25 NOVEMBER 2021

As 2021 draws to a close and we begin to gaze towards a Federal election in 2022, there is an opportunity for people experiencing persisting pain, along with their families and carers, to critically survey the Australian health care landscape.

Spending on COVID-19 has produced large budget deficits and there is a need to prioritise health expenditure. However, looking to the future it remains unclear whether our Federal, State and Territory governments are primarily seeking ways to contain costs or ways to invest in the nation’s health. The early months of the upcoming year may bring greater clarity.

Policy with regard to pain medicines illustrates some of the challenges. For example, there has been a clear tightening of regulation around opioid prescribing for chronic pain. The Therapeutic Goods Administration states that “opioids are no longer indicated for chronic pain other than in exceptional circumstances”. In addition, real time prescription monitoring is being rolled out by State and Territory departments of health. These systems alert doctors and pharmacists to the problems of medication overuse and doctor shopping.

All these changes can reduce harms from over-reliance on medications such as opioids and benzodiazepines. There can be an associated reduction in health care costs. However, reducing harm is not actively improving health. That requires planned investment in effective treatments.

The challenge of weighing harm reduction and cost containment on one hand and support for effective treatments on the other is fundamental to the Federal Government’s current consideration of the recommendations of the Medicare Benefits Schedule (MBS) Taskforce. The recommendations to government of the MBS Review (2015-2020) are progressively being processed.

Personally, I had the privilege of serving as Chair of the Pain Management Clinical Committee which was tasked with reviewing pain related item numbers and reporting to the MBS Taskforce.

Essentially there were two major categories of recommendations that our committee made. Firstly, we made recommendations to modernise and streamline item numbers related to pain procedures. Inherent in this category were limitations to the numbers of procedures permitted in a given time period. This has the potential to reduce over-servicing and bring significant cost savings.

Secondly, we made recommendations designed to increase access to multidisciplinary pain management. This is the area where there is the greatest weight of scientific evidence of long-term benefit in treating chronic pain. 

Key recommendations in this category included: that chronic pain be explicitly recognised as a chronic condition; that increased numbers of visits to allied health professionals are permitted under chronic condition management plans; and that item numbers are developed for group pain management programs.

In one way the introduction of such new item numbers might be predicted to increase health care costs. However, the potential for cost increase is offset by the potential for improved quality of life and reduction in disability.

Currently the pain management section of the MBS review is timetabled for consideration in 2022. Analysis of the recommendations will inevitably address possible cost savings as over-reliance on pain procedures may be curtailed. This needs to be counter-balanced by careful investment in the nation’s health via endorsement of new item numbers supporting multidisciplinary care and group programs.

As we approach an election year I encourage consumers, carers and families to ask questions of politicians about whether the focus of their party is on cost containment, health investment or perhaps a balance of the two?

Dr Chris Hayes, Board Director Painaustralia and former Chair MBS Pain Management Clinical Committee