Diabetes reform plans do not please the AMA

By Dr. Ananya Mandal, MDJul 11 2010

In a bid to reform the way long term illnesses like diabetes are managed in Australia, the federal government announced a $436 million scheme to be introduced from 2012. This scheme would entail paying GPs $1,200 a year for each patient whose care they co-ordinate. The scheme would allow the inclusion of services of other specialists like dietitians, podiatrists and physiotherapists to develop a more personalized and comprehensive care. GPs would also be paid performance bonuses for keeping patients out of hospital. However the doctors are not happy with this scheme. Nearly 88% of them in a national survey say they would oppose patients enrolling in the scheme.

Survey result

The Australian Medical Association has asked for the removal of the scheme even before it can be considered. It has claimed that this scheme would take away the Medicare entitlements of these patients and restrict their choices. The national survey included 500 GPs and was conducted last month. The results showed;

• 2% believed that this scheme would result in doctors being able to spend more time with patients
• 2% felt it was an improvement on existing Medicare arrangements
• 4% were willing to participate in the scheme.
• 32% were unsure

AMA vice-president Steve Hambleton said the survey reinforced the association's opposition to the scheme. “From day one, we have said this scheme will not deliver better care for patients with diabetes,” he said.

The scheme was announced this March and the federal government is expecting more than 4300 general practices, including about 60 per cent of GPs, to join up. The government also promised a further $6.5 million over the next five years for the Diabetes Vaccine Development Centre to continue its work to develop vaccines that prevent or delay the progress of type 1 diabetes.

A spokesman for the Health Minister, Nicola Roxon responded to AMA reaction to the scheme saying that the government needs to make “no apology for putting the interest of patients first” and would be working closely with Diabetes Australia and health professionals before finer details are ironed out.

Ms Roxon, supported by Diabetes Australia's Victorian branch head Greg Johnson, emphasized that the proposal did not move away from Medicare. “It's a shift for us to blend payments so that there are Medicare payments and bulk payments which allow GP practices to be more flexible in the way they spend their money.” Mr. Johnson feels that there is still time to work on the tiny flaws if any in the design. “We noted that the program doesn't start until 2012 so we believe there's plenty of time for us to get the design right,” he said.

Support

Australian General Practice Network chairman Emil Djakic supports this scheme. Dr. Djakic said that there are over 1 million Australians with diabetes today and the figures would be 2.2 million by 2020 and something needs to be done. In his statement he said, “It would be remiss of the medical profession to reject what the government has on the table…We have time to design a system that works for patients and the profession, but we need to start now…It is time for the government to put in place the working party and consultation mechanisms it promised to ensure the effectiveness of the new system…Without voluntary enrolment and flexible funding options, diabetes patients end up with serious consequences of their disease, which contributes to Australia's astoundingly high hospitalization rates.”

Support is also offered by the Australian Nursing Federation. Secretary, Lee Thomas said general practice nurses would, under the scheme be able to “use their considerable expertise to manage and improve the health of enrolled patients with diabetes” and thus help patients and specialists. “There is no doubt that we need change to improve chronic disease management and preventative healthcare. The best way to achieve this is through a flexible approach to treatment,” Thomas said.