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You are not Robinson Crusoe

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A huge undertaking, but is it about improving outcomes or cutting costs?

Dean of Medicine at the University of Sydney, Bruce Robinson, is leading the Medicare Benefits Schedule (MBS) Review Taskforce in its examination of how more than 5500 listed services can be aligned with contemporary clinical evidence and improve health outcomes for patients.1

It would be informative if the federal government had the Department of Finance provide a figure indicating how much money it wants to save. Disguising a rationing exercise by saying it is about improving outcomes will cut little ice unless the level of rationing is acceptable to the medical profession.

Pricing MBS items is a cost-accounting exercise. Trying to evaluate whether a particular service, based on the Medicare price, improves health outcomes could lead the taskforce into a paper chase seeking clinical evidence, when the intent of the exercise is all about increasing cost efficiencies.

Advances in technology improve efficiency. Pathology services were an early target because the original MBS items were based on tests undertaken manually. Once tests became automated, throughput increased and pathology service providers made substantial windfall gains before the MBS prices were adjusted.

On the other hand, the pricing for cataract removal has been largely immune from any recognition of…