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."


QUESTION: WHAT SHOULD A MIDWIFE WHO WISHES TO BE ELIGIBLE FOR MEDICARE DO?




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.