2. About the Medicare Benefits Schedule (MBS) Review

2.1 Medicare and the MBS

What is Medicare?

Medicare is Australia’s universal health scheme that enables all Australian residents (and some overseas visitors) to have access to a wide range of health services and medicines at little or no cost.

Introduced in 1984, Medicare has three components:

  • Δ free public hospital services for public patients
  • Δ subsidised drugs covered by the Pharmaceutical Benefits Scheme (PBS)
  • Δ subsidised health professional services listed on the Medicare Benefits Schedule (MBS).

What is the Medicare Benefits Schedule (MBS)?

The Medicare Benefits Schedule (MBS) is a listing of the health professional services subsidised by the Australian Government. There are more than 5700 MBS items that provide benefits to patients for a comprehensive range of services, including consultations, diagnostic tests and operations.

2.2 What is the MBS Review Taskforce?

The Government established the MBS Review Taskforce (the Taskforce) as an advisory body to review all of the 5,700 MBS items to ensure they are aligned with contemporary clinical evidence and practice and improve health outcomes for patients. The Taskforce will also modernise the MBS by identifying any services that may be unnecessary, outdated or potentially unsafe. The Review is clinician-led, and there are no targets for savings attached to the Review.

What are the goals of the Taskforce?

The Taskforce is committed to providing recommendations to the Minister that will allow the MBS to deliver on each of these four key goals:

  • ΔAffordable and universal access—the evidence demonstrates that the MBS supports very good access to primary care services for most Australians, particularly in urban Australia. However, despite increases in the specialist workforce over the last decade, access to many specialist services remains problematic, with some rural patients being particularly under-serviced.
  • ΔBest practice health services—one of the core objectives of the Review is to modernise the MBS, ensuring that individual items and their descriptors are consistent with contemporary best practice and the evidence base when possible. Although the Medical Services Advisory Committee (MSAC) plays a crucial role in thoroughly evaluating new services, the vast majority of existing MBS items pre-date this process and have never been reviewed.
  • ΔValue for the individual patient—another core objective of the Review is to have an MBS that supports the delivery of services that are appropriate to the patient’s needs, provide real clinical value and do not expose the patient to unnecessary risk or expense.
  • ΔValue for the health system—achieving the above elements of the vision will go a long way to achieving improved value for the health system overall. Reducing the volume of services that provide little or no clinical benefit will enable resources to be redirected to new and existing services that have proven benefit and are underused, particularly for patients who cannot readily access those services currently.

2.3 The Taskforce’s approach

The Taskforce is reviewing the existing MBS items, with a primary focus on ensuring that individual items and usage meet the definition of best practice.

Within the Taskforce’s brief there is considerable scope to review and advise on all aspects that would contribute to a modern, transparent and responsive system. This includes not only making recommendations about new items or services being added to the MBS, but also about a MBS structure that could better accommodate changing health service models.

The Taskforce has made a conscious decision to be ambitious in its approach and seize this unique opportunity to recommend changes to modernise the MBS on all levels, from the clinical detail of individual items, through administrative rules and mechanisms, to structural, whole-of-MBS issues.

The Taskforce will also develop a mechanism for the ongoing review of the MBS after the current Review is concluded.

As the Review is to be clinician led, the Taskforce has decided that the detailed review of MBS items should be done by clinical committees. The committees are broad based in their membership and members have been appointed in their individual capacity, not as representatives of any organisation. This draft report details the work done by the specific clinical committee and describes the committee’s recommendations and their rationale.

The draft report does not represent the final position of the committee. A consultation process will inform recommendations of the committee and assist it in finalising its report to the Taskforce.

After consultation the committee will provide its final advice to the Taskforce. The Taskforce will consider the Review Report from the clinical committees and stakeholder feedback before making recommendations to the Minister for consideration by Government.

2.4 Prioritisation process

All MBS items will be reviewed during the course of the MBS Review. However, given the breadth of, and timeframe for, the Review, each clinical committee has needed to develop a workplan and assign priorities, keeping in mind the objectives of the Review.

With a focus on improving the clinical value of MBS services, the clinical committees have taken account of factors including the volume of services, service patterns and growth and variation in the per capita use of services, to prioritise their work. In addition to MBS data, important resources for the Taskforce and the Clinical Committees have included:

  • ΔThe Choosing Wisely recommendations, both from Australian and internationally1-3
  • ΔThe National Institute for Health and Care Excellence (NICE UK) Do Not Do recommendations and clinical guidance4
  • ΔOther literature on low-value care, including Elshaug et al’s (2012) Medical Journal of Australia article on potentially low-value health services5
  • ΔThe Australian Commission on Safety and Quality in Health Care’s (ACSQHC) Atlas of Healthcare Variation.6
|

_________________________________________

References

1. Australia CW. Tests, treatments, and procedures for healthcare providers and consumers to question. 2017.
http://www.choosingwisely.org.au/recommendations?displayby=MedicalTest (accessed.

2. Canada CW. The Lists. 2017. http://www.choosingwiselycanada.org/wp-content/uploads/2014/01/Choosing-Wisely-Canada-collection-of-lists.pdf (accessed 14th June).

3. USA CW. The Choosing Wisely Lists. 2017. http://www.choosingwisely.org/doctor-patient-lists/ (accessed 14th June).

4. Excellence NIfHaC. Do not do recommendations. 2017. https://www.nice.org.uk/savingsandproductivity/collection (accessed 14th June).

5. Elshaug AG, Watt AM, Mundy L, et al. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012;197:556-60. https://www.ncbi.nlm.nih.gov/pubmed/23163685.

6. Care ACoSaQiH. The Australian Atlas of Healthcare Variation. 2017. https://www.safetyandquality.gov.au/atlas/ (accessed 14th June).