Billions wasted says ex-PSR chief

THE former director of the Professional Services Review has described Medicare as dysfunctional and called for a comprehensive review of health care delivery and funding in Australia.

In a wide-ranging opinion piece in the MJA, Dr Tony Webber, director of the PSR until August last year, estimated that up to $3 billion was spent inappropriately each year through misuse of the Medicare Benefits Schedule (MBS), the Pharmaceutical Benefits Scheme and the Medicare Safety Net. (1)

Dr Webber was particularly critical of general practice management plans and team care arrangements, saying they had “created opportunities for a bonanza for some practices”.

“Several practices I have reported on have admitted that their corporate owner had a business plan based on a defined number of these items claimed every week, irrespective of clinical need”, he wrote.

Dr Webber had told a recent senate inquiry that he would like the PSR to have a greater role in investigating corporate medicine. (2)

“I can certainly see PSR — and this may be somewhat controversial — having an own-motion ability to investigate scams and unacceptable corporate behaviour, of which I have seen significant examples”, he told the inquiry.

In the MJA article Dr Webber described the Medicare Safety Net as “one of the most poorly thought out pieces of health legislation”, saying it offered opportunities for exploitation by unscrupulous doctors.

Dr Webber told MJA InSight he repeatedly raised many of these concerns with the Department of Health and Ageing when he was director of the PSR but nothing changed.

“It was frustrating. The department would tell you that changes to chronic disease management were underway but nothing ever seemed to happen”, he said.

A spokeswoman for the Department of Health and Ageing said the government had introduced upper limits on benefits paid for certain items under the Medicare Safety Net following a review that identified these items as areas where doctors were using the safety net to raise fees.

However, she said that it would be inappropriate and misleading to extrapolate the practise of the few practitioners seen by the PSR to the entire medical community.

Dr Webber agreed most practitioners practised appropriately, and he had tried to draw doctors’ attention to the problems that existed, such as through medical media.

He called for a major review of health care delivery, saying Australia’s health system had changed substantially since Medicare was introduced.

“A bit like the Deeble review that brought in the original Medibank in 1973, that is the scale of reform that is needed … the whole fee-for-service in private practice needs to be reconsidered, the perverse incentives in the system need to be done away with. The Commonwealth–state divide within health care is dysfunctional at many levels”, he told MJA InSight.

However, AMA president Dr Steve Hambleton said many of the issues Dr Webber raised in the MJA article were audit issues rather than policy matters.  For instance, Dr Hambleton said the move towards structured chronic disease management was positive and achieved beneficial health outcomes for many patients.

“The great majority of doctors do the right thing. You can’t design a system to stop 2% of people misappropriating stuff — but you do need a system which will allow those people to be called to account”, he said.

Dr Hambleton said feedback from the PSR to the profession and the department about any structural problems within the health system could be strengthened.

In another article in the same issue of the MJA, Dr Scott Masters, a GP and senior lecturer in the school of medicine at the University of Queensland, said that Medicare and the PSR give little guidance to GPs on the approved use of MBS item numbers. (3)

Dr Masters, who was audited three times by Medicare Australia, said the PSR was heavy-handed and focused too much on investigating statistical outliers, with fines often running into five or six figures.

Health journalist Ray Moynihan, in the same issue of the MJA, said health authorities had so far found no meaningful mechanism to police the corporate medicine sector. He said it was time to assess “how well the private-for-profit corporate structure sits with the spirit of a publicly funded universal health insurance scheme”. (4)

- Sophie McNamara

1. MJA 2012; 196; 18-19
2. Commonwealth of Australia 2011; Professional Services Review scheme (Hansard) 22 September
3. MJA 2012; 196; 20-21
4. MJA 2012; 196; 15

Posted 16 January 2012

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