Maternity Services Reform: Fantastic news for hospital birth and private midwifery

For further information, contact Melissa Maimann at Essential Birth Consulting. From the budget .... significant changes that will see midwifery recognised as a profession in its own right. The proposal does not cover home birth, only hospital birth with a private midwife. But it's a significant shift from the current delivery of services to a more woman-friendly approach. The finer details have not been ascertained as far as I can tell, and many questions remain unanswered, such as:

- which midwives will be eligible for medicare funding and access to PBS and insurance? - does it cover private hospitals ot only public hospitals? - how will the midwife demonstrate collaborative care?

The Government is providing $121 million over four years to reform maternity services to increase access for women and their babies to collaborative models of care, such as through greater involvement of midwives. This new spending has been achieved by removing excessive cost pressures in the health system.

The Government will provide $120.5 million over four years for the introduction of Medicare‑supported midwifery services to provide greater choice for women during pregnancy, birthing and postnatal maternity care. This measure includes $3.1 million in capital funding in 2009‑10 for Medicare Australia.

The new arrangements will allow midwives to work as private practitioners, provide services subsidised by the Medical Benefits Schedule and prescribe medications subsidised under the Pharmaceutical Benefits Schedule. The Government will also provide subsidised medical indemnity for eligible midwives working in collaborative arrangements in hospitals and healthcare settings. To ensure that Australia maintains its strong record of safety and quality in maternity care, a safety and quality framework, including professional guidance and an advanced midwifery credentialing framework, will be developed. A new 24‑hour, seven‑days‑a‑week helpline will also be established to provide antenatal, birthing and postnatal maternity advice and information to women, partners and families during the ante‑natal period and up to 12 months following the birth of a child.

The measure will also assist women in rural and remote areas by expanding the Medical Specialist Outreach Assistance Program to provide integrated outreach maternity service teams for women in under serviced areas. The expanded teams will include midwives, obstetricians, general practitioners and other health professionals, such as paediatricians and Aboriginal health workers. Additionally, funding will be provided for the professional development of midwives and for general practitioners to undertake additional training to become GP obstetricians or GP anaesthetists. The package will be implemented progressively from 1 July 2009.

The Government also understands that maternity services in Australia are under growing pressure as the number of births continues to rise and workforce shortages worsen and that many Australian women are frustrated at the limited choices available to them for their maternity care. Limited access to maternity services in rural and remote communities is also a growing concern. To address these issues, the Government is investing $121 million over four years to reform maternity services to increase access for women and their babies to collaborative models of care and to involve midwives in a more substantive role. This package makes it possible for the Government to make better use of the maternity workforce, ensuring that the right professionals can provide the right care at the right time in the right place.

The current EMSN meets 80 per cent of the out‑of‑pocket costs for out‑of‑hospital Medicare services once an annual threshold is met. This is regardless of how much the doctor charges. In 2007 it is estimated that up to 78 per cent of EMSN spending went to meeting providers' higher fees, rather than reducing patients' out‑of‑pocket costs. EMSN expenditure on the items to be capped has grown at an average rate of approximately 50 per cent for the past two years.

The new EMSN caps will apply on all related items, including pregnancy‑related scans for example, to ensure that specialists do not shift their high fees to items that are not covered by a cap. In conjunction with the introduction of the cap, the Government will increase Medicare Benefits Schedule items for obstetrics to reduce the incentive to charge excessive fees. The cap per Medicare Benefits Schedule item will be set at different levels depending on the schedule fee of the item. Cap amounts will be indexed on 1 January by the Consumer Price Index, consistent with safety net thresholds. Should a patient claim an item more than once in a calendar year (for example, ante natal attendance), she would be eligible for the same maximum EMSN benefit each time she claimed the item.

It seems that the incentives for obstetric care are diminishing, and the incentives for midwifery care are increasing. Hopefully this will encourage women to pursue midwifery care, resulting in a lower caesarean rate, lower postnatal depression, higher breastfeeding rates, lower rates of induction, epidural, episiotomy, forceps, vacuum deliveries .... the list goes on!

Melissa Maimann, Essential Birth Consulting 0400 418 448