Speeches and Transcripts

AMA Transcript - Government's announcement of a Medicare Benefits Schedule Taskforce

Published 22 April 2015

Transcript: AMA President A/Prof Brian Owler interview with Andrew Geoghegan, 22 April 2015"

Subject: MBS Review Taskforce

ANDREW GEOGHEGAN: The Federal Health Minister, Sussan Ley, has announced an extensive review of Medicare with three expert panels to examine every subsidised test, treatment and procedure. For more we're joined by the President of the Australian Medical Association, Associate Professor Brian Owler. Good to see you.

BRIAN OWLER: Thank you.

ANDREW GEOGHEGAN: What do you make of these proposed changes? Do you have any particular concerns?

BRIAN OWLER: The AMA is happy that we've got a constructive process, a clinician-led process, that will look at the MBS schedule. It is outdated and does need modernising. What the AMA can't support is the process that has any sort of hit list and is only about savings. Now, we're reassured that that's not going to be the case, and we have confidence in the clinicians that have been appointed to conduct this process. So obviously, we will be looking forward to hearing what they have to say in their initial scoping studies.

ANDREW GEOGHEGAN: Do you feel as though this is also about a crackdown on perhaps GPs that may be rorting the system?

BRIAN OWLER: No, that's not what this is about at all. We actually have a very constructive and robust process in place – the Professional Services Review that actually does that already. This is actually about looking at the procedures that are covered under the schedule, and to see whether or not those procedures reflect modern medical practice. We know that there are many procedures that actually aren't included on the schedule which probably should be. And so, we will actually be looking for some of the savings, or any savings, to actually be reinvested into the system, to make sure we get the schedule that we need.

ANDREW GEOGHEGAN: Can you perhaps give us some examples then of those procedures and tests that you would like to see redundant?

BRIAN OWLER: I don't think it's appropriate for me to start pinpointing areas that I think might need to change because I don't want to pre-empt what the group is going to come up with, that's up to the clinicians and the various specialty groups to do. But to look at some the of the changes that have already occurred, we did see a change to vitamin D testing which did actually identify fairly substantial savings because the test probably was being overused. So, if we can actually put some structures around, such as decision support, that actually help clinicians to choose the right tests, that will also help in making sure we get savings.

ANDREW GEOGHEGAN: An example used has been Type 2 diabetes, the late onset, where perhaps some tests where you are constantly monitoring your blood glucose level and perhaps a better system would be to better manage your diet and test less frequently.

BRIAN OWLER: Yeah, that's right. So I think there are two very distinct parts to what the Government has announced today. One is the MBS schedule review itself, which is actually more about the procedures and the items that are actually covered. The other aspect is about GP services and how they're actually funded and resourced to make sure that, particularly, they do chronic disease management well. We know that some of the chronic disease management item numbers are probably not used in the best ways, and they could be restructured to make sure that the patient's regular GP is rewarded for doing the sort of work, such as in diabetes, to make sure that we get better health outcomes for patients.

ANDREW GEOGHEGAN: During this review the pause on indexation of GP and specialist Medicare rebates will remain in place. Is that a problem for you?

BRIAN OWLER: That's something we remain very disappointed about. The indexation freeze is an issue for patients. People have to remember that the schedule and the indexation affects the patient's rebate at the end of the day. It's actually not about the money going to the doctor. It's actually about what the Government provides to the patient in their rebate.

ANDREW GEOGHEGAN: You're saying over the course of these reviews that it's more likely the patient will be out-of-pocket?

BRIAN OWLER: It's the patient's rebate. That’s what the schedule actually is. It's not how much the doctor gets paid. It's actually what the patient rebate is.
So, the problem with freezing the indexation for GP rebates is that eventually the doctors' costs are going up, they have to charge an out-of-pocket expense. So, you’re going to see less bulk-billing with the indexation freeze over a four year period.
For specialists it becomes a bit more complex but effectively it's the same. Private health insurance schedules actually rely on the MBS schedule. So if they don't index you’re going to see more gaps or out-of-pocket expenses, or if private health insurers do index, their private health insurance premiums are likely to increase further beyond the 6 to 8 per cent we saw in the last round.

ANDREW GEOGHEGAN: Are you confident from the reassurances of Sussan Ley that there will be no GP co-payment?

BRIAN OWLER: We're confident that there won't be a co-payment. Certainly in any way, shape or form that we saw the government playing around with previously.

ANDREW GEOGHEGAN: But, obviously, savings have to be made to ensure that the system is sustainable. Therefore, inevitably there will be some trade-offs, will there not?

BRIAN OWLER: We're happy to have trade-offs. We're happy to make sure that we get an efficient schedule and Medicare system. But we have got to make sure that patients’ access to services are maintained because that is the real concern here is that if you start taking procedures out of the schedule, you start taking things away, actually that affects patients' access to the schedule, to actually getting medical services. That's the big concern for the AMA.

ANDREW GEOGHEGAN: Associate Professor Brian Owler from the AMA, thanks very much.