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What can Medicare data tell us about system design?

Recently, Adjunct Associate Professor at the Menzies Centre for Health Policy, University of Sydney, Lesley Russell published a paper on Scrbd that reminds us how underutilized the data available to us on medical services really areMedicare obstetrics services and costs: an analysis of publicly-available data 2003-04 to 2013-14, demonstrates that data aren’t t always just about answers but can sometimes be  useful pointers to the most pertinent questions. In particular Dr  Russell is keen to demonstrate what examining financial data can tell us about system design and utilization.

The introduction to Lesley’s study is provided below. The full text can be found here.

Dr Russell writes:

Medicare obstetrics services and costs: an analysis of publicly-available data 2003-04 to 2013-14.

Introduction

The key purpose of this paper is to highlight how little we currently use the available Medicare data to inform both policy making and the updating and reform of health services delivery and financing.

I have analysed the Medicare data and costs for obstetric services over the decade since 2003-14 (in some case I have included early data back to 1997-98 to highlight trends over time).

This is an interesting area deserving of more attention and analysis than it currently receives for several reasons:

  • Obstetricians deliver Medicare-funded services to patients in both the community and acute care;
  • There is evidence that surgical interventions and caesarian rates are higher in the private sector although this does not reflect increased risk;
  • A significant number of obstetricians were seen to be inappropriately rejigging their costs to enable patients to benefit from the Extended Medicare Safety Net after its introduction in 2004, leading to government curbs;
  • There have been a number of changes to Medicare items and fees in response to budget blow-outs, although the schedule of Medicare items and fees has not been reviewed or updated in any concerted way to reflect changes in obstetric practice over time.
  • This is an area where tolerance for risk by both clinicians and patients is low and technology is increasing; and
  • The schedule of Medicare items and fees has not been reviewed or updated in any concerted way to reflect changes in obstetric practice over time.

I am not aware of any concerted public effort to look at the impacts of these changes and pressures on clinicians, patients and the way obstetrics is practiced.

There is an endless debate about the over-medicalisation of the very natural fact of pregnancy.  Australia’s traditional maternity system institutionalises a medical view of pregnancy and birth both in terms of financing arrangements and professional power.  Maternity care is funded within a medically dominated, fee-for-service structure and acute hospital budgets.  It has been argued that this approach means most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based ‘best practice’.   I do not intend to enter this debate except to state that it is important that women are provided with appropriate and affordable choices and that these reflect cultural sensitivities.

It is clear that for many women, especially those who deliver in the private sector, there can be substantial out-of-pocket (OOP) costs for obstetric services.  Although the bulk billing rate for obstetric services (41%) is considerably higher than the average rate for specialist services (27%), the average OOP cost per service for those who are not bulk billed is $218. I have previously written on the need to do more to constrain OOP costs for specialist services.

Regardless of who oversees a woman’s pregnancy, childbirth and post-natal care, and where the woman decides to deliver her baby, this episode in the life of a woman and her child / children is critical for their future health and wellbeing.  This requires that all appropriate tests and screenings are done and the pregnancy, delivery and post-natal care is well planned and well managed by the appropriate team, focused on the mother’s needs.

It also means that there are unexplored opportunities for Medicare to look at different, more efficient and more cost-effective ways to deliver and finance obstetrics care.

The aim of this paper is to instigate discussion, further and more detailed analyses, and curiosity and interest about what is happening with the delivery and financing of our health care system in this important area.  I hope that my work will encourage others with data and evaluations to enter the discussion so that Australian health care funders (both public and private) and policy makers have the best evidence on which to base their policies and programs.  Only then can we hope to develop and find support for reforms that will benefit public and private health funders, clinicians and health care professionals, and – most especially – mothers and children.

 

 

 

 

 

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