Saturday, October 18, 2008

Maternity Services Review Question 7. How is current Commonwealth funding targeted?

Current Commonwealth funding for maternity services supports a deeply embedded funding monopoly which directs healthy pregnant women into private medical care, and obstructs women who seek primary maternity care from a midwife. This targeting of government funds is, we believe, contrary to the Trade Practices Act, and should be reformed as soon as possible.

The fact that the government’s funding monopoly supporting the one competing professional care provider, the doctor, and all but excluding the midwife is in breach of the Trade Practices Act was clearly pointed out by Professor Allan Fels in 1998, when he was Chairman of the Australian Competition and Consumer Commission (ACCC),
"competition policy is based on the premise that consumer choice, rather than the collective judgment of the sellers, should determine the range and prices of goods and services that are available. Or in other words that competitive suppliers should not pre-empt the working of the market by deciding themselves what their customers need, rather than allowing the market to respond to what consumers demand."

The role of the ACCC includes
"looking at health professionals' conduct to determine whether it promotes or hinders patients' interests in being able to choose among a variety of service and price options according to their needs."
(from The Trade Practices Act and the Health Sector, Australian College of Health Service Executives, 1998.)

The following list uses the government’s funding items listed in the Review’s Discussion Paper, and briefly outlines the way in which these items support a funding monopoly that is not in the interest of the consumer of maternity services.

1. Medicare Benefits Schedule Applies only to doctors, and excludes midwives. The woman who seeks maternity care from a midwife is required to pay the fee independently
2. Extended Medicare Safety Net Applies only to the fees charged by doctors, and is particularly useful in rebating part of the large booking fees charged by obstetricians for private maternity patients, many of whom are low risk and their care needs are within the scope of midwifery.
3. Private Health Insurance Rebate This rebate supports the monopoly of obstetrics over healthy pregnant women, as in #2 above.
Few private health insurance companies offer rebates for midwives services. Most women who seek the care of a midwife privately pay for that without any rebate.
4. Australian Health Care Agreements Most public hospitals accept doctors providing private services, but exclude midwives. The only midwives who can attend women in hospitals are those employed directly by the hospital.
5. Support for professional indemnity insurance The Federal government’s ‘rescue packages’ in the early 2000s, after the collapse of United Medical Protection, included large annual sums under the Policy Support Scheme to support obstetricians and rural procedural GPs who are the mainstay of rural maternity services. No such rescue packages have been available to midwives, who practise without indemnity insurance. In Northern Territory, where professional indemnity insurance is mandated, independent midwifery is illegal.

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