Dr Rachel David spoke with 5AA on the Four Corners investigation into spine surgery for back pain

Station: 5AA
Program: Mornings
Date: 8/4/2024
Time: 10:20 AM
Compere: Matthew Pantelis
Interviewee: Dr Rachel David, CEO, Private Healthcare Australia


MATTHEW PANTELIS: Let’s talk about back pain, and Private Healthcare Australia on the front foot about, a Four Corners report into spinal surgery. Doctor Rachel David, CEO, Private Healthcare Australia, on the line. Rachel. Good morning.
RACHEL DAVID: Morning, Matthew.
MATTHEW PANTELIS: What’s the issue here?
RACHEL DAVID: Well, look, we were approached some time ago by the ABC Four Corners program for some data about back pain surgery. And Matthew, look, one of the problems we have for this is that what it revealed was that- so, the back pain surgery’s a very complex surgery, is being done on people where it has no chance of success. So this particular procedure is very expensive. It’s being done on people who are presenting with chronic back pain, for which it is not indicated. They’re getting some very bad outcomes. And I suppose one of the things that really- I really struggle with is that health funds under our current regulation are forced to pay for these procedures. We have no choice even if we know they have no chance of success. And we know, as the ABC has alleged in some of the comments that it’s made on its website and on- in the media today that they are a source of fraud, waste and abuse for the health system.
MATTHEW PANTELIS: So that’s a fact, is it? It is a case in some cases of fraud, waste and abuse?
RACHEL DAVID: Yeah. Well, look, we have seen the report that the ABC is referring to, and I understand that they will be making it public later today. And it shows that not only are these procedures very expensive, but they’re being performed on some people for whom they’re seriously not a good idea – like people who are very elderly, frail, and where surgery has no chance of reducing their pain or disability. And furthermore, in association with those procedures, there has been massive overuse of medical devices which are overpriced, and some fraudulent behaviour of some of the clinicians concerned.
MATTHEW PANTELIS: What’s happening in that space? I mean, are people being deregistered? Can they be? Should they be?
RACHEL DAVID: Well, look, we need to investigate this further, and we will be commencing an investigation as soon as the ABC makes its report public. But I think that one of the main issues here is that the Department of Health needs to be pulling in the same direction as we are. We cannot investigate this and get it under control unless they do their bit and investigate the Medicare fraud and the medical device fraud that could be happening at the same time. So we really are relying on them to help us out.
MATTHEW PANTELIS: Why would- I suppose people are looking for a solution to chronic back pain, and they’re promised that, a panacea – just go under the knife for a bit and we’ll fix you up, and you’ll be right as rain. And so they’re taking up that option if it- believing it will mean the end to their pain.
RACHEL DAVID: Well, look, for a start, the science of pain and chronic pain is evolving every year. And one thing that the pain experts have told me is that a lot of it is in the brain. And you can see all sorts of abnormalities as people get older on x-rays, but they’re most likely not the cause of the pain. And if you get in there and do major surgery and you’re correcting for these abnormalities, particularly if the patient is old, they have thinning bones and they’re frail, the chances of success are close to zero.
RACHEL DAVID: And yet, everybody seems to be making money out of these procedures except the patient. So you’ve got surgeons, anaesthetists making a fortune. In some cases, we’ve seen hundreds, over $100,000 worth of medical implants billed in association with these procedures, which is actually multiple times what we’re even paying the doctor. And when we know this has no chance of success, and we know that premiums are going up for people and people are struggling to fund their healthcare, and the Government’s struggling to fund Medicare, we really need to bring this to a halt.
MATTHEW PANTELIS: And this wouldn’t be helping at all, would it, in terms of premiums? It would be a- probably a reasonable factor and contributor to the rise in premiums.
RACHEL DAVID: Some of these procedures are some of the most expensive procedures that we are being asked to pay for. And when the chances of success are so low, that’s what really- that’s what we really have a problem with. I mean, there are some situations in which spinal fusion surgery is appropriate if someone has broken their back, or if someone has been born with a deformity of their back.
RACHEL DAVID: Those are situations in which you might want to do some of these major procedures. But if someone has chronic pain, particularly if they’re older and they have other health conditions, this is not an appropriate procedure. And yet, we’re seeing that it is being done increasingly and that the surgeon- and that the types of surgery are getting more and more complex, and using more and more medical devices and surgical supplies in ways which seem to be earning a lot of money …
RACHEL DAVID: … for the companies that supplied them, but are doing nothing for the care of that patient.
MATTHEW PANTELIS: What needs to happen, Rachel, for this practice to stop, whether it’s back surgery or other- whatever healthcare where people are just being ripped off in this regard? Because for those of us with private health, we do so in the good faith. We buy it and sacrifice other things to afford the premiums. And we do so in the good faith that the system isn’t essentially ripping us off in those premiums – yet, it seems to be. So what needs to happen for this to stop?

Look, with spinal fusion surgery, I think the first thing the Government needs to do is to go back to the original recommendations of a review that the previous government did of the area. So there was a review of the Medicare benefits paid for these procedures, and it advised that this procedure come off the Medicare benefit schedule. Instead, what happened was that there was lobbying by some of the surgeons involved, so it went back on with some conditions. And it does specifically say that spinal fusion surgery should not be performed for chronic back pain. But of course, now that we’ve looked into what that- what has actually been billed, it clearly is being used for chronic back pain. And the patients are coming back in large numbers within a year for further surgery because it doesn’t work. So that’s the first thing.

And the second thing which I have raised- being raised and been campaigning on for years is the overpricing of medical implants and surgical supplies. This is driving a lot of the behaviour. And as I mentioned before, we’ve had some procedures where we’ve spent over 100 of thousands of- over $100,000, and most of that is going straight offshore to the medical device companies. Now, we have just got to bring these prices back down in line with the global market, or abandon the Commonwealth price list altogether and pay a single fee for the procedure. And that will stop the- that will eliminate a key driver, financial driver for some of these surgeries to take place.

MATTHEW PANTELIS: Rachel, thanks for your time this morning.
RACHEL DAVID: Thanks, Matthew.
MATTHEW PANTELIS: Dr Rachel David, CEO, Private Healthcare Australia.
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