A single mid-life health check to replace five: the MBS proposal

Five separate Medicare item numbers. Five different eligibility criteria. Five different billing pathways for conditions that frequently coexist in the same body, in the same decade of life.

A federal government review released this week recommends consolidating those five into one — and if the proposal is adopted, the mid-life health check in Australia could look substantially different within the next few years.

The review, reported by RACGP’s newsGP, proposes replacing the current standalone assessments for menopause and perimenopause, heart health, chronic disease risk, and type 2 diabetes with a single comprehensive mid-life health assessment using time-tiered MBS items. The logic: these conditions share risk factors, they converge in the same age window, and the women who need one assessment frequently need all of them.

What currently exists

The current MBS landscape for mid-life preventive care includes separate items for cardiovascular risk assessment, perimenopause and menopause health assessment, chronic disease risk evaluation, and type 2 diabetes risk assessment. Each carries its own eligibility rules, consultation requirements, and billing codes. Some items cannot be billed on the same day as others.

The result is a system where comprehensive mid-life care requires a GP to navigate multiple overlapping item numbers — many of which address conditions that share the same upstream risk factors (sedentary lifestyle, weight, family history, smoking) and that benefit from the same clinical conversation. A woman presenting with perimenopause symptoms, elevated cardiovascular risk, and a family history of type 2 diabetes is a single patient with connected concerns, assessed through a fragmented billing architecture.

Dr Michael Wright, RACGP President, told newsGP the current arrangement does not reflect how general practice works. Conditions don’t present in silos, and GPs don’t assess them that way — but the billing structure rewards siloed thinking.

Why uptake has been modest

The Review of MBS Health Assessment Services examined claims data from 2018–19 to 2022–23 and found only modest uptake of most mid-life assessment items. The RACGP noted this in its submission: the items support earlier disease identification in high-risk groups, but complex billing and eligibility requirements reduce how often they are used in practice.

The proposed reform addresses this by simplifying: one item, time-tiered, covering the full terrain. A consultation that covers cardiovascular risk, metabolic risk, perimenopause, and bone health would be billed under a single assessment framework rather than requiring navigation through multiple item numbers — some of which are incompatible on the same day.

This matters not just for administrative efficiency but for clinical completeness. When a GP has limited consultation time and multiple item pathways to navigate, the comprehensive assessment gets traded for the most pressing single concern. A bundled item removes that pressure point.

Both-and

The reform, if enacted, addresses genuine friction. But RACGP President Dr Wright acknowledged that broader mid-life assessments suit longitudinal, relationship-based general practice more than episodic-care settings. Walk-in clinics and high-turnover group practices may find comprehensive mid-life assessments structurally difficult to deliver regardless of billing simplification.

The RACGP’s own submission also identified a missed opportunity in the report: the review recommended age-specific eligibility thresholds, but the college argued that health assessments should be available based on clinical need, not age alone. Cardiovascular disease and perimenopause don’t arrive on a fixed schedule — a 42-year-old with elevated metabolic risk has the same clinical need as a 50-year-old, regardless of whether she has crossed an age-based eligibility line.

The report also recommends assessing whether nurse practitioners should be able to deliver health assessments in workforce shortage areas — a sensible acknowledgement that the GP workforce alone will not meet preventive care demand in underserved communities.

2 cents

Nothing changes today. The Review of MBS Health Assessment Services is a recommendations document, not implemented policy. A government response is expected in the coming months; any regulatory change beyond that would take additional time.

What is available now: if you are in your 40s or 50s and have not had a structured cardiovascular risk assessment, a metabolic risk review, or a perimenopause conversation in the last two years, those discussions can happen within existing MBS items today. Most GPs can incorporate them into a longer planned consultation — but it helps to request the appointment explicitly as a health review rather than booking for an acute concern.

Ask for a dedicated appointment rather than adding it to an acute visit. Come with a list of what you want to cover. The system is imperfect; a well-prepared patient-GP conversation is where it becomes useful.

Verdict: yes — a policy shift worth knowing about if you are in the mid-life window where these assessments converge.

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Sources cited

1. New mid-life health assessment item proposed — RACGP newsGP