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The Guardian - AU
The Guardian - AU
Melissa Davey Medical editor

Pregnant women increasingly left out of pocket by Medicare antenatal consultations, doctors say

Pregnant woman
The Royal Australian College of General Practitioners there have been major advances in antenatal care but Medicare patient rebates have not kept pace. Photograph: Tracey Nearmy/AAP

Expectant mothers are unable to afford some antenatal consultations, the peak body representing GPs says, as doctors call on the federal government to raise the Medicare rebate.

Dr Karen Price, the president of the Royal Australian College of General Practitioners [Racgp], says there have been significant advances in antenatal care over the years but Medicare patient rebates had not kept pace with the costs of providing it.

In a letter to the health minister Greg Hunt, Price said designated Medicare items for antenatal care – which pay $41.70 regardless of the duration of the appointment – do not reflect the growing complexity of consultations during pregnancy.

“Antenatal consultations today involve extensive monitoring of health problems and potential complications, such as diabetes and anaemia,” she said.

“GPs also provide advice on nutrition and physical activity and help prepare the new mother for childbirth and breastfeeding.”

As a result, Price said, antenatal care is often highly complex and consultations can extend well beyond 20 minutes – the time covered by the rebate.

“This is particularly true for vulnerable and disadvantaged patient groups, such as those in rural and remote communities, Aboriginal and Torres Strait Islander patients and culturally and linguistically diverse patients,” she said.

“However, current Medicare funding for patients does not allow for longer consultations.”

Price said she wanted the government to amend level C and D Medicare Benefits Schedule general attendance items, which are for longer GP consultations, so that GPs can use them for antenatal appointments that are longer than 20 minutes.

Guardian Australia has contacted Hunt’s office for comment. A Department of Health spokeswoman said the department has already had preliminary discussions with representatives of the RACGP on this matter, and will continue to work with them.

“Expectant mothers have a multitude of options available to receive antenatal assistance in Australia, including and in addition to the GP network,” the spokeswoman said.

“They can receive antenatal, birthing and postnatal care through the public health system, privately, or through a combination of public and private services under shared care arrangements. Care can be provided by midwives, GPs, GP obstetricians and specialist obstetricians.

“In addition, obstetric services are part of universal telehealth, providing further options for mothers to find the appropriate level of care required for their needs. These telehealth items apply for nurses, midwives and obstetricians, as well as GPs. A number of other rebates are also available for expectant mothers receiving care from specialist obstetricians and privately practicing midwives.”

There have been calls for rebate increases in a number of areas. A Senate committee’s interim report into GP and related primary health services in outer metropolitan, rural and regional areas recommended substantially increasing Medicare rebates for general practice consultations.

After last month’s federal budget, the Australian Association of Psychologists called for the Medicare rebate for clients of all psychologists to be raised to $150.

But Margaret Faux, a lawyer and expert in Medicare claiming and compliance, said any further changes to Medicare item descriptions and rebates should not occur until structural problems within Medicare are first addressed.

Faux said the entire Medicare billing system was in need of reform, with some health providers failing to bill correctly because the system was so complicated.

“Changing the descriptions of level C and D consults is highly technical and complex work and if rushed may worsen the already challenging compliance issues that GPs face,” she said.

“A better solution, in the short term, is to use existing Medicare Billing Scheme item numbers and enable co-claiming.”

Co-claiming is when two Medicare item numbers can be claimed at the same time, such as a consultation and stitching a laceration.

In the case of pregnant women, Faux said, it should be made possible to claim, for example, one item for clinical needs and another item for mental health needs.

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