Medicare billed over a million times a day, needs deep clean: Ley


hand out for money - coins in palm

Medicare is now being billed over one million times a day for the first time in history, as new figures show growth in claims outstripped the number of new patients three-to-one over the past decade.

Minister for Health Sussan Ley today released the annual Medicare figures for 2014-15, which show 21 million Australians accessed over 368 million individual services on the Medicare Benefit Schedule (MBS) at a cost to taxpayers of over $20 billion.

“About 90% of the population accessed Medicare last year, with taxpayers billed an average of 17 times per patient at a cost of over $800 each in 2014-15,” Minister Ley says.

“Or to put it another way, Medicare was billed an average of one million times every single day last year – the first time this has ever happened.”

The Minister says Medicare usage has continued to skyrocket, with MBS claims increasing by about 60% over the past decade and the overall bill to taxpayers increasing 100%.

This is despite the number of new patients accessing Medicare growing at just 21% over the same 10 year period (population growth was 19% between 2004-05 and 2014-15), she says.

“Medicare claims are now an average of $350 a year higher than they were 10 years ago.

“Essentially, we’ve seen the number of Medicare claims triple the growth in new patients over the past decade. This has in turn seen the cost to taxpayers double.

“These figures paint a complex picture around the impacts of Australia’s ageing population and the ever-expanding list of new and improved medical treatments available in our Medicare system.

“That’s why this Government is currently developing a blueprint to build a healthier Medicare that is patient-focussed in direct consultation with clinicians and consumers.”

Minister Ley says there are now more than 5700 items available for subsidisation on the nation’s Medicare Benefit Schedule – about 1000 extra items than ten years ago – and has become clear the “cupboard needed a deep clean”.

“We’ve seen the size of the Medicare Benefits Schedule expand by about 100 items per year over the past decade,” Ms Ley said.

“It’s a positive that we’re continually discovering and funding new and improved medical treatments to keep us living healthier lives longer, but the challenge is to ensure we’re also improving education and removing out-dated and unproven procedures at the same time.

“It also demonstrates the importance of looking at the way primary health care is delivered overall and whether our current funding model is best supporting the integrated care models millions of Australians living with chronic disease need.

“This includes utilising new technology. Embracing digital health doesn’t mean pushing more people towards ‘Dr Google’ – it’s about enabling clinicians to play an even closer role in the day-to-day management of their patient’s health and that’s a good thing.”

The Government is currently undertaking a three-pronged approach to Medicare reform, including a full, clinician-led review of the effectiveness of the more than 5700 items on the Medicare Benefit Schedule, a full review of the primary care system, including the need for more integrated models; and better education and compliance around MBS items.

Minister Ley says all medical professionals also have a direct role to play in building a healthier Medicare by addressing issues such as over-testing through industry education programs, including Choosing Wisely.

Other statistics released today show bulk billing rates continued to grow to historic highs in 2014-15 at 77.6% for all services (77.2% in 2013-14) and 84.5% for GPs specifically (83.4% in 2013-14).

Minister Ley says the current reviews of the MBS Taskforce and Primary Health Care Advisory Group were due to report to the Government by the end of 2015.

Public consultation is currently being undertaken on a discussion paper from the Primary Health Care Advisory Group – headed by former Australian Medical Association President Dr Steve Hambleton – which can be found on the Department of Health’s website.

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