Government tightens up Health Insurance Act

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PDF printable version of Government tightens up Health Insurance Act (PDF 23 KB)

21 September 2005
ABB112/05

The report in the Daily Telegraph today claiming sinister intentions behind an amendment to the Health Insurance Act 1973 has no foundation.

The amendment was proposed by the Department of Health and Ageing following concerns that doctors were using existing Medicare item numbers for procedures which had not been approved through the relevant Medical Services Advisory Committee (MSAC) process.

With rapid advances in medical technology, there is evidence that some doctors are finding Medicare Benefits Schedule item numbers which are a close match to new techniques they wish to use. In some cases these new techniques have not yet been proven to be safe, effective and cost effective and should not be claimed by doctors under Medicare.

One example is vertebroplasty, a technique used for spinal fractures. As vertebroplasty is currently being assessed by MSAC, it has not been approved for use under Medicare. Despite this, there is evidence that doctors have been using the technique and claiming against an existing Medicare item number which was never intended for that purpose. Another example is uterine artery embolisation, a technique used for fibroids, which is currently being assessed by MSAC. There are no appropriate MBS items available for this procedure.

The proposed amendment aims to clarify and tighten existing legislation to ensure that only appropriately approved procedures can be claimed under Medicare. There are no changes to existing Medicare items. It does not permit existing items to be withdrawn.

This is a clarification that will prevent Medicare benefits being paid for potentially unsafe technologies which have not yet been assessed by MSAC. It is not anticipated that this will be used often but this amendment will better equip the Department of Health and Ageing and the Health Insurance Commission to ensure Medicare is used for approved procedures.

Effectively, the amendment will enable a determination to be made that new and untested procedures are not covered by particular existing Medicare item numbers.

The Australian Medical Association was advised of the proposed change and the protocols to be used in determining whether benefits should be payable in respect of a particular procedure. These protocols include consultation with the AMA prior to a decision being made.

For more information call Mr Abbott's office on ph 02 6277 7220.