Saving money starts at the knees

In a letter to the ANZ Journal of Surgery, Dr Chris Dalton, the National Medical Director for Bupa ANZ asks why are so many knee arthroscopies still being performed?

Your knee has been hurting for years so you see a surgeon who recommends a knee arthroscopy. What do you do next?

Dr Chris Dalton, the National Medical Director for Bupa Australia & New Zealand has some advice.

“If you are over 55, we encourage patients who have been recommended a knee arthroscopy to get a second opinion, and be aware that if you’re doing it because of pain there’s no good evidence to show that it’s beneficial.”

Dr Dalton says as people get older knee joints start to wear out, while osteoarthritis can be a cause of pain, long term injuries and degeneration are often the culprit.

“It seems likely large numbers of these procedures are being performed for degenerative disease,” he says.

“People get aches and pains and the idea was that if you trimmed or cleaned up any torn cartilage or damaged tissues in the knee you’ll relieve some of that pain.”

An analysis of Bupa data from 2011 to April 2016 shows the total number of knee arthroscopy episodes was 73,874, with 51% of these performed in patients over 55.

The total spend by Bupa on knee arthroscopies from 2011 to March 2017, including known out of pocket costs, was close to $343,000,000.

With affordability being the biggest issue for private health care, Dr Dalton says spending vast sums on these sorts of procedures just isn’t sustainable.


Dr Chris Dalton, National Medical Director, Bupa Australia & New Zealand
“If we can save money on procedures of questionable or low value, we hand it back to our members in lower premiums.”
Dr Chris Dalton, National Medical Director, Bupa Australia & New Zealand

“It’s better for everybody because that encourages people to take up private health insurance if the cost is lower and that takes strain off the public system.

Dr Dalton refers to trials in which an ‘operation’ was done by making an incision on a patient’s knee but not actually performing any procedure.

“They compared those patients to people having cartilage trimmed up or loose tissue removed. The patients were unaware which group they were in and there was no difference between the two groups.”

“That was pretty good evidence this procedure wasn’t achieving anything in terms of pain relief or improved function.”

“Because the knee is deteriorating these minor procedures won’t do anything to alleviate that.”

Taking strain off the knee though weight loss and strengthening the muscles around the knee is a better option in many cases.

Dr Dalton stresses every case is different and with inevitable deterioration the ultimate solution is a knee replacement.

But there’s some hope. From 2014 to 2016, there’s been a 26% decline in the numbers of knee arthroscopies in Bupa members over 55 years old.

“It’s a better deal all round. If we can hold costs down, we can hold our premiums down,” says Dr Dalton.