Medicare is dysfunctional, outdated, and susceptible to rorts totalling as much as $3 billion annually, says the former head of the body responsible for policing it.
In a
scathing critique published in today’s
MJA, Dr Tony Webber identified a system “riddled with misdirected incentives” for doctors, with inadequate safeguards to protect against rorting by unscrupulous practitioners.
Webber, who ended a six-year tenure as Director of Professional Services Review (PSR) last August, took aim at the Medical Benefits Schedule (MBS) for not keeping up to date with technological improvements.
“Once items are on the MBS, as long as they are still being used, they are rarely re-evaluated, and they attract the yearly rise in benefit level,” he wrote.
This was despite certain procedures being much quicker, cheaper, and easier to perform than when they were added, with some practitioners charging more than $4000 for procedures that can be performed more than twenty times a day.
Dr Webber also criticised the Medicare Safety Net, which despite being introduced to help patients avoid excessive out-of-hospital costs, has been used by a “minority of unscrupulous and greedy practitioners” to raise fees and subsidise cosmetic procedures.
“Many doctors I have spoken to are disillusioned by the inappropriate claiming,” he wrote. “They feel disempowered to be able to effect change in our current health system.”
While there are some instances of rorting, the majority of practitioners were doing the right thing, the President of the AMA, Steve Hambleton, told ABC Radio.
“It seems to me that [Webber] has taken things that he has seen in that role, [in] a very small number of professionals, and perhaps expanded that to the rest of the profession,” he said.
A statement released on behalf of the Acting Health Minister, Nicola Roxon, said Dr Webber was unable to comment with authority on the issue, since the PSR has no responsibility in health policy or funding.
Dr Webber rejected the assertions, claiming in his tenure to have seen over 20,000 medical records.
“The abuses were widespread,” he told ABC Radio.