The Medical Benefits Schedule (MBS) is a key part of Australia’s universal healthcare system. It is a list of attendances, procedures and tests which the Australian Medicare system will subsidise through direct payments to health professionals or patients. For device suppliers, it is important to note that the MBS fee is intended for subsidy of the delivery of the service by a health professional and theoretically does not cover the cost of a device used during that procedure. While low-cost disposable items may implicitly be included in the cost of delivering a service, this becomes impractical as the cost of the device increases.
Over the past five years, over 5000 items have been reviewed by over 700 clinical experts, health system experts and consumers. The review produced over 60 reports from over 100 clinical specialities with the goal of updating and modernising the MBS, removing obsolete or ineffective interventions. It also aimed to update the rules surrounding claiming so that services are delivered efficiently and cost-effectively and to prevent overcharging. Overall, the process has been supported across the political spectrum with the final report being released at the end of 2020. The Australian Government has agreed to recommendations that have involved changes to 2,000 MBS items. The report is available here.
While changes have been implemented since 2017, there has been controversy over the latest changes implemented this week, possibly because they include changes to 900 item numbers related to general, cardiac and orthopaedic surgery. The main complaint is about the timing in that the changes were implemented without enough time for hospitals and doctors to update their systems to accommodate the changes to the MBS.
While there may be some implications for device manufacturers, they are likely to be limited to where a procedure has been removed from the MBS or given a narrower indication. Overall, device manufacturers are not likely to suffer a major effect. This is because of the following:
- Doctors who perform procedures in public hospitals do not, in most cases, claim fees from the MBS. Australians are able to access public hospitals for free, with the hospitals responsible for paying doctors, rather than the MBS. One exception is where a patient with private insurance opts to be admitted as a private patient. In this situation the doctor may access the fee from the MBS
- It must be remembered that the MBS fee is for the service only, and in most cases does not cover the cost of the device. In private hospitals, the cost of the device is covered either by the benefit paid by private insurers for the cost of the admission which will include device costs. In the case of implantable devices, they are covered by benefits paid under the Prostheses List
- Higher cost devices used in private outpatient procedures are not specifically covered under the Australian Medicare arrangements. However, the changes to the MBS are not likely to impact this in any significant way.
For new technologies, where there is not an existing item number on the MBS and application must be made to the Medical Services Advisory Committee (MSAC). For new implantable items, an application must be made the Prostheses List Advisory Committee (PLAC).
If your organisation needs help with making a MSAC submission or you have any questions about accessing the Australian market, contact us today. MedTechnique Consulting has helped many organisations navigate the Australian healthcare landscape, gain market access and submit successful MSAC and reimbursement applications. Email: info@medtechnique.com.au or Phone: + 61 448 058 600.
About the Author: Sarah Griffin, Director of MedTechnique Consulting, Experts in medical device reimbursement and market access in Australia. Sarah is a health economist, reimbursement strategist, health policy advocate and experienced speaker. Connect with Sarah Griffin on LinkedIn.
If you would like to learn more about Sarah’s speaking experience for your next event please email: Kim MacDonald, Spindrift Marketing