About 6000 people - or 16 a day - had ineffective treatments that cost up to $4400 in both public and private hospitals in 2010-11, a Grattan Institute report says.

The research also suggests an unknown number of pregnant women are having interventions during childbirth that they do not need.

The ineffective procedures performed on nearly 6000 patients included the surgical removal of healthy ovaries during a procedure to remove the uterus; surgery to fill a backbone with cement; and hyperbaric oxygen therapy for a range of conditions including cancer, and wounds and ulcers.

The report said insertion of a tube to remove tissue in the knee to treat osteoarthritis, and surgery to destroy a ligament that contains nerve fibres to treat chronic pelvic pain, were also being done without evidence to support their use.

In some cases, clinical evidence has shown that the treatments do not work. In others, studies have failed to prove that they work.

Health program director for the Grattan Institute, Stephen Duckett, said some of the patients who had the treatments developed infections during their hospital stay or could have avoided the stress, cost, inconvenience and risk of a hospital stay altogether. The inappropriate procedures also meant other patients waiting for legitimate surgery or treatment may have waited longer than they should.

"These treatments happen in only a minority of hospitals, but some of those hospitals provide them at 10 or 20 times the average rate, at great cost to patients and the community," he said.

PREGNANT WOMEN

The researchers also analysed some treatments that are effective but should not be done routinely and concluded that some women were receiving potentially harmful interventions during childbirth that they do not need.

The report said episiotomies, a surgical cut made between the vagina and anus during labour for spontaneous vaginal births without complications, were being done at much higher rates in some hospitals, suggesting inappropriate use. Similarly, amniotomy, an artificial rupture of membranes to augment labour during a normal delivery, was occurring at a suspicious rate in some hospitals.

"These treatments should not be given automatically, although they may be the best choice for some patients, such as those with unusual problems or conditions, or where other options have failed. Yet very high variation in how often these procedures are given suggests that some hospitals choose them much too often," the report said.

"Strikingly, women with spontaneous vaginal deliveries are almost three times more likely to have an episiotomy in the private sector."

DIFFERENCE BETWEEN PUBLIC AND PRIVATE HOSPITALS 

The report found that three of the ineffective treatments - hyperbaric oxygen, vertebroplasty and nerve ablation – were more frequent in private hospitals by a large margin.

The difference for vertebroplasty is mostly due to private hospitals in NSW and WA where rates are 10 and 12 times higher than in other hospitals.

However, public hospitals were 2.5 times more likely to do knee arthroscopies for osteoarthritis.

WHY IT'S HAPPENING 

While there were financial incentives for procedures to be done, the report said some clinicians might not realise they were performing treatments that were no longer supported by scientific evidence. "There are financial incentives to provide ineffective care and the incentives not to provide ineffective care are too weak," the report said.

There is also little systematic monitoring of where ineffective treatments happen, the report said, leaving clinicians and hospitals in the dark about where problems might exist.

"Finally, the health system does not manage this problem well. There are rarely major negative consequences for providing ineffective care. In fact, there are incentives that go the other way – hospitals and clinicians get income for giving ineffective care." the report said.

POTENTIAL SOLUTIONS 

The report called for the Australian Commission on Safety and Quality in Health Care to publish a list of "do-not-do treatments". It should then identify public and private hospitals that provide these treatments more often than usual.

"There could be a good reason for a do-not-do treatment, but if some hospitals provide them consistently it is a real concern. These outlier hospitals should be asked to improve. If they do not, a clinical review by the state health department should check whether the hospital is providing the right care. If it is not, and if it still fails to improve, there should be consequences for the hospital's management and funding," the report said.