Put and end to unnecessary tests and expensive prescriptions, Australian Health Minister Nicola Roxon has firmly told doctors. She said that her government was ready for a showdown on the issue.
Speaking at a health reform conference of the Committee for Economic Development in Australia, Ms Roxon yesterday threatened tighter controls on the use of expensive cancer drugs and to put private pathology services out to tender to rein in high costs generated by doctors.
She charged that doctors did not always choose the best and most cost-effective treatments and lashed out at pathologists, cancer doctors and surgeons installing expensive but failure-prone artificial joints.
Doctors were free to choose whichever treatment they considered most appropriate "with little consideration of cost", the health minister said.
Hip replacements were a good example of how this didn't always result in taxpayers getting value for money.
On the question of prescribing cancer drugs, which can cost the taxpayer up to $50,000 a year, she was critical of their use towards the end of life when evidence showed them to be less effective.
Ms Roxon questioned whether the community would support measures to better control such medicines for use only when they were effective, balanced by more investment in palliative care.
''These are highly charged and sensitive discussions, where no government or health minister treads without care and some level of trepidation.''
Another example was that doctors were prescribing high-cost cholesterol-lowering drugs, costing $80 a month, when three-quarters of the patients would be successfully managed on cheaper generic medicines costing about $30.
"We need to manage our scarce health resources more effectively if we are to be able to fund reforms to improve our health system for the future," Ms. Roxon said and wanted Australians to prepare for ''hard decisions'' in choosing where to spend health dollars.
She also said the Australian Competition and Consumer Commission was investigating claims that pathologists were co-ordinating a campaign asking general practitioners to tell them pathology would no longer be bulk billed once the reduced Medicare rebates take effect in November.
If such practices were to continue, the Government would have to consider the ''radical'' step of introducing tenders for pathology services.
Ms Roxon also criticised some fertility specialists who also face cuts in Medicare payments. She claimed they had raised their fees before the cuts took effect in order to highlight the impact on patients' out-of-pocket costs.
Doctors promptly hit back at the minister's claims.
The Australian Medical Association (AMA) criticised Ms Roxon's comments, saying "bean counters" didn't know what was best for patients.
President Andrew Pesce said doctors were trained to think independently.
"Our choice of device is based on the clinical needs of our patients," he said in a statement.
"Prosthesis choice is not and must not be the domain of health department bean counters, Treasury officials or private health insurers, all of whom are looking for savings, not better health outcomes."
Dr Pesce said when doctors planned surgery they considered the most appropriate prosthesis for their patient "based on that patient's individual needs and circumstances".
President of the Australian Association of Pathology Practices, Dr Ian Clark, said pathology rebates were now lower in absolute terms than 25 years ago and to open services to tender would result in the ''lowest common denominator''.