Part 1 of Presentation - MBS Review Stakeholder forums October-November 2015

Page last updated: 25 February 2016

PDF version: Part 1 of Presentation - MBS Review Stakeholder Forums November 2015 (PDF 1170 KB)

Slide 1: Agenda item - Introduction

  • Background to the MBS review
  • Overview of approach and status

Slide 2: Australia achieves very strong outcomes compared to peer systems


Life expectancy at birth and self-reported health score. See following table for a text description of these graphs

Source: World Health Organization (life expectancy), OECD (self-reported health score)

Larger version of Slide 2: Australian high-level health outcomes (PDF 104 KB)

Text version of Australian high-level health outcomes

This image consists of two bar charts: Top of page

Life expectancy at birth (years)

Years per capita, 2013

Country
Life expectancy (years)
Japan
84
Australia
83
Italy
83
Spain
83
Switzerland
83
Canada
82
France
82
Iceland
82
Luxembourg
82
New Zealand
82
Norway
82
South Korea
82
Israel
82
Sweden
82
Austria
81
Finland
81
Germany
81
Portugal
81
United Kingdom
81
Greece
81
Ireland
81
Netherlands
81
Belgium
80
Denmark
80
Chile
80
Slovenia
80
USA
79

Highlighted on this graph is that Australia has the second-highest life expectancy of the listed countries.
Source: World Health Organization

Self-reported health score

Percentage of population aged 15+ who report their health to be good/ very good, 2011.Top of page

Note. This graph provides 2011 data for most countries. Exceptions: for some countries only prior data is available (2006-2010). Newer data is used (2012-2013) where available.

Country
% of population aged 15+ who report their health to be good/ very good
New Zealand
90
Canada
89
USA
88
Australia
85
Israel
84
Ireland
83
Switzerland
82
Sweden
81
Norway
79
Iceland
77
Netherlands
76
Greece
75
United Kingdom
75
Belgium
74
Spain
74
Luxembourg
74
Denmark
71
Austria
70
Turkey
69
Italy
68
France
68
Finland
67
Slovak Republic
66
Mexico
66
Germany
65
Slovenia
63
Top of page

Highlighted on this graph is that Australia has the fourth-highest self-reported health score of the listed countries.
Source: OECD

Slide 3: The primary purpose of the MBS review is to achieve better value for the Australian healthcare system through improved patient health outcomes

A text version of slide 3 is provided in the below text.

Text version of how to improve patient health outcomes

Slide 3 consist of 3 iconic images.
Image 1 is a bag with the medical cross and the supporting text: Cease funding unsafe and obsolete services, which provide no or negligible clinical benefit and, in some cases, may harm patients,
Image 2 is a checklist icon with the supporting text: Address concerns about low-value care, clinically unnecessary service provision and adherence to clinical guidelines and
Image 3 is a hospital icon with the supporting text: There is no saving target - scope for reinvestment in high-value services

Slide 4: The MBS is a significant component of the Australian healthcare system


A text version of Slide 4 is provided in the tables below this image

Text version of components of the Australian healthcare system

This image consist of a bar graph and and a pie chart Top of page

Note: Medicare benefits constitute ~ 30% of Australian Government health expenditure

Federal Government health expenditure1

Health expenditure
AUD (billion) 2013-14
1 Not including capital expenditure
MBS
$19.1
SPP to states
$16.8
PBS
$9.1
PHI rebates
$5.5
Other
$13.2

Breakdown of MBS expenditure2

MBS expenditure
Percentage 2013-14
2 Operations and Procedures include anaesthetics services; other MBS services include radiotherapy, obstetrics, IVF and other diagnostics; other health professionals include optometry, allied health and psychology services
GP services
33%
Diagnostic Imaging
16%
Pathology
13%
Operations and procedures
11%
Specialist attendances
11%
Other MBS services
10%
Other health professions
6%

Slide 5: The MBS has evolved significantly since its inception


A text version of Slide 5 is provided in the text below this image

Source: Department of Health

Text version of the MBS evolution

This image consist of a timeline of the MBS Top of page

1950 - First schedule underpinned by the National Health Act 1953
1970 - MBS to include a list of "Most Common Fees" for each state
1984 - Medicare introduced (replacing Medibank), bulk-billing resrored, and Medicare Levy introduced
1986 - Listing of separate fees for each state replaced by uniform fees across Australia
1991 - MBS reconstructed into Categories, Groups and Subgroups (replacing previous Parts and Divisions) to better reflect sequence or services
1999-2000 - Enhanced Primary Care (EPC) MBS items introduced
2004-05 -Introduction of funding for allied health services and replacement of EPC items with Chronic Disease Management (CDM)
2015 - Over 5,700 active items listed on the MBS, 70% of which have not been amended since they were created

Slide 6: What will this review mean for patients and consumers?

  1. More evidence-based care
  2. Increased access to valuable, yet underutilised, treatments
  3. Prevention of unnecessary treatments and tests
  4. More appropriate referrals and appointments
  5. Adoption of new, best-practice, health care technologies

Slide 7: Overview of MBS review process and where this forum fits


A text version of slide 7 is provided below this image

Text version of the MBS review process

This image consist of a timeline of the MBS review process Top of page

June - Task force Established
July - Initial set of Stakeholder Forums
September - Consultation Paper on initial parameters of Review
October-December - Pilot Clinical Committees, and second set of Forums
December - 1st Report to Government
2016 - Bulk of Reviews
December 2016 - 2nd Report to Government

Slide 8: MBS review activities have been distributed among several groups


A text version of slide 8 has been provided in the below text

Text version of the MBS review activities

This image is a flowchart of the MBS review activities

Start: MBS Review Taskforce (this steps down into two separate paths)
Path 1. Clinical Committees and Item specific working groups
Path 2. Principles and Rules Committee and Consultation with stakeholder groups
Note: linkages are formed between Clinical committees (path 1), Principles and Rules committee and consultation with stakeholders (path 2).Top of page

Slide 9: The MBS Review Taskforce


A text version of slide 9 is provided below this image

Text version of the MBS Taskforce Members

This image consist of an photographic image of Committee members on the MBS Review Taskforce. These members are:

  • Professor Bruce Robinson
  • Ms Rebecca James
  • Professor Paul Glaziou
  • Dr Lee Gruner
  • Professor Michael Besser
  • Dr Michael Coglin
  • Dr Steve Hambleton
  • Professor Michael Grigg
  • Dr Bev Rowbotham
  • Professor Nick Talley
  • Dr Matthew McConnell
  • Dr Matthew Andrews
  • Associate Professor Adam Elshaug
  • Top of page

Slide 10: The Principles and Rules Committee examines issues which affect many or all Clinical Committees

Description of the Principles and Rules CommitteeExamples of issues raised by stakeholders
  • The Taskforce will recommend updates to the legislation which underpins the MBS
  • Referral regulation: what role should the GP play?
  • The Committee contains a broad range of participants, including Taskforce members clinicians, and others
  • MBS item descriptors: how can MBS items be more clearly defined and user-friendly?
  • Stakeholders are invited to actively contribute to the refinement of Rules
  • Ongoing MBS reviews: how frequently should items be revisited?
  • Rural delivery of care: how should items be regionally adjusted?

Slide 11: To ensure the Review is clinically led, each category is being evaluated by a peer-nominated clinical committee



Text version of the MBS Taskforce Members

This image consist of a table of examples of clinical committees Top of page

Chair Examples of members
Obstetrics Prof. Michael Permezel Midwife, GP obstetrician, specialist OB, rural obstetrician, pathologist
Diagnostic imaging Prof. Ken Thomson Radiologist, nuclear medicine specialist, GP, health economist
Gastro-enterology Prof. Anne Duggan Gastroenterologist, general surgeon, GE nurse, GP
Thoracic Prof. Christine Jenkins Thoracic medicine, respiratory and sleep specialists, GP
ENT Prof. Patrick Guiney ENT surgeon, paediatrician, GP working in Indigenous health

Slide 12: The Clinical Committees are following a consistent five-step approach


A text version of slide 12 is provided in the text below this image

Text version of the five-step approach the Clinical committees follow

This image consist of a donut chart illustrating the five-step approach which Clinical committees follow.

  1. Triage - Examine item descriptors and usage patterns to identify items requiring detailed investigation
  2. Evaluation - Conduct rapid evidence reviews and targeted analyses as needed for each item
  3. Recommendation - Propose changes to items and articulate rationale
  4. Consultation - Colleges, peak bodies and other affected stakeholders are notified of the recommended changes and invited to contribute feedback
  5. Inclusion - Taskforce finalises decision and changes are incorporated into MBS items

Slide 13: An initial wave of six pilot clinical committees has been launched

A rapid start
Based on stakeholder input
Promising signs of progress
1 Obstetrics, ENT, Gastroenterology, Thoracic surgery, Pathology, and Diagnostic imaging.
  • Of the 30 Clinical Committees, 6 priority areas were launched in October1
  • Objective is to quickly address high-priority items and to test the rapid review methodology
Selection of priority areas was based on:
  • Stakeholder feedback on high-importance items
  • Initial Taskforce assessment of MBS categories
  • A cross-section of committee types
  • Triage of items carried out
  • Preliminary list of obsolete items is being examined further
  • Target areas are being moved into evaluation (e.g., sleep studies, pre-natal testing)
  • Several new items have been proposed
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