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The AMA may be smiling but not everyone is happy about Government’s backdown on diabetes reform

After the federal election, AMA federal president Dr Andrew Pesce’s blog on the AMA website stated that the new political dynamic “may even make the AMA’s influence over health policy stronger than it already is”.

So what to make of Health Minister Nicola Roxon’s recent back-down on plans to overhaul diabetes care?

Roxon buckles to AMA stance was the verdict of headline writers at The Age.

Robert Wells, Director of the Menzies Centre for Health Policy and Director of the Australian Primary Health Care Research Institute at the ANU, is not impressed. Delaying the introduction of such an important innovation is not smart policy, he says.

Robert  Wells writes:

The diabetes care measure announced in the 2009 Budget was one of the true reform measures in the whole health reform agenda. It was informed by extensive evidence about best practice in the management of chronic diseases.

The measure as announced in 2009 included a voluntary enrolment incentive so that patients would sign up with a particular practice to ensure continuity of care and an annual lump sum payment to the practice to provide that care, including capacity within that to fund support care from health professionals outside the practice (eg podiatrists).

The measure had a long lead time – implementation from July 2012 – and an expert committee under the chairmanship of the Chief Commonwealth Medical Officer was established to advise on detailed implementation.

It was a surprise therefore that, unexpectedly, the Government announced on 12 November that there would be a trial of the measure to take 3-4 years and cost several millions of dollars before any implementation would occur.

This announcement was most odd, particularly as little detail was made available as to the nature of the trial and what it would be designed to demonstrate.

In its welcoming announcement, the AMA clearly envisages a ‘clinical trial’, which suggests that it is intended to demonstrate the efficacy of management of diabetes patients in primary care – which seems to have been well demonstrated already.

At the time, there was considerable professional disquiet about some aspects of the program, principally how such a measure might fit into the existing Medicare arrangements and how care for patients’ diabetes could be isolated from their overall health needs.

These are important concerns and might well need further analysis and some on the ground testing.

However, a full blown ‘clinical trial’ would not necessarily be the best means of responding to these concerns.

It is disappointing that the Government has, in effect, deferred indefinitely this important innovation at a time when chronic disease, diabetes in particular, is one of the major health risks for Australia.

It is to be hoped that there will be a transparent process for progressing the new approach and the possibility of that being staged so some elements of the original measure might be put back on the agenda earlier than the 3-4 year time horizon.

Comments 4

  1. Jennifer Doggett says:

    It is very heartening to see the AMA championing the cause of evidence-based policy. I’m now looking forward to their support for an evaluation of the PHI rebate to assess whether or not the billions funnelled into this scheme are delivering value for money.

  2. Andrew Pesce says:

    Mr Wells’ opinion misrepresents the AMA’s position.
    The AMA is not disputing the efficacy of managing diabetes in primary care, and nothing in our comments on the announcement of the proposed trial suggests this.
    http://ama.com.au/node/6199
    What we have said is that there is no good evidence that the diabetes plan as announced would improve the overall delivery of necessary services to patients with diabetes, and risks unintended negative outcomes. International evidence on capitated funding and patient enrolment reveals mixed outcomes, some positive and some negative. A 2009 Cochrane review of different models of funding primary care (1) concluded “There was no evidence … concerning other important outcomes such as patient health status.”
    There are several models of co-ordinated primary care which might improve the health outcomes of people with diabetes. Decisions on how to improve services should be informed by evidence, and that evidence does not currently exist in Australia.
    The AMA has consistently said that a trial is needed to assess models of funding and service provision for all people with chronic illness, not just diabetes.
    It is for these reasons that the AMA supports the Minister’s decision. In an area where there is significant disagreement with the previously announced plan (including from RACGP, AGPN, RDAA, and ACCRM) a properly conducted trial will provide evidence upon which to base the government’s final decision.

    Dr Andrew Pesce
    President,
    Australian Medical Association

    1. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Gosden T, Forland F, Kristiansen I, Sutton M, Leese B, Giuffrida A, Sergison M, Pedersen L Cochrane Collaboration 2009 Wiley and Sons

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Australian Palliative Care Conference
2018 conferences
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