Medicare rebate for specialist medical practitioners from physiotherapy referrals: analysis of the potential impact on the Australian healthcare system

Abstract

Objective To identify and examine the likely impact on referrals to specialist medical practitioners, cost to government and patient out-of-pocket costs by providing a rebate under the Medicare Benefits Scheme to patients who attend a specialist medical practitioner upon referral direct from a physiotherapist.

Methods A model was constructed to synthesise the costs and benefits of referral with a rebate. Data to inform the model was obtained from administrative sources and from a direct survey of physiotherapists.

Results Given that six referrals per month are made by physiotherapists for a specialist consultation, allowing direct referral to medical specialists and providing patients with a Medicare rebate would result in a likely cost saving to the government of up to $13 million per year. A range of sensitivity analyses were conducted with all scenarios resulting in some cost savings.

Conclusions The impact of the proposed policy shift to allow direct referral of patients by physiotherapists to specialist medical practitioners and provide patients with a Medicare rebate would be cost saving.

What is known about the topic? Extending Medicare rebates payable to patients when physiotherapists directly refer patients to specialist medical practitioners is a contentious topic. Physiotherapy groups have argued that direct referral with a rebate would allow faster access to consultant advice resulting in better patient care. However, it has also been argued that widening criteria for rebates would increase overall costs to Medicare Australia.

What does this paper add? This analysis finds that allowing direct referral with a rebate would result in a cost saving to both the government funder and patient out-of-pocket costs.

What are the implications for practitioners? Policymakers should consider widening the criteria for rebates payable for referral to medical specialists to include physiotherapists, as this could result in faster management of patients and cost savings for both patients and Medicare Australia.