Huge backing for independent MBS rebate body

Jolyon Attwooll

17/11/2023 3:16:37 PM

More than four in five newsGP readers have said they would welcome an independent statutory body to set the level of MBS rebates.

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Most GPs would prefer MBS rebates to be decided independently of the Government of the day.

GPs overwhelmingly support the introduction of an independent body responsible for setting MBS rebates, the results of a newsGP survey suggest.
In a poll that ran last week, 81% of newsGP readers answered ‘yes’ when asked if they would support the introduction of an independent authority to carry out such a task.
Of the rest, 5% declared their opposition to the suggestion, while the remainder were unsure.
There were 1305 votes in total.
Dr Michael Wright, the Chair of the RACGP’s Expert Committee – Funding and Health System Reform (REC–FHSR), believes there would be advantages if rebates were set at arm’s length from the government of the day.
‘I think there is benefit in having an objective umpire in setting prices for health services, removed from the political cycle,’ he told newsGP
He cited the work of the independent organisation, formerly known as Independent Hospital Pricing Authority (IHPA), and suggested a similar approach could be used for MBS rebates.
Set up under the National Health Reform Agreement in 2011, IHPA was designed to give independent and transparent advice for public hospitals funding.
In 2021, legislation was introduced to enable the same organisation to look at funding for aged care, leading to the establishment of the Independent Health and Aged Care Pricing Authority (IHACPA).
‘IHPA, now IHACPA, has done an excellent job in setting efficient prices for hospital services, and more recently aged care,’ Dr Wright said.
‘Their prices take into consideration of the costs of providing care – including salaries, capital costs and consumables – and so provide a more comprehensive view and realistic view of prices.’
He said using independent analysis to look at setting fair prices for general practice would be helpful.
‘Patient MBS rebates often get viewed as “the doctor’s pay” when we know it pays for a lot more than that,’ he said.
Dr Wright also highlighted the impact of Federal Government interventions into the MBS rebate, pointing to the freezing of MBS prices for six years. 
Other GPs have also pointed out how MBS rebates have not kept pace with inflation. This year, most MBS rebates were indexed at 3.6%, well below the consumer price index.
‘The MBS could have kept up with increasing costs if automatic indexation had been a consistent feature,’ Dr Wright said.
‘But it hasn’t and so we see an ongoing massive devaluation in MBS payments for GP services, leading to decreased ability to accept the rebate for full payment, and that has seen bulk-billing rates plunge.’
Dr Wright believes forming an independent statutory body to consider MBS rebates could help redress the shortfall that the previous rebate freeze has caused.
‘It would be good to look at costs, reset the MBS, and this independent body could do it,’ he said.
However, Dr Wright also noted the complexities of using a system where the costs of care are not always simple to calibrate.
‘One potential challenge for general practice we have seen with the MBS is that it can be easier to cost active interventions, such as putting in a heart stent, than it is to cost preventive interventions such as smoking cessation advice which might prevent a heart attack,’ he said.
‘Similarly caution and collaboration would be needed in setting appropriate prices for GP consultation and generalist care. 
‘But it can be done.’
As well as from newsGP readers, backing for an independent statutory body for rebates has come from health system experts, including Professor Stephen Duckett, a prominent academic and former healthcare official who sat on the Strengthening Medicare Taskforce.
He has previously noted the existence of an independent rebate tribunal in the early days of Medicare.
In an article earlier this year, Professor Duckett described the rebates as being set ‘on political whim’ and referenced the six-year rebate freeze.
There was no mention of an independent statutory body in the Strengthening Medicare Report released earlier this year.
Another academic to suggest making MBS rebates independent of Government is Anthony Scott, the Professor of Health Economics at the University of Melbourne.

He has said such a body could guarantee the best use of independent evidence on the costs of general practice services, while also stating that it would remove political interference in indexation.
In the meantime, Dr Wright said broad support within general practice would be needed to make any such reform work.
‘There would need to be good buy-in from the profession and also a commitment from funders to pay what an independent authority determines is a fair price,’ he said.
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newsGP weekly poll What areas of healthcare were you hoping would get more funding in this year's Federal Budget?



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