PBS payments outsourced
August 8, 2014
THE Department of Health could
be looking to outsource Medical
and Pharmaceutical Benefits
Scheme (PBS) payments in a move
that would see the handling of
$10b for pharmaceutical claims
annually move into private hands.
In an advertisement posted in
the Australian Financial Review,
the Department said it sought
expressions of interest (EOIs)
for the commercial provision
of Medical and Pharmaceutical
Benefits claims and payment
services provided by the
Department of Human Services and
similar payment services provided
for the Department of Veterans’
Affairs (DVA).
The Department said the
processing of these claims and
payments involved $19b in medical
benefits claims annually and $10b
for pharmaceutical claims from
600m transactions, with “steady
growth” over the past three years.
For the DVA, pharmaceutical
claims involved $425m as a result
of more than 33m transactions,
which also included $2b for DVA
medical, allied health and hospital
claims.
The Department said the scope of
work that could be offered, as well
as expectations and performance
standards, would be finalised later.
EOI responses should be received
by 22 Aug, the Department said.
The move to outsource payments
and claims from the Department of
Human Services was a suggestion
in the Commission of Audit, citing
greater efficiency and lesser cost.
The Commission said specialist
outsourcing providers preferred
low complexity activities.
However there was market
interest in the provision of payment
systems, the Commission said,
citing a proposal of Australia Post’s
to deliver some of the services
provided by the Department.
The Commission said outsourcing
the payments system arrangements
would be a “substantial and
potentially high risk undertaking
requiring careful consideration.
It said it did not support the
outsourcing of assessment of
entitlements.
CLICK HERE for the Commission’s
recommendations.
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