My 2020 idea: Stop funding ineffective medical treatments
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I will be heading to the 2020 Summit with at least one suggestion certain to raise the ire of many of the powerbrokers in health: it is well past time that Australian taxpayers stopped paying for medical treatments that don’t work or are of only marginal benefit. The Medical Benefits Schedule should be reviewed so that ineffective interventions can be removed from the list of treatments receiving government subsidy.
Off the top of my head I can think of several treatments whose public funding should be reviewed:
The government committee charged with looking at the appropriateness of funding devices is prevented by legislation from reviewing old devices and can only look at new ones. We continue to fund from the public purse a number of procedures for which there is little or no evidence for efficacy. Should not the MBS be reviewed in much the same way as the Pharmaceutical Benefits Advisory Committee recommends funding of drugs on the basis of efficacy and cost effectiveness /benefit – a big task but an important one if we espouse the principles of evidence- based medicine? I suspect that if the renumeration for what I still consider to be the best investigation in medicine – taking a good history and performing a thorough physical examination (now reimbursed at approx $100) – versus performing an endoscopy (reimbursed at $400-$600) was reversed, it would lead to significant behavioural change in health practitioners. And we would end up with better outcomes for patients. Similarly, remuneration should be reviewed when operations get easier and quicker to perform (such as cataract surgery) at the same time as increasing demand due to ageing of the population. If the normal laws of supply and demand were allowed to prevail, the costs might come down. There are many ways we can improve the health system, by making it more efficient and accountable, without always asking for more money. If the Government, the professions and the community really want a better health system, some of these tough questions must be asked, even though they present a major challenge to some of the most powerful groups in the system. Dr Brooks is Executive Dean of Health Sciences at the University of Queensland. |
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11 Comments
Sound ideas but it’s not as if the PBAC is a perfect model. Look at Vioxx for example, which many of your colleagues prescribed by the bucketload despite it having less than marginal benefits over traditional and much cheaper anti-inflammatories. Medicare should insist on more robust and longer term evidence of superiority , not just equivalence, before subsidising expensive new treatments.
Although professor Brooks makes perfectly valid points, the problems in the delivery of medical services are far more deep seated. While medical science and technology continue to charge ahead, the basic attitudes and the structures they support languish in the 18th. Century when practitioners were entrepreneurial barbers and alchemists and when the idea that one has any sort of right to survive illness or injury was the jealously guarded preserve of the powerful and wealthy - who were heavily soaked for the privilege. While the various parts of the medical hierarchy will resist to the last squeal any attempt to drag them into the 21st. Century, things will not improve until that occurs. May have to be the 22nd. Century by then.
Could not agree more re back surgery. Though a few years ago I would not have believed my exercise programme would be so effective. Its taken years but has fix all my back problems except for an occasional niggle when I sit badly or when I do too much wipper snipping. I am soo glad I don’t have cement in the vertebra.
Sounds like somebody with a particular axe to grind…….eh Dr. Brooks?
Dr Brooks wrote a commendable article. I only hope he is allowed a hearing.
I have recently left general practice to become a palliative care consultant and I am not aware that palliative medicine will have any voice at the summit.
General Practice will be represented by a pharmacist!
Adam Elshaug
Monday, 14 April 2008 3:41:08 PM
Those interested in this topic might like to read the following papers that I have published in the area along with my colleagues A/Prof John Moss and Prof Janet Hiller: Elshaug AG, Hiller JE and Moss JR. Exploring Policymakers’ Perspectives on Disinvestment from Ineffective Health Care Practices. International Journal of Technology Assessment in Health Care, 2008; 24(1): 1-9. Please contact me if you are unable to access this paper online. Elshaug AG, Hiller JE, Tunis SR and Moss JR. Challenges in Australian policy processes for disinvestment from existing, ineffective health care practices. Australia and New Zealand Health Policy, 2007; 4: 23 (31 Oct 2007). FREE: http://www.anzhealthpolicy.com/content/4/1/ and an interview with Norman Swan on the ABC Radio National Health Report, available at (The second half is explicitly about disinvestment from ineffective health care): http://www.adelaide.edu.au/podcasts/interviews/health/
p.s. Apple pie is good…..Can I come? Can I? Hmmm..please?
I will just deal with the “examples ,just of the top of my head” expressed in this article.
1. Nobody is admitted to an acute hospital for back pain.
2.Arthoscopies can be therapeutic but are often helpful diagnostically and in treatment planning. They are day day only procedures. Ask the relevant specialist doctors of their efficacy.
3.Spinal surgery is not for chronic back pain
4.Crush fractures of vertebra is a common cause of pain, disability and consequent massive health expenditure.Verebraplasty often works for severe pain and may have a role in preventing some of the dire consequences of crush fracture.
If Dr. Brooks had his way we would still be performing open gall bladder operations rather than keyhole surgery.
Dr. Brooks is more a health bureaucrat rather than a clinician, I suspect.
He is talking nonsense. It has to be asked……Why? Would it be self serving perhaps?
I had already taken a dim view of this nonsense ideas summit. I am now positively concerned knowing that there are people of Dr. Brooks’ obvious stature with the frightening ability to influence government policy with not an iota of common sense.
I have a burnt esophagus and need an endoscopy to keep an eye on it, an examination would not do.Cancer is a possible out-come if the burning keep’s up, so ,some-thing’s can’t be changed just to save a few bob, I pay taxes I deserve the best. Thanking you J Vinn
Dear Peter,
When you go to the Summit, ask them to look at treatments that are not only ineffective but also harmful in that they increase numbers of sick people needing treatment.
It is easy to discover: Just google the name of the ‘expert’ advisor together with Pfizer, Eli Lilly, Sanofi Aventis etc, those being the names of the drug companies and the grants and prizes that doctor has won all come up. They seem to get honours as well: AM, AO are not unusual.
This is what happens when governments listen to doctors who are getting benefits from the pharmaceutical companies, research funds and the like.
If you can find time please read this paper on my website.
http://www.lucire.com.au/documents/Re-focussing-Upstream-New-Generation-Drugs-and-Public-Health.aspx
This would make sense if the goal of the state was to i produce an ever-growing market for a drug, or program.
It is both shocking and unacceptable if the government reallly wants to provide an effective health ser