CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Health Review   
Australian Health Review
http://www.aushealthcare.com.au/
  Journal of the Australian Healthcare & Hospitals Association
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Structure
Contacts
For Advertisers
Content
Online Early
Current Issue
Just Accepted
All Issues
Sample Issue
For Authors
General Information
Author Instructions
Submit Article
Scope
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
Call for Reviewers
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates

blue arrow e-Alerts
blank image
Subscribe to our Email Alert or RSS feeds for the latest journal papers.

red arrow Connect with AHR
blank image
facebook   TwitterIcon

red arrow Connect with CP
blank image
facebook twitter youtube

 

Open Access Article << Previous     |     Next >>   Contents Vol 35(4)

Investing in big ideas: utilisation and cost of Medicare Allied Health services in Australia under the Chronic Disease Management initiative in primary care

Robyn P. Cant A C and Michele M. Foster B

A Monash University, School of Nursing and Midwifery, Churchill, VIC 3842, Australia.
B Social Policy Unit, School of Social Work and Human Services, The University of Queensland, St Lucia, QLD 4072, Australia. Email: fosterm@uq.edu.au
C Corresponding author. Email: robyn.cant@monash.edu

Australian Health Review 35(4) 468-474 http://dx.doi.org/10.1071/AH10938
Submitted: 19 June 2010  Accepted: 16 February 2011   Published: 14 October 2011


 
 Full Text
 PDF (439 KB)
 Export Citation
 Print
  
Abstract

Objective. To critically examine utilisation of the 13 allied health services provided through Medicare Chronic Disease Management program and related general practitioner (GP) care planning initiatives.

Methods. Statistics generated from national billing data from July 2005 to June 2009 were extracted from Medicare data and compared by profession, State or Territory and population.

Results. Most services grew over 4 years although nationally consistent service levels were not found for any allied health provider profession. On referral from GPs, podiatry, physiotherapy and dietetics provided most services (82%) in 2008–09. Professions had unique patterns of referral instanced by age range and sex of clientele. Wide variation was apparent in per capita utilisation of allied health services by State or Territory; some with far less than average national use and others with high use. Annual number of GP Management Plans or Team Care Arrangements was low (mean: ≤22 per GP in 2008–09), indicating low use of care planning.

Conclusion. Inequality of accessibility for patients was apparent. Five years into the program, a review of Medicare Allied Health CDM policy is warranted.

Implications. Research and evaluation is needed to identify whether the program is meeting the needs of GPs, allied health providers and chronic disease patients.

What is known about the topic? Since 2004, Medicare Chronic Disease Management program has offered Australian patients with chronic or complex disease access to 13 allied health professions via private clinics on referral from their general practitioner – with costs subsidised by Medicare. Little is known about the demographics of referred patients or which allied health services are utilised.

What does this paper add? We take a multidisciplinary perspective to describe program use and find wide variation by profession nationally. Per capita State and Territory data indicate inequality of accessibility. Podiatry, physiotherapy and dietetics provided 82% of all services in 2008–09. Referrals initiated by GPs via patient care plans are increasing, but at present referrals per each GP are low.

What are the implications for practitioners? More needs to be known about the dynamics that affect referral, the local accessibility of allied health providers and issues that affect uptake by patients.

Additional keywords: access, dietetics, physiotherapy, podiatry, self-management.


References

[1]  Chronic diseases and associated risk factors in Australia, 2006 . Canberra: Australian Institute of Health and Welfare; 2006. AIHW Cat. No. PHE 81.

[2]  National Chronic Disease Strategy. Canberra: Department of Health and Ageing. Available at http://www.health.gov.au/internet/wcms/publishing.nsf/ [verified 12 May 2009].

[3]  Wilkinson D, McElroy H, Beilby J, Mott K, Price K, Morey S, Best J. Uptake of health assessments, care plans and case conferences by general practitioners through the Enhanced Primary Care program between November 1999 and October 2001. Aust Health Rev 2002; 25: 1–11.
CrossRef | PubMed |

[4]  Enhanced Primary Care program Overview. Department of Health and Ageing; 2010. Available from: http://www.health.gov.au/epc [verified 28 September 2009].

[5]  Enhanced Primary Care Program (EPC) Chronic Disease Management. (CDM) Medicare Items. Department of Health and Ageing; 2005. Available at http://www.health.gov.au/internet/wcms/publishing.nsf/Content/pcd-programs-epc-chronic [verified 14 May 2009].

[6]  Medicare benefits schedule Allied Health Services. Canberra: Department of Health and Ageing; 2009.

[7]  Cant RP, Aroni R. Melbourne dietitians’ experience of Medicare policy on allied health services (Strengthening Medicare; Enhanced Primary Care) in the first 12 months. J Nutr Diet 2007; 64: 43–9.
CrossRef |

[8]  Mitchell LJ, Capra S, Macdonald-Wicks L. Structural change in Medicare funding: impact on dietetics workforce. Nutr Diet. 2009; 66: 170–5.
CrossRef |

[9]  Menz HB. Utilisation of podiatry services in Australia under the Medicare Enhanced Primary Care program, 2004–2008. J Foot Ankle Res. 2009; 2: 30.
CrossRef | PubMed |

[10]  Statistics: Medicare allied health 2008–2009 financial year. Canberra: Medicare Australia; 2009.

[11]  Foster M, Cornwell P, Fleming J, Mitchell GK, Tweedy SM, Hart AL, et al Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners. Aust J Prim Health 2009; 15: 326–34.
CrossRef |

[12]  Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming J. Does Enhanced Primary Care enhance care? Policy-induced dilemmas for allied health professionals. Med J Aust 2008; 188: 29–32.
| PubMed |

[13]  O’Halloran J, Harrison C, Britt E. The management of chronic problems. Aust Fam Physician 2008; 37: 697.
| PubMed |

[14]  Menz HB, Gill TK, Taylor AW, Hill CL. Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study. J Foot Ankle Res. 2008; 1: 8.
CrossRef | PubMed |

[15]  Ottawa Methods Group Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys Ther 2005; 85: 907–71.
| PubMed |

[16]  Cant RP. Today’s profession: views and practices of private practice dietitians re Medicare Chronic Disease Management. Nutr Diet. 2010; 67: 77–83.
CrossRef |

[17]  Diabetes Model of Care. Perth: Health Networks Branch, Department of Health Western Australia; 2008. Available at http://www.diabetes.health.wa.gov.au/docs/Diabetes_MOC_intro.pdf [verified 17 January 2011].

[18]  The SARRAH Rural and remote allied health and Medicare. Aust J Rural Health 2007; 15: 140–1.
CrossRef |

[19]  Williams E, D’Amore W, McMeeken J. Physiotherapy in rural and regional Australia. Aust J Rural Health 2007; 15: 380–6.
CrossRef | PubMed |

[20]  Rural RARH. Indicators of Health Status and Determinants of Health. Canberra: Australian Institute of Health and Welfare; 2008.

[21]  Achat HM, Thomas P, Close GR, Moerkerken LR, Harris MF. General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population. Aust J Prim Health 2010; 16: 132–40.
CrossRef | PubMed |

[22]  Pomeroy SEM, Cant RP. General practitioners’ decision to refer patients to dietitians: insight into the clinical reasoning process. Aust J Prim Health 2010; 16: 147–53.
CrossRef |

[23]  Wilson SF, Marks R, Donohue S, Chapman M, Zwar N. General practitioner multidisciplinary skills for enhanced primary care. Aust Fam Physician 2004; 33: 479–80.
| PubMed |

[24]  GP Super Clinics. Department of Health and Ageing; 2011. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclinics [verified 17 January 2011].


   
 


    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2015