Worrying trends in MBS review
There are mounting concerns about the direction of the Federal Government’s far-reaching overhaul of the Medicare Benefits Schedule amid indications up to 100 review groups will be established to examine specialist items.
The AMA has cautiously welcomed the MBS review, led by Sydney University Medical School Dean Professor Bruce Robinson, and has undertaken to help organise and coordinate the input of clinicians.
But AMA President Brian Owler has convened a meeting of medical profession leaders for the later this month to discuss worrying aspects of the Government’s approach to the review, including excluding specialist colleges and societies from direct involvement, opaque processes for the selection of review members that raised the risk of influence by individual vested interests, and a lack of transparency regarding the work of review groups and their decision-making.
Professor Owler warned the Government that it risks jeopardising the medical profession’s support for the process if it turns out to be just a cost-cutting exercise that lacks transparency and excludes clinical input.
“Doctors are not afraid of change and reform. We will willingly participate in reform where it is in the best interests of our patients,” he told the National Press Club last month.
He said the MBS, which list treatments and procedures for which the Government will provide a Medicare rebate, was due for an update because of improvements in medical technology and innovations by doctors to provide better and more effective treatments.
“However, our support is predicated on this review not being aimed at cutting the funding to health,” Professor Owler said. “We agree with not paying for procedures that don’t work for certain indications, but we also need to ensure that we don’t deprive people of important services.”
He voiced concern that the Government might use the review mostly to remove items from the MBS, rather than ensuring the schedule was up-to-date and reflected advances in care and medical practice.
“The MBS review cannot be a cost-cutting exercise,” he said. “If there are clearly savings that are identified and the evidence is there that supports those savings, then fine. But we also need to make sure that we have the ability to introduce new items onto the MBS. This cannot be about just taking items off.”
The AMA President said there were a lot of procedures and services currently not covered by the MBS that should be included, and lamented that currently the process for getting new items on the schedule was lengthy and costly.
He said an important aspect of the review was the opportunity to add new items and make the MBS “modern”.
“What we need to do as part of this review is ensure that we can actually add new things on and make sure that we do actually come up with a modern MBS,” the AMA President said. “If we get the sense that this is a cost-cutting exercise, then AMA support and, I suspect, the support of the whole medical profession, will be jeopardised.”
The MBS review meeting by convened by the AMA later this month will be addressed by Professor Robinson.
In his letter to college and society leaders inviting them to the meeting, Professor Owler detailed a number of issues regarding the Government’s approach to the review, including that:
- it had not articulated a strategic vision for the health system to guide the review’s outcomes;
- that it had not been given specific and quantifiable aims;
- that specialist colleges and societies were excluded from direct involvement;
- that the criteria to be used to select review members was unclear; and
- there was a lack of transparency around individual reviews as they progress, and the decisions that will come from them.
“Any review of this nature must bring the profession along with it,” the AMA President wrote in his letter. “In the absence of a Government process that facilitates that, it is very important for the medical profession to be collaborative and coordinated.”