The Medical Benefits Schedule (MBS) http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Home is the primary vehicle of public subsidy for services delivered in Australia by doctors and other health professionals such as midwives and psychologists and has been in operation since 1984. The Australian Government has appointed an expert committee, the MBS Review Taskforce to investigate the following
- All current MBS items and the services they describe;
- Increasing the value derived from services;
- Concerns about safety, clinically unnecessary service provision and concurrence with guidelines;
- Evidence for services, appropriateness, best practice options, levels and frequency of support; and
- Legislation and rules that underpin the MBS
While the review has generally been welcomed, it has not been without controversy, and has received a huge amount of media attention including an hour long documentary by the national broadcaster. http://www.abc.net.au/4corners/stories/2015/09/28/4318883.htm
Many of the issues highlighted in the media put medical devices and technologies front and centre. The following issues, among others, have been raised:
- Are coronary stents being used unnecessarily?
- Are coronary pressure wires being used enough?
- Is imaging being overused?
- Is spinal fusion effective in treating back pain?
- Is arthroscopy useless for osteoarthritis?
While the Australian Government is not proposing an imminent disinvestment in these technologies, there is certainly going to be increased scrutiny placed on the appropriate indications and utilisation.
The Government’s position is that a lean and efficient MBS allows for investment in new technologies and procedures. There is currently a complex and lengthy process in place to list new procedures on the MBS. This is administered by the Medical Services Advisory Committee (MSAC) http://www.msac.gov.au/. The current review does not include the MSAC.
The MBS Review Taskforce has called for public submissions:
http://www.health.gov.au/internet/main/publishing.nsf/Content/consultation-mbsreviewtaskforce which should provide interesting reading.