Let’s not be stuck with the old and overwhelmed by the new in healthcare

Wednesday, October 4, 2017

‘Disinvesting in low-value healthcare services is essential if we are to maximise the effectiveness of our health dollars and keep the system affordable’, says Alison Verhoeven, Chief Executive of the Australian Healthcare and Hospitals Association (AHHA).

AHHA has released a Deeble Institute Issues Brief, Active disinvestment in low-value care in Australia will improve patient outcomes and reduce waste, by 2017 Deeble Scholar, Victoria McCreanor.

‘Our current processes for government investment in health treatments and services have resulted in continued support for outmoded treatments and services while being overwhelmed by the new’, Ms Verhoeven said.

Ms McCreanor said ‘Australia does have good systems for ensuring that government funding decisions on new medical services, products or technologies are backed by evidence of cost-effectiveness and efficacy—and the current Medicare Benefits Schedule Review is a very positive step forward.

‘But many existing services, some funded a long time ago, may not ever have been subject to a thorough evaluation of their effectiveness or cost-effectiveness. And they are rarely routinely reviewed against the latest evidence.

‘Also, where old services are superseded by new technology, there isn’t a formal and ongoing process for coordinated, active disinvestment in the outdated services’

‘Not only does this result in resources being wasted when they could have been spent on higher-value care, it may also compromise health outcomes for patients’, Ms McCreanor said.
Ms Verhoeven said that some steps towards disinvestment are under way: ‘For example, the independent Choosing Wisely and Evolve campaigns are promoting public awareness of low-value care. The current MBS Review is examining the value of more than 5,000 items.

‘But more needs to be done. Ironically, in terms of leadership and resources, we need more investment in disinvestment.

‘Some of this could occur by expanding the activities of the Medical Services Advisory Committee (MSAC), which evaluates medical services for public funding through Medicare, and the Pharmaceutical Benefits Advisory Committee (PBAC), which has a similar role with medicines for the Pharmaceutical Benefits Scheme’, Ms Verhoeven said.

‘With appropriate resourcing, both Committees could have formal regular reviews of services and medicines added to their responsibilities.
‘Concurrently, processes for approving new cost-effective services and medicines could be sped up. The two committees meet only three times a year. The current MSAC process from submission to creation of an MBS item can take over 12 months. The PBAC process from submission to recommendation for listing on the PBS typically takes 8 months, plus more time after that before actual listing occurs.’

Other key recommendations emerging from the evidence brief include changing funding mechanisms to focus on outcomes rather than outputs. This will need enhanced health outcomes data development, collection and sharing.

‘We also recommend that as a condition of receiving over $6 billion per year from the Australian Government for the private health insurance rebate, the health insurance funds could actively assess the value of types of care that they fund, and exclude those of low-value’, Ms Verhoeven said.

The Australian Healthcare and Hospitals Association is the national peak body for public and not-for-profit hospitals, community and primary healthcare services. Visit the AHHA at www.ahha.asn.au.

The annual Deeble Scholarships offered by AHHA are sponsored by HESTA.

Media enquiries: Alison Verhoeven, Chief Executive, Australian Healthcare and Hospitals Association, 0403 282 501