Medicare is sick

In case you have missed it, the Australian government is undertaking a review of Medicare, or more specifically the Medicare Benefits Schedule. The MBS is a list of codes for procedures or consultations, delivered by health care professionals that have a cost associated with them. Social media has been quick to pick up on a slightly underdone news report by the SBS about some procedures that are set to be axed.

Let’s be very clear about something. Medicare is sick. This country is in desperate need of a wake-up call that the public (and to a lesser extent, private) purse is not a bottomless pit, even for vital services such as health care. The MBS desperately needs to be properly and thoroughly reviewed with appropriate values assigned to procedures and delisting of procedures that have no scientific basis. We need to start rationing the health care dollar in order to get the best from it.

We are all healthcare consumers and we should all care where our money is being spent. Think of it like this. While we are wasting money on one thing, say a procedure that may not work, that money could be missing to find a procedure that does work. It’s like buying a pair of jeans that don’t fit properly, then when you go to buy some that do, the cash is not available. Our entire country should start thinking about how we spend our money and ensure we get bang for a our buck.

The MBS has been around since 1984 and currently lists codes for around 5700 procedures. Some procedures that are still listed are no longer utilised as they have been superseded. Not all procedures are what we call ‘evidenced based’ where the best possible scientific evidence has been examined to determine when, where and for who we are supposed to use a certain intervention. Some procedures are grossly overpriced and some procedures are grossly underpriced. The MBS has become a matted tangle of codes for procedures that have not been revised since their addition. At the same time, medical care has been advanced and refined. Medicare is also poorly structured to account for the complexities of chronic care and the increasing complex problems doctors manage in modern times.

The review is long overdue. Doctors are commonly heard to be lamenting the complexities, inaccuracies and redundancies in the MBS. It is important that this review becomes an important tool in modernising our medical system and maintaining a high level of care to patients. It is also important that this serves as a reminder of responsible use of the healthcare dollar; that is to say that we as a community spend an appropriate amount on procedures that are both safe and efficacious. I hope that review continues to be strongly influenced by clinicians, those with much more experience and knowledge than I have. Doctors are very happy to be a part of system that reflects the excellent health care that we can provide our patients.

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