AUSTRALIAN COLLEGE OF MIDWIVES
Advocacy Update
11 August 2005
Federal Health Minister requested to consider Medicare Numbers for
Midwives
Leader of the Australian Democrats, Senator Lyn Allison and Barb Vernon
from
the ACM met yesterday with Federal Minister for Health Tony Abbott. The
meeting focused on three related issues:
1. the ongoing problem of a lack of professional indemnity for
midwives,
2. the lack of access for midwives to public funding for their
professional services (i.e. Medicare Provider Numbers), and
3. the ACM
<http://www.pc.gov.au/study/healthworkforce/subs/sub099.pdf>
's submission to the Productivity Commission Inquiry into the Health
Workforce.
Senator Allison opened the meeting by outlining the negative effects on
women of an ongoing lack of access to indemnity for midwives. There was
discussion about whether the Medical Indemnity Act, which provides for
subsidies to doctor's indemnity premiums and for the payment of 50% of
successful claims above $2m, would apply to midwives if they were able to
secure an indemnity policy. The Minister indicated the Act relates only
to
doctors. Mr Abbott reiterated his view that there is no role for the
Commonwealth in assisting midwives to gain indemnity because 98% of
midwives
have indemnity through their employer, and because the Commonwealth is not
a
provider of insurance.
Barb Vernon summarised the pressures facing rural maternity services. She
flagged the benefits that would arise if the federal government supported
midwives to provide private midwifery services to women, especially in
communities that currently lack maternity care, by providing access to
Medicare rebates for relevant services. The Minister identified that he
was
prepared to consider ways in which midwives services might be supported
through midwives being employed by a GP or specialist obstetrician, whose
insurance would cover the midwives work. This option was not advanced by
either Senator Allison or Barb Vernon, but was one the Minister thought of
in wanting to ensure any moves in this area fit within existing policy
arrangements.
Senator Allison proposed that it would be important in any new arrangement
for midwives to have direct access to public funding and indemnity, and
for
women to have direct access to midwives. The Minister suggested that it
might be possible to develop a model similar to that currently used for
the
Medicare allied health and dental care initiative. This initiative
involves
GPs referring a person to certain allied health professionals and, where
certain conditions have been met, the allied health professional has a
Medicare provider number. The Minister has committed to providing more
information on this issue
Barb Vernon proposed that the government should analyse existing Medicare
payments for maternity services, which have been rising on a per birth
basis
over the past 10 years, and summarised evidence of over-servicing of
healthy
women by obstetricians. She also summarised the key argument in the ACM's
submission to the Productivity commission that the skill mix in maternity
services is currently unsustainable, and that we need to reserve the
skills
of obstetricians for the minority of women who need obstetric care and
expand the role of midwives in providing primary care to the healthy
majority of women. The Minister did not agree with this argument, and
represented obstetricians as being the ideal provider of maternity care
given their ability to provide care to both healthy women and those with
complications.
The Minister acknowledged at the end of the meeting that there is merit in
the proposal that there should be a national maternity services policy, in
light of the fact that through its Medicare contributions, the
Commonwealth
is a major player in the provision of maternity care across both the
public
and private sectors. He did not, however, commit to developing a policy.
The College acknowledges with thanks the invitation from Senator Lyn
Allison
to accompany her to this meeting, and her ongoing interest in finding
solutions to the problems affecting midwives and women.
Dr Barb Vernon
Executive Officer
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