Medibank: chronic pain costs economy $22bn a year

Health insurance giant Medibank is pushing for a greater focus on primary care, instead of ­surgery intervention.

Andrew Wilson, Medibank’s group executive of healthcare and strategy.

Health insurance giant Medibank is pushing for a greater focus on primary care, instead of ­surgery intervention, for a leading cause of chronic pain that is costing the economy $22 billion annually.

Andrew Wilson, Medibank’s group executive of healthcare and strategy, used an industry event yesterday to highlight that osteoarthritis was one of Medibank’s leading areas of expenditure. “Often that is expenditure at the tail end of the person’s disease progression, so we are funding care that is very expensive,” he said.

Osteoarthritis, the most common chronic condition of the joints, affects 2.2 million Australians, and a leading cause of chronic pain, disability and lost productivity in Australia, costing the health system $3.75bn last year and the economy about $22bn a year in lost productivity.

Medibank chief executive Craig Drummond said the ­Australian health system was under growing pressure, particularly as the health needs changed. “We think the current rate of growth in health spending is not sustainable,” he said.

In osteoarthritis, Medibank funds more than 35,000 surgical procedures related to musculoskeletal conditions each year.

Dr Wilson said that level of surgical procedures fuelled the issue of affordability.

“We are spending hundreds of millions of dollars on the treatment of interventions for osteoarthritis that are fundamentally surgical interventions,” Dr Wilson said ahead of yesterday’s Osteoarthritis Summit. “But all the evidence points to interventions in primary care focused around the GP and their patient being the way forward.

“There’s a lot of ­low-value care being funded by ­Medibank and other insurers and there’s a huge opportunity for change and ­improvement in the system that allows members to get better care at a lower cost.”

Dr Wilson said the government was indifferent about whether the care it funded was high value or low value. “For us as a private payer, if the government pays through the MBS (Medicare Benefits Schedule) for a procedure, we by law have to pay,” he said. “It’s one thing to send a ­signal to say we want care to ­improve, but the money has to follow that line of argument.”

He said the government’s ­review of the MBS was a move in the right direction of where it could act to address affordability.

Dr Wilson said the health ­system should fund on evidence and patient-centred outcomes.

He said Australia had been slow to embrace patient-reported outcomes but added that the health system was now becoming more consumer focused.

“Making data available to GPs and consumers will be the turning point ... I think it will fundamentally change healthcare.”