Manufacturers of innovative technology are often eager to have the medical procedure for their new technology included on the Australian Medical Benefits Schedule (MBS).  This is the list of procedures, tests and consultations which the Australian Medicare System will subsidise. The MBS is fundamental to the Australian health financing system and is a prerequisite for coverage by private health insurers for hospital procedures.  Additionally, devices cannot be included on the Australian Prostheses List if there is not an associated MBS item number.

It must be remembered that the MBS is a system of subsidies for procedures performed by doctors and other health professionals.  It is the fee charged by these professionals that is being subsidised. Therefore, the input of these professionals is key to determining whether a new procedure is eligible to be assessed by MSAC. It is a requirement that a ‘statement of clinical relevance’ from the professional body that represents the health professionals who will be providing the new service.  MSAC requires that the professional body ‘generally accepts the proposed service as a ‘necessary’ treatment and not simply treatment that is regarded as convenient or desirable’.

This requirement can be challenging for new procedures and technologies, particularly if they are for small populations, or alternatively they may be performed by members of several different associations.  It sometimes creates a ‘chicken and egg’ situation where a procedure is not performed frequently in Australia primarily because there is no MBS item number, and consequently, for some procedures, they are little known.

Education of the people who will be performing the procedure that includes new technology is key.  Relationships with key opinion leaders in the relevant profession are essential if a new technology is to be understood and acknowledged.  Understanding these key relationships is essential. Without this, very deserving technology, that may offer substantial clinical and economic good to Australians, may struggle to get past the first hurdle.

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