Submission to the Medicare Benefits Schedule Review

CPSA welcomes the review into the Medicare Benefits Schedule (MBS) and is appreciative of the opportunity to comment on the Consultation Paper.
CPSA is supportive of a review of the items on the Medicare Benefits Schedule and an overhaul of the services which are listed and subsidised. CPSA is not in a position to comment on the merit or otherwise of particular items. CPSA stresses, however, that any savings made by the removal of items deemed ineffective or no longer best practice should be reinvested into the listing of updated tests and procedures which are evidence based and provide the best outcomes for patients.

While supportive of MBS listed items providing value for money, the Association is wary of this being the primary motivator. CPSA stresses that item additions and removals should be made in the best interest of patients, providing the most accurate and positive outcomes. We do not want to see the best solutions being avoided purely due to cost considerations.

CPSA is concerned that ‘rapid reviews’ will be conducted to determine the evidence of interventions. Two to four weeks may not be enough time to determine the effectiveness of some MBS items, particularly where results vary based on illnesses or demographic factors. CPSA does not want to see items removed from the MBS when they may be the best intervention for certain groups of people, even if not appropriate across the population as a whole. We are also concerned about doctors continuing to request certain tests and treatments, even if the items are removed from the MBS. This could see patients continue to be pushed towards less effective treatments and investigations while facing higher out of pocket costs.

The Consultation Paper refers to a study which found 156 MBS listed items were potentially inappropriate, ineffective or unsafe. While it is important that these are addressed, Elshaug et al’s study screened 5,209 articles bringing these questionable items in at 3% of those investigated.[1] CPSA is not suggesting that it is not important that these items are reviewed more thoroughly and replaced, but it does not lead one to believe that there is necessarily a plethora of inappropriate items on the MBS.

CPSA strongly believes that the MBS should remain as an uncapped, demand driven program. We also believe that the prohibition against the payment of health insurance benefits for health screening services should remain. To open up such testing to health insurers will be to the detriment of those who cannot afford health insurance coverage and will lead to an exacerbation of unequal health outcomes between different socio-economic groups. It is also likely to increase the prices charged for such services. We need to ensure that vital screenings remain covered under Medicare so that out of pocket costs do not prohibit someone from undertaking tests that may save their life.
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1. Elshaug, A, Watt, A, Mundy, L and Willis, C (2012) ‘Over 150 potentially low-value health care practices: An Australian Study’, The Medical Journal of Australia, 197(10), pp. 556-560.