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:
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- Look at the number of hospital bed days taken up by patients with back pain – there is no evidence that bed rest helps, in fact it harms!
- There are so many arthroscopies carried out, when their benefit in the treatment of knee conditions is doubtful in many cases.
- Look at the funding that goes on spinal surgery when very few outcome studies show any benefit of surgery for chronic back pain.
- And what about the funding of vertebraplasty (operations in which cement is injected into fractured vertebra), even though appropriate studies have not been carried out in this country and those from overseas were inconclusive to say the least.
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.