The first Australian Atlas of Healthcare Variation has called for the removal of MBS items for arthroscopy in patients with degenerative knee changes.

The Atlas, just released by the Australian Commission on Safety and Quality in Health Care, also recommends that the Commission develops a clinical care standard for investigating and managing osteoarthritic knee pain based on recommendations from its Knee Pain Expert Working Group.

The report notes that Australia has one of the highest per capita rates of knee arthroscopies among OECD countries.

Analysing hospital admissions for knee arthroscopy in patients aged 55 or more, it found the rate was more than three times higher in South Australia than the ACT, and there were wide variations in areas within the larger states.

Possible contributors to the variation included clinicians’ approach to evidence-based practice in their clinical decision making, rates of private health insurance cover and the accessibility of private hospitals: about 80% of admissions are in the private sector.

Other variables might include differences in the occurrence of risk factors for knee problems (including obesity and occupational injuries), access to imaging and alternatives to surgery such as physiotherapy for people in remote locations, and rates of repeat procedures for the same patient.

“To explore this variation, further analysis could focus on investigating repeat knee arthroscopies, rates of MRI that progress to knee arthroscopy, rates of knee arthroscopy that progress to knee replacements, and the influence of the private and public sectors on rates of knee arthroscopy,” the report says.

Ten-fold variations in the rate of opioid prescriptions across Australia have also been identified.

“Modern medicine is characterised by an increasing expectation that people will receive care that is evidence based,” the report says.

“Despite this expectation the safety and quality of health care varies, both across geographic areas and among individual clinicians.

“Understanding this variation is critical to improving the quality, value and appropriateness of health care.

Although some variation is desirable and warranted, reflecting reflects differences in people’s needs, unwarranted variation signals that people are not getting appropriate care, it says.