Association of regulatory body actions and subsequent media coverage with use of services in a fee-for-service system: a longitudinal cohort study of CT scanning in Australia

OBJECTIVE: The professional service review (PSR) is an Australian Government agency aiming to reduce inappropriate practices funded via Medicare, Australia’s public insurer. Our objective was to examine changes in CT following the 2008–2009 PSR annual report, which noted excessive CT use. DESIGN: Interrupted time series analysis examined trends in CT use following the 2008–2009 PSR report, estimating both change in the immediate rate of CT and the slope of the trend in usage postintervention. SETTING: Medicare-funded imaging (most out-of-hospital imaging) in Australia. PARTICIPANTS: Patients receiving Medicare-funded CT and other imaging. INTERVENTION: The 2008–2009 PSR report highlighted concerns regarding excessive CT use. Two providers were financially penalised for CT overuse with these cases detailed in the PSR report and highlighted in an associated Report to the Professions, distributed to 50 000 providers. Media articles on radiation risks followed. OUTCOMES: Quarterly rates of out-of-hospital CT, MRI (as a comparator), and all other Medicare-funded diagnostic imaging examinations 2001–2019. RESULTS: CT scanning increased from 4663.5 per 100 000 person-years in 2001 to 14 506 in 2019 (211% increase), with substantial variation by type and anatomical region. The 2008–2009 PSR report was followed by an immediate reduction in CT scanning of 237.7 CTs per 100 000 people per quarter (95% CI −333.4 to −141.9) though growth in use soon continued at the preintervention rate. The degree of change in utilisation following the report differed between states/territories and by scan type, both in terms of the immediate change and the slope. For other diagnostic imaging modalities, there was an increase in the slope, while for MRI there was no change in either parameter. CONCLUSION: Actions consisting of financial disincentives for service overtesting and provider/public education components may limit excessive use of diagnostic imaging in fee-for-service systems, however, effects observed here were only short lived.