Medicare should change how it pays doctors: CHF

stethoscope on computer keyboard

The way doctors are paid must be changed to ensure consumers and the community get the best value out of Medicare, the Consumers Health Forum (CHF) says.

The lobby group today released its submission to the review into Medicare Benefits Schedule (MBS).

“It is clear that the traditional Medicare fee for service arrangements are no longer the best way to meet consumer need,” says CHF CEO, Leanne Wells.

It says paying doctors on a session basis needs to change because so much healthcare is focused on managing chronic disease. The current system  “short changes the patient” and there is no incentive for the doctor to initiate, maintain, or innovate, coordinated “wrap-around” care that is required.

The CHF points out that Medicare was established more than 30 years ago when the country’s disease profile and population health issues were different.

“In that time the MBS has grown from 300 items to the current 5,700, with no comprehensive review or delisting of outmoded items,” it says.

“The MBS should be geared to provide the right incentives and create the conditions for best practice care of chronic conditions with GPs leading a coordinated team of other health practitioners.This will require innovative payment regimes, not the old fee-for-service approach. The same applies to preventive health care,” says Wells.

“Unnecessary red tape and workload for GPs, and most importantly, cost and inconvenience for consumers should be removed in areas like the current requirement for the annual renewal of referrals.

She says if the MBS is amended correctly, both consumers and clinicians will benefit.

“The outcome of the review should also reflect the more active role consumers are taking in their health care.Medical leaders often say they seek to ‘put the patient first’.

Health literacy

Wells adds there should be more emphasis on improving health literacy so that the consumer understands the nature of their condition, the treatment required and how the health system works so that they can make the best use of it.

“Almost 60% of Australians have low levels of health literacy and difficulty understanding the healthcare system. To give consumers a better grasp of the health system, CHF recommends a community awareness program about Medicare and the MBS. This will help consumers make better choices about services, in consultation with their doctor, if they know more about the costs of particular services.

“The arrangements for adding new treatments for listing on the MBS need clarity and systematic appraisal particularly as there is likely to be a heavy demand for new listings arising out of the review. We can’t afford the addition of new items to be a lottery.

“And to ensure Australia benefits appropriately from health technology advances, there needs to be a system that keeps up with and assesses advances in treatment. The insight that consumers and patients can offer in considering the impact of new technology is powerful.

“Under future arrangements, we need a more robust engagement strategy that transcends the traditional one consumer representative on a committee. Health technology assessment arrangements that more extensively involve the people who bear the risks, pay a share of the cost and reap the benefits of MBS-funded services will deliver more robust decisions about value: what should be in and what should be out of the MBS. There should be a requirement that consumers have an active role in the assessment process,” says Wells.

A copy of CHF’s submission can be found here.


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