Crackdown on doctor rorts: IVF and Obstetrics

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MEDICAL specialists will come under pressure to cut fees for some services - especially in obstetrics and IVF - under a plan in next Tuesday's federal budget to crack down on rorting of the Medicare safety net.

Under the changes, patients charged excessive fees will have new limits put on how much they can claim back on the Medicare safety net. This could leave some people facing large out-of-pocket expenses for obstetrics, IVF... and some other services if they use high-fee specialists.

But the Government hopes its crackdown, rather than penalising patients, will instead put pressure on high-end specialists to moderate charges.

As an incentive to specialists to cut fees, the Government will increase the cap on its coverage of the services - in effect, raising the base level of its rebate.

... Since the advent of the safety net, fees have leapt by 290% for IVF and 40% for obstetrics - giving rise to claims that the system is being rorted.

... Areas targeted for cuts include artificial reproductive technology (IVF), obstetrics and varicose vein treatment, identified in a report into the scheme.

... The net will continue to cover 80 per cent of patients' out-of-pocket costs once they reach the threshold - but only up to a new limit in "capped" areas.

... The review found that the safety net benefits were going excessively to some specialists.

For some obstetrics and IVF services, of every dollar spent on the safety net, "78 cents is going to providers and only 22 cents to reducing patients' costs", the review said. Providers knew patients were likely to qualify for the net and felt "fewer competitive constraints on their fees".

Between 2003 and 2008, the average fee charged for planning and management of an artifical reproductive treatment cycle increased from $294 to $1148. The average obstetrics fee for planning and management of a pregnancy rose 40 per cent between September 2004 and 2008 - from $1238 to $1732.

Specialists' incomes in these areas have soared. In 2008, the highest 10 per cent of IVF specialists were paid $4.5 million each through Medicare - including $2.2 million through the safety net.

In addition to providing incentives to moderate fees, the higher obstetrics medical benefits are also designed to give more incentives for obstetricians to practice in under-serviced areas ...

It will be interesting to see the added effects if the changes proposed in the Maternity Services Review are implemented. Those changes will provide private midwives with the right to order tests, prescribe medications and bill through Medicare. In effect, women will have the choice of the public health system, a private obstetrician, or a private midwife. Private midwifery will no doubt be far cheaper for women than private obstetrics, and will confer greater benefits in terms of: - lower rates of postnatal depression - lower rates of birth trauma - lower rates of intervention in pregnancy and labour, and lower rates of complications from said intervention - higher rates of natural birth - higher rates of breastfeeding - higher rates of birth satisfaction from women - less birth trauma for the baby - lower rates of admission to special care nursery for the baby - fewer antenatal (pregnancy) admissions to hospital - more care provided in women's homes than hospitals - lower caeasarean, induction, epidural, episiotomy, forceps and vacuum rates - higher rates of VBAC - true continuity of care - even with private obstetrics, you are cared for by midwives you have not met before; with private midwifery, all your care is with the same midwife who you've chosen - more choice and control in birth