NEWS RELEASE - Thursday August 28 2003

Improved Maternity Care & Savings through Midwives and Medicare
Medicare Committee receives evidence on how

In Melbourne yesterday the Maternity Coalition a national community organisation presented oral evidence to the Senate Select Committee on Medicare. "Maternity services account for a considerable slice of the Medicare budget; childbirth accounts for the highest number of hospital bed days", said Joy Johnston, mother, midwife and spokesperson to the committee for the Coalition.
 
"By better use of the midwifery workforce, a saving of an estimated at $200 Million could be made to the federal health budget annually. Maternity care is provided annually for 250,000 women and their babies. Prenatal care is a huge item in Medicare rebates.
 
"Best practice maternity care for the vast majority of women is the care of a known midwife. Medicare unfairly prevents midwives from providing primary care services to women during pregnancy, and therefore prevents most women from choosing this option. Medicare gives an effective monopoly of community based prenatal services to medical practitioners" said Justine Caines Acting National President and mother of 3 young children.
 
"Considering the huge downturn in practice from both general practitioners (GPs) and specialist obstetricians Medicare's restrictions are severely limiting the care women can receive. In rural areas many women are forced to travel many hours not just for the birth, but also their prenatal (pregnancy) care. This puts women at unnecessary risk." said Ms Johnston.
 
"The Federal Government funded rural nurse positions in the last budget. By funding midwives we would not only restore services and support GPs but we would bring best practice to women who often do without care" said Ms Johnston.
 
"The Maternity Coalition proposes the following reforms to Medicare to restore services, improve the quality of care (in line with best practice which only 1% of Australian women currently access) and to help save millions on current obstetric over servicing." Said Ms Caines
  
"We propose that basic maternity services be removed from MEDICARE. 
We propose that a new fund be established to cover basic maternity services. 
We propose that the same services provided by midwives or doctors be eligible for the same rebate through the reformed funding arrangement (as is the case in New Zealand). This would help to ensure that access to basic maternity services is available in all Australian communities, at an affordable cost to the individual consumer and to the public health funding scheme.
 
"A major feature of this proposal is that for the first time midwives would be utilised appropriately (for what they were trained.) Midwives currently are prevented from offering the full scope of midwifery practice. The midwife primary carer is able to identify those women for whom medical attention is appropriate. This change has a potential to reduce the risk of burn-out amongst medical practitioners, as their skills would be more appropriately used. It would also enable specialist obstetricians to concentrate on the complex medical and obstetric needs of those women who need their specialist services. This would lead to more effective use of the obstetric workforce than is the current situation, without any increase in adverse outcomes and a potential benefit to women." 
 
Contact: Joy Johnston 04111 90448 Justine Caines 0408210273 
For More information on the Select Committee into Medicare please contact Chair Sen. McLucas on (07) 40316009

MEDICARE SAVINGS FROM MATERNITY SERVICES REFORM

KEY ISSUES 

• There is potential for reform of Australian maternity services to deliver millions of dollars in savings to the Medicare budget. Savings could be channelled into other areas of healthcare, such as policies to increase rates of bulk billing. 
• While maternity services are largely the responsibility of state and territory governments, a federal government could play a key leadership role in encouraging major expansion of caseload midwifery services across Australia. Such services would lower rates of obstetric intervention in childbirth and thereby lower costs claimed by doctors against the MBS for maternity procedures. 
• The College and the Maternity Coalition are happy to provide the Opposition with research evidence to enable the ALP to analyze the full extent of potential savings 

EVIDENCE OF POTENTIAL FOR SAVINGS 

• Internationally published Australian research confirms that there is currently significant over-servicing of pregnant and birthing women by doctors in Australia.
  • Australia has higher rates of obstetric intervention in labour and birth (including inductions, augmentations, forceps and vacuum extractions, caesarean sections) than other OECD countries that have equal or better rates of maternal and infant mortality. 
  • International statistics show that up to 85% of women in OECD countries are capable of uncomplicated birth. In Australia, fewer than 20% of healthy low risk women give birth without at least one obstetric intervention. 
  • Australia has a national caesarean section rate of 25% (rates in private hospitals can be as high as 50-60%). The World Health Organization recommends that caesarean section is used in not more than 10-15% of births. 
• High rates of obstetric intervention involve higher costs.
  • An Australian study published in the latest British Journal of Obstetrics & Gynecology shows that as interventions in labour accumulated, the costs of birth increase - by up to 50% for low risk women having their first baby, and - by up to 36% for low risk women having a second or subsequent baby 
• Caseload midwifery care has been shown in randomized controlled trials to reduce the use of interventions in labour and birth while being as safe for mothers and babies as standard maternity care
  • Caseload midwifery is where a midwife cares for a caseload of typically around 40 women per year, providing continuity of care to each woman from early in pregnancy, during labour and birth, until 4 weeks after birth) · Caseload midwifery care if widely available to the majority of pregnant women (250,000 each year) would lower costs by: 
  • Lowering intervention rates in labour and birth, especially caesarean section rates (costed at 2.5 times the cost of an uncomplicated vaginal birth) 
  • Lowering the use of specialist anaesthetic and obstetric staff in total births, and associated claims for services against the MBS o Shortening hospital day stays post birth (a state budget expense) o Lowering demand for postnatal care services, especially consultations with doctors for postnatal depression (PND) since women who receive continuity of midwifery care have been found to experience less PND. 
  • International experience bears out the potential for cost savings from continuity of midwifery care being a mainstream option in maternity services 
    • E.g. in New Zealand, there has been an annual saving of $3million (NZ$13million) over each of the last 5 years since reforms were introduced giving women access to caseload midwifery care through the public health system
• Expanding midwifery care models would also address workforce issues:
  • AHWAC has found there is currently a shortage of 1847 midwives and the average age of the workforce is 45 years 
  • Currently midwives are limited in their employment options. Most midwives work within either public or private institutions that offer high cost, low efficiency roster based systems of work that fragment the care provided to women. Caseload midwifery would increase the options for midwives and also for women receiving this care, and help to attract and retain midwives.

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EXAMPLES OF POTENTIAL COST SAVINGS

Annual Australian births: 250,000

This does not include any antenatal, postnatal, readmission to hospital or neonatal intensive care services.

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