Greater access to physios, dietitians, and other allied health essential to stem staggering rise in hip and knee replacements
Arthritis Australia is calling for urgent, affordable access to lifestyle behavioural care from physiotherapists, dietitians, and other multidisciplinary allied health, to help address the escalating crisis in arthritis and musculoskeletal conditions now placing unprecedented strain on communities, hospitals and health budgets.
The Australian Government's Commission on Safety and Quality in Healthcare last week set a revised Clinical Care Standard for osteoarthritis of the knee, affirming that most patients can improve pain and mobility without costly joint replacement surgery, when they have access to best practice non-surgical care. But such care is currently not well funded or accessible.
"There's a significant gap between the Care Standard and what is accessible to people with osteoarthritis under current funding models. Consumers lack affordable access to necessary care and are left with few alternatives to surgery. Hands-on support from allied health professionals for pain management, physical activity, and weight loss is crucial to control the rising number of surgeries," says Jonathan Smither CEO, Arthritis Australia.
"If properly funded it will alleviate pressure on the hospital system and most importantly improve people's health, quality of life and keep many in the workforce and actively contributing," he adds.
Research shows education, exercise therapy and support for weight loss and pain management from physiotherapists, dietitians and other allied healthcare professionals, as recommended within clinical guidelines, could reduce high-cost hip and knee replacements for osteoarthritis by a third, saving $1.01 billion a year by 2029 if proven models of care are rolled out nationally.1
Hip and knee replacements for osteoarthritis have reached a record high, averaging over 370 procedures per day and projected to more than double by 2030 to an unsustainable over 650 daily surgeries. 2,3,4
Private hospitals manage over 70% of these procedures, with osteoarthritis responsible for 11% ($2.6 billion) of private hospital expenditure.5 In the public system painful waiting lists exist – the median waiting time for a knee replacement in 2022-23 was over 300 days from referral to surgery.6
Largely ignored and sitting 'under the health radar', arthritis and musculoskeletal conditions, including low back pain, affect one in three Australians and are our highest cost disease group at $15 billion a year.7 The annual direct healthcare expenditure of osteoarthritis and rheumatoid arthritis alone exceeds $5.26 billion, sitting well above the $3.4 billion spent on diabetes and $2.5 billion on coronary heart disease.5,8
Cost of living pressures are also impacting access to allied health support for those living with arthritis and related conditions. New insights from Arthritis Australia and Australian National University's Associate Professor Jane Desborough, gathered from a survey of 760 people living with arthritis and musculoskeletal conditions has found:9
Nearly half (44%) spend over $100 a month out of pocket on allied healthcare, for which there is currently limited government funded access
Almost half (48%) surveyed report cutting back on allied healthcare spending this year due to cost-of-living pressures
43% report that reducing their spending on healthcare has resulted in increased pain and other symptoms, with 39% also reporting mental health impacts
"Over half of Australians living with osteoarthritis are not receiving care according to clinical guidelines. Our healthcare system incentivises high-cost, late-stage procedures, while failing to fund earlier lifestyle behavioural interventions. By providing better clinical care at an earlier stage, we can help individuals manage their arthritis more effectively and avoid or delay invasive surgeries to alleviate pain," adds Professor David Hunter, Florance and Cope Chair of Rheumatology, consultant rheumatologist at Royal North Shore Hospital and leading authority on osteoarthritis.
"Arthritis and musculoskeletal conditions such as osteoarthritis and back pain have been overlooked for too long, both in funding evidence-based care and crucial research to reduce use of ineffective treatments and replace them with better care options," said Professor Rachelle Buchbinder, Head of the Musculoskeletal Health and Wiser Health Care Units in the School of Public Health and Preventive Medicine at Monash University and Chair of the Australia & New Zealand Musculoskeletal (ANZMUSC) Clinical Trials Network.
Arthritis Australia is holding a Summit in Parliament House on Thursday, 22nd August, to place an urgent spotlight on the issues facing those living with arthritis and musculoskeletal conditions, the health and hospital system and the challenges facing governments. Almost 90 consumers and health system leaders and experts from around Australia will examine the significant current challenges and build a comprehensive path forward focussed on high value care, equity of access and reducing the health and economic burden.
Four areas will be considered:
Workforce: Utilising allied health professionals effectively in both public and private sectors, including new funding models and upskilling measures.
Innovative Models of Care: Funding models of care in accordance with clinically recommended guidelines to improve patients' quality of life, shorten surgical waiting lists and save the health system money.
Out-of-Pocket Costs: Strategies to reduce the substantial expenses imposed on patients, including affordable access to allied health care.
Research: Funding a Medical Research Future Fund Mission to turbo charge arthritis and musculoskeletal research to develop higher quality treatments and interventions.
References:
Ackerman IN, Skou ST, Roos EM, Barton CJ, Kemp JL, Crossley KM, Liew D, Ademi Z. Implementing a national first-line management program for moderate-severe knee osteoarthritis in Australia: A budget impact analysis focusing on knee replacement avoidance. Osteoarthr Cartil Open. 2020 May 6;2(3):100070. doi: 10.1016/j.ocarto.2020.100070. PMID: 36474677; PMCID: PMC9718332
Ackerman I et. al., (2019). The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. Accessed 13 August 2024
Australian Orthopaedic Association National Joint Replacement Registry, Procedures Reported (hip and knee). Accessed at https://aoanjrr.sahmri.com/procedures-reported.
Ackerman, I.N., Bohensky, M.A., Zomer, E. et al. The projected burden of primary total knee and hip replacement for osteoarthritis in Australia to the year 2030. BMC Musculoskelet Disord 20, 90 (2019). https://doi.org/10.1186/s12891-019-2411-9
Australian Institute of Health and Welfare, 'Heart, stroke and vascular disease: Australian facts', Dec 2023. Accessed Feb 2024.
Australian Institute of Health and Welfare, 'Elective Surgery', Dec 2023. Accessed Aug 2024.
Australian Institute of Health and Welfare (2023) Health system spending on disease and injury in Australia, 2020-21, AIHW, Australian Government, accessed 25 January 2024.
Australian Institute of Health and Welfare, 'Diabetes: Australian facts', Dec 2023. Accessed Feb 2024.
Unpublished survey, August 2024.
About us:
About Arthritis Australia
Arthritis Australia is the peak national body for arthritis, advocating on behalf of over 4 million Australians living with arthritis, and working with many other arthritis organisations to deliver information and support to people living with more than 100 types of arthritis and musculoskeletal conditions. We are a leading non-government funder of arthritis research in Australia and advocate for policies, programs and funding initiatives that will improve the health and wellbeing of people living with arthritis.
