Out-Patient Rehab Superior to In-Patient

Australia has one of the highest rates of knee replacements in the world.

Between 2003 and 2014, the number of knee replacements performed each year increased by 97% in the private sector and 71% in the public sector.

In-hospital rehabilitation after knee replacements has also been increasing in Australia. This is despite the fact that cheaper options have been demonstrated to be better for patients. While other countries have embraced at-home or community services after surgery, the rate of in-hospital rehabilitation in Australia increased from 31% of patients in 2009 to 45% in 2016 in private hospitals. The rate in the public hospital system is only 17%.

According to an article in the Medical Journal of Australia (MJA) if private hospitals followed best practice guidelines they would save $50 million in private health expenditures each year and free up 60,000 hospital bed days.

Researchers analyzed Medibank claims data and hospital case-mix records for 35,389 patients aged 40-89 years who had not previously needed a new joint and underwent a total knee replacement in a private hospital.

Author Chris Schilling, a health economist, said “There is a significant opportunity to reduce in-hospital rehabilitation rates, without having any detrimental effect on health outcomes. To ensure the sustainability and affordability of the healthcare system, it is important that every dollar be invested in high-value care.”

A separate study in the MJA found in-patient rehabilitation “did not achieve better joint-specific outcomes or health scores than alternatives.” Australia’s aging population and an increasing obesity rate has made in-hospital rehabilitation a pressing problem.