Private Health Insurance Rebate (PHIR) ReviewGeneral, Government, Industry
AAMT Member Update 6
Private Health Insurance Rebate (PHIR) Review
Recently, a ‘confidential’ draft report titled Review of the Australian Government Rebate on Natural Therapies for Private Health Insurance conducted by Professor Chris Baggoley AO, under the umbrella of the National Health Medical Research Council (NHMRC) was leaked to the media and some industry stakeholders.
The NRMRC report is not available officially, being under consideration, and this limits considerably, what we can report to members on current developments. However, given that the NHMRC review was presumably sighted by the media who reported on its content, we can assume that their statements and comments are in the main accurate.
The media reports note that the NHMRC Review is largely unfavourable to natural therapies, finding that the majority of research fails to meet Cochrane level standards. A positive for massage is that the review reportedly found that some 99 studies into massage did meet the standard, albeit the majority of these were considered low quality.
Subsequent media coverage speculates that the PHIR for natural therapies will be removed, providing the Federal Government with tens of millions of dollars in savings to the health budget. These reports come amid claims that health dollars are better spent on cures that are known to work. Importantly, massage is not claimed to be a cure; it is a valuable part of recovery and a means to maintain physical and psychological wellbeing.
Notably, cost savings in health are very much on the Federal Budget agenda with the focus on GP co-payments as a means to achieve this end. The controversy arising from introducing such a change with far reaching consequences for Australians has led to its withdrawal and the need to find savings elsewhere.
The pressure to find sources of other savings measures makes it reasonable to assume that any decision to cut or limit the PHIR for massage will be driven primarily by economics and not by its positive contribution to community health.
AAMT’s position on the reported findings
While there are thousands of studies that offer positive results in support of massage for a variety of health conditions, the reported Cochrane level findings reportedly found to be inadequate by the NHMRC Review are not surprising insofar as they mirror similar reviews of studies commissioned by AAMT in 2008 and 2013.
Alongside this, the vast the majority of research into health care practices including osteotherapy and physiotherapy, do not meet the extremely high Cochrane standards applied by the NHMRC.
Given that massage is an integral part of osteopathy and physiotherapy treatments, it is of particular concern that these treatments were not included in the Overview and will continue to receive the Private Health Insurance Rebate. For massage therapists, this inconsistency in policy is significant, because it discriminates against highly qualified massage therapists. AAMT will continue to make government officials aware of this issue.
Importantly, a failure to meet Cochrane research standards does not indicate that the findings of a study are wrong; it means that the research methodology or reporting was below the Cochrane standard and therefore inconclusive.
Reassuringly for your massage clinic, it is worth noting that people have used massage for thousands of years and that the majority will continue to do so because it makes them feel better, not because they think it works as a cure or solely because of a government rebate.
AAMT will also continue to make government officials aware that it is extremely difficult and sometimes impossible to apply Cochrane research standards to massage research. This is because it is not possible to control all inputs and external influences in order to establish an irrefutable cause and effect case for the use of an intervention.
The authors of the Adelaide University International Centre for Allied Health 2013 study commissioned by AAMT pointed out that:
‘One of the challenges of undertaking primary research in areas such as massage therapy is the conflict between replicating what occurs in clinical practice while adhering to strict research criteria.
In a clinical practice context, massage therapy is often offered as a ‘package of care’ in addition to advice, education and using a combination of modalities. However, in a research context, a ‘package of care’ is rarely offered.
Therefore, the primary research undertaken may not truly capture and replicate what occurs in a clinical practice context. This is a challenge and a limitation when undertaking and interpreting findings of research evidence for massage therapy.’
In our view, the NHMRC Overview highlights again the need for a system of research that is appropriate for the massage context and with appropriate recognised research methodologies.
An AAMT initiative to meet this challenge
Given the rapid growth of the massage sector, the AAMT is arguing for a collaborative approach to developing a standard scope of practice and a research methodology that can prove, irrefutably the benefits of massage, including: infants, depression and post-natal depression, labour pain, fibromyalgia, premenstrual syndrome, urinary symptoms in multiple sclerosis, myofascial pain, and osteoarthritis of the knee.
AAMT is holding a symposium of key researchers, both national and international, during February to address the methodology and paucity of Cochrane level studies. AAMT believes that gaining acknowledgement and collaboration with the NHMRC on developing an appropriate mixed method to further research into this important modality is essential for the growth and recognition of the profession.