Midwives seek access to Medicare

MIDWIVES will challenge doctors' financial monopoly over birth and pregnancy after a new government report proposed they be allowed to bill Medicare and the Pharmaceutical Benefits Scheme for their services.

Kevin Rudd's maternity services review will today deliver a long-awaited report that could dramatically increase opportunities for Australia's 12,000 midwives to set up their own practices, consult to public hospitals and provide subsidised services from private hospitals for expectant mothers.

It has left the door open to setting up midwives as the only Medicare billers who may operate without a GP referral -- a privilege so far denied medical specialists. And it could also give midwives the right to write subsidised prescriptions and order MBS blood tests and ultrasounds.

The Government's chief nurse, Rosemary Bryant, who chaired the review, used the report's foreword to predict resistance to its recommendations. "I am conscious that the findings of this review may not satisfy all contributors. Nonetheless, the case for change is unarguable," she said.

Doctors in rural and remote areas can currently claim a government rebate for antenatal services provided on their behalf by midwives, but the latter profession has no direct access to Medicare or the PBS in its own right.

The Australian Medical Association wants government funding of midwifery services expanded only if they remain under medical supervision.

Obstetricians also strongly object on safety grounds to separate Medicare access for midwives who operate their own practices.

Midwifery groups, on the other hand, prefer a New Zealand-style system where each pregnant woman receives a certain amount of funding and is given the choice of provider, whether midwife, GP or specialist obstetrician.

But their wish lists allow for separate Medicare billing for services provided by midwives, without GP referral, as a compromise option.

Federal Health Minister Nicola Roxon has made no secret of her desire to expand the roles of nurses and midwives, bringing her into sharp conflict with the AMA. She said Australia could not afford to be complacent about its maternity services, despite their high standard.

"I'm determined that our kids are given the best start in life, and that will be the focus of the Rudd Government's actions," she said.

"That means giving women the choices they need, wherever they live, and whatever the challenges confronting them."

The review report, however, requires that midwives work as part of a team, involving doctors in some way in the care of expectant and new mothers. It also demands a higher standard of training from midwives given access to Medicare and the PBS. And it rejects government rebates for home births, which means parents who choose the option will continue to pay its full costs.

The report offers the prospect of government support for professional indemnity insurance for midwives, acknowledging their current inability to secure cover for independent practice.

The Australian reported earlier this month that Canberra was considering underwriting insurance for independent midwives, before the July 2010 start date of a new national registration scheme for the profession.

The review also proposes an expansion of indigenous maternal health services.

By Siobhain Ryan

Article from www.theaustralian.news.com.au