Sunday, July 25, 2010

Collaborative arrangements for midwives eligible for Medicare funding

The National Health (Collaborative Arrangements for Midwives) Determination 2010 has now become law.

Midwives who anticipate taking up the provisions of this reform, and applying to be eligible for Medicare funding and other extensions to practice from 1 November 2010 now have a clear process to follow.

Concerns about a potential medical veto have been raised repeatedly in discussions, email groups, and submissions to the law makers. The Queensland Branch of Maternity Coalition has published a blog post outlining these matters.

"The Determination provides 4 options for collaborative arrangements. Each option requires the midwife to have some form of permission from a doctor, before a woman can receive Medicare rebates.

"The minimum form of permission is an "Arrangement - midwife's written records" (section 7 in the Determination). This option requires a named doctor of a specific type to acknowledge "that the practitioner will be collaborating in the patient’s care", and that the named doctor has received copies of a hospital booking letter and a maternity care plan.

"These requirements will make it very difficult for women to access Medicare-funded care from midwives in private midwifery practice. We don't expect midwives in private midwifery practice (working for themselves, not a doctor) to be able to find private doctors who are willing to enter collaborative arrangements with them. In some cases this may be possible under very specific conditions. However it is unrealistic to expect that private doctors will collaborate in the care of women planning homebirths.

"Even for women planning births in public hospitals, these requirements for collaborative arrangements will make it extremely unlikely for them to be able to access Medicare-funded midwifery care. There is no reason to expect public hospital doctors to enter the required collaborative arrangements with private midwives. They have no incentive, and there is no sign that state governments are planning to push them.

"In March 2010 when the Senate was debating this legislation, the Government stated that "There is no intention to provide a right of veto over another health professional’s practice". However, under intense pressure from the medical lobby, this is exactly what has occurred. Most importantly, it is women's choices and access to care which are being vetoed, to protect medical control of the maternity marketplace.

"If these reforms are to deliver the "choice and access" promised to Australian women by Government, the medical veto must be removed. Midwives must be accountable to the women they care for, and to their regulating body, not to another profession."


Midwives who wish to be authorised will need to approach doctors and hospitals in their area, obtain agreement, and prepare care plans that meet the legal requiremens established in this Determination.

A new website, Midwives Australia, has up to date information on Medicare eligibility.

The Queensland branch of the Australian College of Midwives has announced a pre-conference workshop on Medicare for midwives. Click here for details.

1 comment:

Joy Johnston said...

Australian College of Midwives
Collaborative arrangements – cause for concern

From 1 November 2010, midwives will be able to provide Medicare funded care to women in the community and in hospitals, thanks to major reforms legislated by the government in March this year. The Australian College of Midwives commends the Health Minister Nicola Roxon for giving women wider choice with these important reforms.
“We remain very concerned however that the recently released secondary regulations known as the ‘National Health Collaborative Arrangements for Midwives’ could hinder the Health Minister Nicola Roxon’s intentions for maternity reform,” said Associate Professor Hannah Dahlen, President of the Australian College of Midwives
“We are yet to see whether doctors will be willing to collaborate with midwives and whether they will use this arrangement to try and control midwifery practice and impact on women’s childbirth choices.”
“We know that women and their babies experience measurable benefits from one-to one care from a midwife but midwives now can’t take up this historic opportunity to provide Medicare services without a collaborative arrangement with a doctor or doctors.”
“The potential ramifications are that there will be reduced choice for women if doctors veto options such as vaginal birth after caesarean or homebirth, and added risk as women may refuse to engage with maternity services when needed and midwives could feel pressured into practices women do not want.”
“We are most concerned about the effect of these collaborative arrangements on women living in rural and remote communities where there may be no doctors at all or doctors on short term contracts that the midwife will constantly be trying to negotiate with. There is a real risk now that midwives will not take up the government’s reforms and they will fail.
“We will be watching the impact of this legislation closely and are asking our members to report any cases where the medical profession uses the arrangements to control midwifery practice or deprive women of choice. The Minister for Health has made it clear that she has no desire to see a medical veto over midwifery practice and we will be making sure that she keeps her word on this.”
“States and Territories must now come to the party and develop state-wide Clinical Privileging and standardised hospital access agreements so midwives can provide care for women in hospitals without all the current barriers they face. We encourage them to facilitate this process and to assist midwives to make these collaborative arrangements work for the sake of women and for the future of evidence based maternity reform in our country.
The Australian College of Midwives commends the National Health and Medical Research Council on the soon to be released National Guidance on Collaborative Maternity Care. A multidisciplinary committee, that most importantly involved consumers, has developed this document. This document is an evidence-based guide to collaboration that will help clinicians to provide women with care that puts them at the centre where they rightly should be.

Australian College of Midwives