23 Medicare Items for Review as Funding Overhaul Begins

Patients’ out-of-pocket expenses could rise as a result of recommendations that 23 medical procedures should no longer be funded by Medicare, the president of the Australian Medical Association, Brian Owler, has warned.

The health minister, Sussan Ley, released the first stage of a medical benefits schedule (MBS) taskforce review, led by Sydney medical school’s dean, Bruce Robertson, which identified items which were considered obsolete and no longer representing clinical best-practice.

The 23 items announced by Ley include seven in diagnostic imaging, nine in ear, nose and throat surgery, five in gastroenterology and one each in obstetrics and thoracic medicine. The items do not form the final list but are the first to be released for further consultation, which is open until 8 February. A total of 5,700 items are up for review.

Labor and the Greens both support the concept of a review of the MBS; both parties, however, say any savings should be returned to the health system.

“Labor is happy to look at sensible reforms to Medicare, but Australians are right to be deeply suspicious about the motives of a government which has already ripped more than $60bn from health, and sought to slug them with a tax every time they visit the doctor,” said Labor’s health spokeswoman, Catherine King.

The opposition said the government had been slow to implement MBS changes, given the Labor government had begun a similar review in 2012 which resulted in “156 potentially ineffective and/or unsafe services being identified for consideration”.

The Greens leader, Richard Di Natale, said his party had long supported a health sector-led review of the MBS.

“The real challenge will come when the taskforce tackles much more frequently used low-value interventions,” he said.

“It’s crucial that any savings are reinvested in the health system.”

Ley said the 23 MBS items were used a combined total of 52,500 times in 2014-15 and were worth $6.8m in Medicare benefits paid.

Owler said he was concerned the MBS review was a way of cutting money out of the health budget – particularly after the midyear economic fiscal outlook (Myefo) cut $650m by ending bulk-billing incentives for pathology and diagnostic imaging.

“I think that gives anyone who has concerns about the MBS review and the government’s intentions, something to think about,” Owler said.

“Our main concern will be to make sure access for patients to medical services are not going to be jeopardised by the review outcome and we’re not going to see more costs being pushed on to patients and their out-of-pocket expenditure increasing yet again.”

As an example of the procedures to be cut he described one which involves the injection of a local anaesthetic around a particular nerve as part of tonsillectomy.

“[This] is a common item number that is used as part of that procedure [which] will no longer be available,” he said.

“Now the impact of that will be that out-of-pocket expenses for patients undergoing that procedure will increase but of course we have to see what the results of the consultation process is going to be.”

Ley said many of the items have not been reviewed since Medicare began in the 1980s.

“Reasons range from more clinically appropriate and/or efficient technologies and procedures already listed on the MBS through to patient safety, unnecessary doubling-up of item claims and decreasing usage,” she said.

“For example, in diagnostic imaging, invasive tests to diagnose blood clots in the lower leg or gall bladder problems have now been replaced by non-invasive ultrasound technology.”

Source: The Guardian, Gabrielle Chan