes:
I am raising funds to create an app to disrupt the private health system, in Australia and America.
You can learn more about why this is needed from an interview I did with Norman Swan at the ABC’s Health Report about overpriced and substandard private cancer treatment.
I have used my nursing background to investigate private hospitals. I found:
• Secretive subcontracting arrangements between not-for-profit groups and private companies.
• A conflict-of-interest between treating doctors and hospital management.
• Inadequate medical and nursing patient to staff ratios.
• Over servicing and kickbacks.
• Secrecy over pricing.
• The use of commercial laws, business contacts and political muscle to hide higher than average hospital error rates.
One-third of Australian hospital beds now operate in the private sector. There is no public disclose of private medical costs, preventing patients from shopping around.
One private hospital surgery can trigger six different bills. Medical specialists can double their wage or more, by performing the same procedures in the private sector. Patients don’t know the difference because they have no pricing to compare. Health insurance companies keep their payment tables secret.
It is impossible to access information on the out of pocket costs of healthcare. The result? Australians are now paying 19% of all healthcare in out of pocket costs, second only to America.
Outrageous prices are not the only problem. Healthcare practice has traditionally been set by individual doctors and hospitals. In practice, public hospitals create in-house policy and procedure manuals. These vary from hospital to hospital.
Some doctors have become so frustrated over the lack of clear guidelines that they have set up blogs – for example, http://www.foamem.com.
Private hospitals can operate with minimal clinical guidelines. Private specialists can simply set their clinical standards and give verbal advice to nurses on what ‘they prefer’ for their patients.
The result? Dramatic variations in clinical practice across public and private hospitals. The worst clinical practice in my experience is consistently in private hospitals.
Like pricing, data about good and bad doctors and hospitals is not easy to find.
The information that patients need is locked in a vast range of ‘information silos’. The cost for one pathology test can vary from nothing to $800. One medical specialist appointment can vary from nothing to $800.
Data on medical and hospital errors is highly skewed. Three per cent of doctors account for 49% of complaints. Bad hospitals and sections of hospitals are known to trigger far higher than average errors.
In order to give patients information on cost and quality of healthcare, a huge amount of data needs to be analysed and delivered to the user. A cloud-based relational database could do this work.
Acquiring the data would involve a range of strategies:
• Cross-referencing public data.
• Getting professional feedback from doctors and nurses.
• Getting feedback from health startups and companies on their services.
• Access pricing information from the large array of individual health service providers.
The Wikihospitals app aims to offer:
- An easy to understand overview of best practice clinical guidelines by disease, an overview of errors that occur and health IT startups that may be helpful
- Suggestions for pathology services, hospitals, clinics and nursing homes, based on the lowest cost, highest quality and current location of the user
- A chance to give accurate feedback on the cost and quality of health care received
- A way to share personal healthcare experiences via social networks.
Three reasons why I would like Croakey readers to support me in this venture:
- There is a way to use big data and mobile technology to disrupt, thwart and overturn the entire private healthcare industry, from Australia to America.
- There is a way to force down healthcare prices, block over servicing and reduce healthcare errors
- There is a way to educate patients, involve them in their care and encourage independence and self-control.
Australians are a smart, inventive peoples. Let’s take on the problem that Silicon Valley still hasn’t solved. Let’s win the most important battle of the twenty-first century – making healthcare safe, sustainable and affordable.
- 2012 submission by Delia Scales to Australian Safety and Quality Goals for Health Care Consultation Paper
- Scales participated in a Consumers Health Forum of Australia workshop earlier this year.
- Elisabeth Rosenthal on Facebook about the ugly side of private health care.