Cataract benefits ‘threat’ is a furphy

A call for Medicare benefits for cataract surgery that at first glance appeared to be a re-run of the then federal government’s attpt in 2009 to slash such benefits has tuned out to be a furphy and nothing more than softening up for whatever the federal government is planning to do with the health sche.The call for cataract surgery benefits to be cut was made on ABC Television’s 7pm News on Saturday evening 23 February by the chief executive officer of the Australian Healthcare and Hospitals Association, Ms Alison Verhoeven, when she welcomed the federal government’s decision to review the whole health-care syst.It was claimed on the ABC News program that cataract procedures only take 20 minutes yet there is a Medicare benefits of $500 for the procedure.
A vice-president and the treasurer of The Royal Australian and New Zealand College of Ophthalmologists, Dr Brad Horsburgh, said on the program that patients are now receiving benefits that are 40 per cent of what they were when the benefit for cataract extraction and intraocular-lens implant was introduced.
Dr Horsburgh later told Insight he was developing a feeling of déjà vu and that it is certainly frustrating for the matter to be raised again. “Why do they persist?” he asked.If the benefits are cut, it would be a breach of the government’s pre- and post-election commitments not to touch health, although that is now up in the air, despite Prime Minister Tony Abbott as recently as 1 February saying there would be no cuts to health.Some weeks later, he stated: “We will absolutely keep our commitments, does that mean that every single bit of existing spending will rain in perpetuity, of course not”, whatever that means.
In a later discussion, Ms Verhoeven told Insight her comment was in the context of the federal government’s planned overall review of health expenditure and referred us to the website of the Medical Services Advisory Committee, which includes details of procedures for its consideration, including cataract-surgery benefits.
The ‘threat’ is the second time in less than five years that cataract surgery benefits under Medicare have come under attack, the previous attack being by the then federal health minister, Ms Nicola Roxon, in 2009. Ms Roxon wanted to cut the benefits by 50 per cent.
That ended with a back-down by Ms Roxon, after The Royal Australian and New Zealand College of Ophthalmologists and the Australian Society of Ophthalmologists fought hard against any reduction, in the end settling for a 10-per-cnt reduction.
Ms Roxon ended up with egg all over her face from the episode.
Had the 50-per-cent cut Ms Roxon wanted gone ahead, the benefit would have been reduced by 96 per cent in real terms since 1987. The planned cut would have been the third since then.
The benefit was to have been reduced from $623.70 to $311.85 from Novber 2009, saving the government-owned Medicare as much as $62 million a year in benefit payouts for the 200,000 cataract procedures each year.
In 1987 there was a 40-per-cent cut, in 1996 there was a 10-per-cent cut and there was to be a 50-per-cent cut in 2009.
In a response to the 2009 budget proposal, RANZCO and ASO said cataract is the leading cause of blindness in the world; of the cataract operations performed in Australia, 70 per cent are performed in the private health syst and 30 per cent in the public syst; and there is a “vast” number of people waiting for cataract surgery in the public syst.
Also, that advancing technology has delivered greatly-improved visual results, with improved safety and improved quality-of-life outcomes; the visual outcomes of cataract surgery are extrely good with greater than 98 per cent of patients being returned to normal vision, allowing th o return to a normal lifestyle (continuing to drive, maintain independence and live at home); and, importantly, dramatically decreasing the risk of falls.
Furthermore, the improved visual outcome also has significant positive impacts on the mental state of patients, with restored confidence, self este and reversal of mental deterioration previously noted by family mbers.
There is a perception that, due to the fact that cataract surgery is so common, being done as a day procedure, and with outcomes so good, it must be a “simple” procedure, according to the RANZCO and the ASO.
“Over the past 20 years the technological advancents has allowed the development of an operation that is far safer, yet technically more difficult, to perform. This is a complex procedure requiring the surgeon to be absolutely meticulous and exact in undertaking the procedure to ensure a good result.”
And that is still the position today.
The greatest current threat to cataract surgery benefits (and who knows what else) is the claim by the federal health minister, Mr Peter Dutton, that the health syst is “riddled with inefficiency and waste” and that he intends to eliminate same, however sources say there is no evidence to date that cuts to cataract-surgery benefits are envisaged.
Mr Dutton’s point of view is contrary to what a number of health experts claim is the true state of affairs, including one of the architects of the universal health sche, Professor John Deeble.