Tag: MBS

Pap smear costs- a storm in a teacup?

The announcement slipped in easily enough just before Christmas. On December 15, in its mid-year budget update, the Federal Government announced that they would scrap the incentive payments for pathologists for bulk billing of tests, because the rate of bulk billing had not increased. In other words, the measure appeared to have failed.

This announcement reflects the work being undertaken in the Medicare Benefit Schedule (MBS) reform process which was established in April 2015. The MBS is a list of more than 5,500 item numbers against which medical practitioners can bill the federal government for payment. It is the basis of business models for public, private and not for profit health services. It includes clinical items as well as this type of incentive payment.

Queue then the entrance of the Royal College of Pathologists, and the Australian Medical Association. In other words, organisations whose bottom line is affected by this change. In some online and newspaper reports, figures were put on the cost to consumers of a pap smear  at around $30. On 6th January an article appeared on Mamma Mia’s website, and a petition about the cost of Pap Smears and pathology tests was launched by Change.org. Signatures are nudging very close to 150,000, and rising as this blog is being written. Yet the incentive payment being scrapped was in the region of $1.30-$1.40 according to the Federal Government. In the short discussion I just had with the media spokesperson for the College of Pathologists, the position of the College seems to be a reluctance to nominate an actual figure to be passed onto consumers. So is this an issue, or isn’t it?

I would venture to suggest that it is not. Change is always a difficult phenomenon to manage, and communication seems to have contributed to the backlash the Federal Government is experiencing. The real story is the reason behind the MBS Review and why it is so important for Australians that this happens. Here are some terrifying facts and figures about the MBS provided by our national body The Consumers Health Forum:

  • Until 1 January 2010, there was no clear process for adding new items to the MBS.
  • There was also no clear, consistent system for identifying and removing items from the MBS when they were no longer considered best practice or effective.
  • There was no consistent and formal process in place to test or review items already on the MBS, or new items coming onto it, to ensure they were doing what they were intended to do and were safe and cost effective.
  • Only three percent of items have been assessed for safety, effectiveness and cost-effectiveness. 

You read that right. Only three percent.

So the MBS Review team are carrying on their work, amidst the media cacophony. They are still very keen to hear from the community, but many people find the topic inaccessible and can fail to see how this may affect them. Perhaps this controversy will raise awareness of this enormous and much-needed reform currently unfolding. It is unfortunate that this Review is always going to get caught up in economic rationalist arguments and the undeniable need for our country to reduce its health costs. Public scrutiny will be important to ensure that the focus is on eradicating inefficiencies, duplication and waste rather than diminishing access to quality health services. But let’s ensure that this is a patient centred discussion, not a vested interest centred discussion.

Just before Christmas the MBS Review Taskforce released a new consultation has to look at obsolete MBS items, with feedback invited until 8th February 2016. If you are brave to work your way through the consultation documents, feel free to have your say.

Written by Pip Brennan, Executive Director of the Health Consumers’ Council of WA.


Wasted – did you watch this?


Did you watch the Four Corners episode Wasted on waste in health care last night? It is highly recommended viewing and made a number of interesting points:

  1. That our Medicare Benefits Schedule (MBS) pays an amount to a health care provider every time they provide a test or treatment. This provides a perverse incentive for medical practitioners to offer more tests and treatments. And more does not always equal better.
  2. That up until the last five years, procedures were not subjected to an evidence base test before being added to the MBS. Which means there are several decades worth of procedures on the MBS that do not pass the evidence base test.
  3. That there is no connection easily made between the number of treatments done and the health outcomes they are achieving for us. So while data is collected from MBS, from our hospitals and health services, from our diagnostic services, this data is collected in silos and cannot easily be translated into a coherent picture of what works, and what doesn’t
  4. That health consumers are sometimes asking for diagnostic procedures and treatments on the understanding that this will ensure they a) reduce their worries and concerns and b) they will get better.
  5. That it takes time in a clinical consultation to explain why tests and treatments may not actually achieve the outcome the consumer is seeking, and spending more time discussing and explaining treatments and options with consumers is not financially rewarded.

At one point consumers are encouraged to ask questions in order to feel sure that the treatment they are having will a) be useful and b) won’t potentially harm them and c) won’t waste our precious resources. A key question is “what’s the evidence for that?”

The imagery throughout the episode of the journey we all face through the different systems once a test is ordered highlights how important it is for us to get on the train knowing exactly where we may end up.

If you have a body and have ever been to a GP, then this story affects you, and you can be part of the change. The current MBS reform has a consumer survey open until 9th November 2015 which aims to help update the MBS to reduce waste and unnecessary treatments. Jump on board now to have your say – you have until 9th November 2015.

This blog was written by Pip Brennan, Executive Director of the Health Consumers’ Council.