Hi Marina,
I would suggest that as a voice for the consumer you could make a strong
issue that the current funding does not allow the woman an equal choice
between the standard medical / hospital models and other evidence based and
appropriate models. The monopoly of medical care prenatally - because of
medicare funding, and hospital care for the birth, followed by patchy bits
and pieces of services for those who can access care - does not in many
cases provide best care for the woman and baby.
The only way I can see out of this is that the policy makers look at it from
first principles. Birth is not an illness. Maternity services require a
unique, purpose built process. Each woman who is pregnant should be
entitled to a basic service, which is adequate for primary care, and to
which realistic funding is attached. This is where that woman has choice.
She should choose, as New Zealand women do, the model of maternity care, and
a lead maternity carer. That carer either follows through with the total
provision of care (as midwives are able to do for well women and babies) or
accesses the services of other professionals. If a doctor is the lead
carer, and does not wish to provide personal continuity of care through the
birthing episode, the doctor pays the midwife an agreed sum. If
complications develop there would be additional funding which can be
accessed, as in the current medical system.
I understand that there were early funding problems in NZ, in that some
people were doubling up on services - midwife and doctor when this was not
necessary. There may be some NZ people on the list who could give us more
information. This has been stopped, but the word got out about the funding
blowout in NZ. Carol mentioned this double dipping in her submission.
Women who 'choose' a service that charges more than the public funding
allows would pay the extra themselves.
Another funding issue that should be tackled by the Senate committee is the
excessive use of public money for obstetric ultrasound. Why is this
allowed, when there is no evidence that outcomes are improved? If every
woman had the 'right' to one funded ultrasound (I don't agree that every
woman needs one, and I am not sure that it is a safe procedure), and any
subsequent referrals for ultrasound had to be supported by indications from
an agreed list, the budgets would certainly be more readily kept in control.
The ACMI Fellows Forum (which is a fancy word for a bunch of committed
midwives) has asked me to lead a group looking at funding issues and
hospital visiting access for midwives, and Kate Cook from WA is helping me.
Please help us as much as you can by putting your ideas and suggestions to
this discussion, on the list. This generates a broad overview, and the
comments of people coming from different perspectives are very valuable.
So thanks in anticipation
Joy Johnston
-----Original Message-----
From: [EMAIL PROTECTED]
[mailto:[EMAIL PROTECTED]] On Behalf Of HomeMidwifery
Association
Sent: Thursday, 9 September 1999 13:00
To: [EMAIL PROTECTED]; [EMAIL PROTECTED]
Subject: Re: Senate Inquiry VERY IMPORTANT
Hi folks,
I'm totally lost on the issue of public funding but willing to pass on the
info during our 40 minutes if someone can provide the necessary details.
Marina
----Original Message Follows----
From: "Carol Thorogood" <[EMAIL PROTECTED]>
To: <[EMAIL PROTECTED]>
Subject: Re: Senate Inquiry VERY IMPORTANT
Date: Wed, 8 Sep 1999 18:58:58 +0930
Dear all
Have just returned from the Senate Select Committee hearing. I represented
the WA ACMI. There's no doubt the committee has read the submissions and are
thinking about issues. Most of my questions came from Sue Knowles and
Rosemary Crowley. I found it difficult at times to separate the me hat from
the ACMI hat. This was harder when some of the questions were What is your
opinion of... and the ACMI doesn't have a stock/united policy.
VERY IMPORTANT After the hearing it was suggested to me that we midwives
must present to the Senate models which show how Federal money can best be
used to fund services - sort of like the ABSP. I just can't do it at the
moment. Maybe we need a joint submission. I get the impression that the
Committee wants ideas about finding sources of money and then ways of using
it. Can this be done by the next hearing? The crux of it is that they want
us to do the work! We've done it all before so can we do it again?
The rest of this post is about my/ACMI (WA) submission.
In my five minute blurb I concentrated on the need for maternity services
that reflect womens' expressed needs etc etc. I used a primary health care
model to show that not all women have services that are equitable,
accessible, appropriate affordable etc etc. I then gave three examples of
this ie homebirth, only two birth centres in WA and none in the rural areas,
inadequate or even absent services for women in remote and rural areas.
Not all the Committee's questions were related to the submission so I had to
think a bit. They asked if DEM educ'n would improve relations with the
medical profession (my answer No)! I think they were a bit surprised at my
somewhat gloomy prognosis about positive relations with our medical
colleagues. I started hedging a bit and talked about my 'colleagues'. But,
RC said which ones? I answered.
There were quite a few questions about accreditation of midwives (visiting
privileges) costs of programs ie homebirths and other midwife managed
services. Another was why did I think the midwives were so old! I said that
I think (but as yet little evidence to support it in mid but if general is
anything to go with) that the midwives and nurses leave the profession in
droves because of dissatisfaction with their working conditions etc. I used
Kalgoorlie (hello Kal) to show that if the work is satisfying and they are
able to practice midwifery as they wuz taught they will stay. So it isn't a
matter of bringing in 'young students' but of finding ways to make 'em stay!
Other comments were about the 'routinisation' of technologies/services,
anti-competitive behaviours, lack of appropriate information on which to
make informed choices; too much money being spent on something to the
detriment of others ie antenatal care etc.
I tried to make the point that in some quarters midwife managed care is
considered an expensive luxury for an elite group. Midwife led services
should be 'instead of' rather than 'as well as' ie it is not an adjunct to
obstetric services but a model of care in its own right. I'm not sure if it
came out like that but that's what I meant!
That'll do for now. It is a bit scary but far from unpleasant. By the way
submissions are the property of the Senate and can't be published. We can
only comment on what is open to the public.
Thanks to those who gave up their time to listen and be supportive
afterwards!
Carol
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