Midwives, rural medical staff gain

More power for midwives and a $134 million program to attract health professionals to regional and rural areas are the big surprises in the health budget.

But the former may prove controversial, with doctors expected to be unhappy that medical decisions could be taken out of their hands.

In a $120.5 million package, midwives will get access to Medicare payments, and be able to prescribe pregnancy and birth-related medicine under the Pharmaceutical Benefits Schedule. They will also get subsidised medical indemnity insurance, except in the case of home births. The package also comes with a new 24-hour phone helpline for pre and post-birth advice.

Health Minister Nicola Roxon said it would quickly lead to more and better options for mothers-to-be, especially in rural areas where doctors are scarce. The midwives plan comes into effect in November 2010, by which time the Government hopes to have combined it with a National Maternity Services Plan: agreements with the states that they will provide new money for birthing centres and rural maternity units.

The package is likely to meet resistance from the Australian Medical Association, which has warned that giving midwives more independence could risk the health of mother and child by pressuring women into natural delivery.

However, Ms Roxon said the maternity changes were about increasing the number of safe choices for women.

"This is a cautious move, but it's the direction that workforce reform is moving," she said. "We want to work with doctors to ensure this is done in a responsible way. It's up to them to be a part of it, or criticise from the sidelines."

Doctors are also likely to be unimpressed by a move to give all nurse practitioners (expert nurses) access to the Medicare benefits schedule and PBS from November next year, costing $59.7 million over four years. However, they will be happy with a $134.4 million rural workforce strategy, intended to encourage doctors, nurses and other health professionals into rural and remote areas using salary bonuses.

Long-feared changes to incentives for rural practitioners had been expected to leave many doctors worse off in Victoria, because they altered incentives on a sliding scale based on distance from a big city. But Ms Roxon guaranteed that, thanks to grandfathering of existing incentives and the extra funding, not one Victorian doctor would end up worse off.

"In fact, a lot of rural communities are big winners," she said.

In Victoria, an extra 251 doctors will be eligible for the GP rural incentive program, including 91 in Bendigo and about 100 in Ballarat. More than 2400 doctors and about 500 communities in Australia will become eligible for support for the first time.

The incentives have been reworked so "the more remote you go, the greater the reward", the Government said. For instance, doctors going from a major city to a regional centre will get a $15,000 grant, but if they go to a very remote area, they will get $120,000. No part of Victoria has been classified as "very remote", with only parts of the most extreme western and eastern ends of the state classed as "remote".

The scheme also rewards city doctors for doing four-week locum placements to give their country cousins a break.

The health budget also:

• Lifts taxes on so-called "malternatives", beer and wine products that imitate alcopops ($135 million revenue over four years).
• Saves about $175 million by cutting subsidies of interchangeable medicines.

Discuss the budget with Essential Baby members here.