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Rebate increase for IUD insertion called out as ‘inadequate’


Anastasia Tsirtsakis


2/03/2022 3:52:42 PM

The MBS rebate has increased by just over $20 – but does that do enough to increase access? A women’s health expert says no.

A gloved hand holding an IUD.
Intrauterine devices are one of the most effective forms of birth control.

The Medicare Benefits Schedule (MBS) fee and rebate for intrauterine device (IUD) procedures, item 35503, has increased as of 1 March.
 
Based on recommendations from the MBS Review Taskforce (the taskforce), the fee has risen from $55.70 to $83.40, and the rebate for non-hospital settings has increased from $47.35 to $70.90, and from $41.80 to $62.55 in hospital settings.
 
According to the taskforce’s Report on Gynaecology MBS Items, the change was recommended to better reflect ‘the level of training, skill, equipment and time required’ to provide the service.
 
A Department of Health spokesperson told newsGP the rebate rise also aims to ‘encourage the greater uptake of GPs using long-acting reversible contraceptives [LARCs] as opposed to traditional contraceptives’.
 
But Professor Danielle Mazza, Chair of General Practice at Monash University and a leader in women’s health, believes the opposite to be true. She says while an increase is welcome, it is inadequate.
 
‘I don’t really understand why that amount was set,’ Professor Mazza told newsGP.
 
‘In setting the amount, Government really needs to consider the issues around access and whether they want to encourage GPs to provide this service – because if they do, they need to invest in it.’
 
Despite IUD’s being the most effective form of contraception available, uptake of LARCs in Australia is low compared to other developed countries.
 
To help increase access, the RACGP made a submission to the MBS review in October 2018, proposing that the new patient rebate for insertion of an IUD be increased to $150.
 
‘This amount better reflects the costs of providing the service and will increase patient access by improving supports for GPs to perform this procedure,’ the submission states.
 
Despite the taskforce’s reasoning, Professor Mazza, who has done extensive research on the benefits of LARCs, said the increase in no way reflects the time and resources providers invest for their patients.
 
‘GPs don’t want to make a loss for a procedure that you usually set aside 30 minutes for and requires extra training,’ she said.
 
‘It also requires the capacity to sterilise that equipment or purchase disposable equipment – or both – and it often requires additional staffing to be on hand if the patient requires supervision or assistance during the procedure.
 
‘For all those reasons, if the Government wants to ensure that this service is provided across Australia, in the community setting, then it needs to be not only adequately reimbursed through the MBS, but also invested in, in terms of ensuring sustainability of our IUD provision workforce.’ 


Beyond funding for the procedure itself, the Melbourne-based GP says there is also a need for Government to invest in the establishment of training pathways for both existing and future GPs.
 
‘At the moment, there are long waiting lists for GPs to access training through family planning organisations,’ Professor Mazza said.
 
‘There’s [also] a significant out of pocket cost to GPs to undergo that training and there are inadequate training opportunities in the community because we don’t have supported community insertion.’
 
As a result, she says some women find themselves in a position of being denied their contraceptive of choice – which has a number of overarching consequences.
 
‘Surely it costs less to provide effective contraception than it does to deal with the fallout of an unplanned or an unwanted pregnancy, and the long-term socioeconomic implications of carrying through with unwanted pregnancies,’ Professor Mazza said.
 
‘So it’s a no brainer that you invest in contraception and make it accessible.
 
‘In fact, internationally, countries are providing free contraception – free products, free access – and we’re putting up all of these barriers for women to be able to access these services.’
 
Reflecting on the National Women’s Health Strategy as International Women’s Day approaches on 8 March, Professor Mazza highlights that one of the strategy’s key objectives is to increase access to LARCs, including copper IUDs, which are not currently subsidised under the PBS.  
 
‘While an increase in the rebate is welcome, this level of increase in and of itself will not guarantee that women will be able to access IUD insertions moving forward,’ she said.
 
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Dr Catherine Alexandra Lee   3/03/2022 11:18:38 AM

Thank-you Prof Mazza and all who advocated for this.