MBS changes can lead to reduced access to telehealth, researchers claim

Telehealth has provided increased access to health services for people in remote parts of Australia. This has meant that women on cattle stations and in remote Aboriginal communities have been able to access a wider range of services.

However, changes to the Medical Benefits Scheme (MBS) have now decreased access to telehealth, including for women and children – the people who need those services the most.

The Cooperative Research Centre for Developing Northern Australia (CRCNA)-funded project – Development of a simple, robust telehealth system for remote communities – has found:

• The nbn Sky Muster Plus satellite internet service is adequate for telehealth via videoconferencing and the use of smart diagnostic tools. Testing during the 2019–20 monsoon period found a typical download of 29 Mbps, upload of 9 Mbps and a ping of approximately 560 milliseconds.
• Many women and children (even in urban areas) are not getting access to the services they need and the Telehealth for the Bush Trial has provided supplementary services. For example, a remote cattle station owner fell off her horse but was unable to get treatment for her injured knee (she lived seven hours from services). However, she was able to have all of her treatments, including physiotherapy, via telehealth with the exception of having an MRI and operation via the public health system.
• Many children in remote areas are not being assessed for developmental issues early enough. In some cases, children are not diagnosed until they start school. Children with severe issues, such as not being able to speak at 10 years of age, can sometimes go without diagnosis and treatment. There is great difficulty accessing specialists and telehealth can fill that gap in services. The situation is particularly difficult for new mothers in remote areas who do not have experience with other children or close friends and family nearby for support.
• Remote Aboriginal Health Services have been able to make savings on travel and access increased Medicare income through the use of telehealth. These additional funds have afforded an opportunity to provide a more holistic approach to health. For example, in one very remote homeland community, the funds have been used to establish a women’s health promotion centre providing showers, baths, hot water and a place where women can meet, yarn and wash their kids.

The majority of telephone health services eligible for rebate have been removed from the MBS. As a result, doctors now have to use videoconferencing instead of telephone for most consultations. While that sounds straightforward and simple in theory, there are reasons which will make it unworkable as many remote areas have unreliable internet. The MBS items for telehealth videoconferencing require the clinician to maintain audio and visual connection for the entire consultation. This will mean, if the clinician or healthcare consumer drops out, the clinician will be unable to claim that consultation on Medicare. This will ultimately increase out-of-pocket costs for healthcare consumers.

Another consequence of these changes is that specialists or GPs may reduce their services to remote people as they may not be able to obtain the Medicare rebate for telehealth services.

Currently, the healthcare consumer needs to have physically seen a GP, or another GP from the same practice, within the previous 12 months before any GP from that practice can claim Medicare rebates. Under the new legislation, healthcare consumers will have to see the same practitioner, in person, three times before they can access telehealth from that practitioner. This will essentially limit the healthcare consumer’s ability to access services from another provider and lock them into access to services from only one GP. This will further exacerbate the difficulty in accessing GPs for people in remote areas, many of whom have limited or no access to a GP.

The result of these changes will be reduced access to health services for women and children in remote areas of Australia.

The authors would like to thank the CRCNA and project partners for supporting this research.