States vary in uptake of Medicare allied health program

Tuesday, November 22, 2011


Podiatry, physiotherapy and dietetics are the most common service providers funded under the Medicare Allied Health Chronic Disease Management program, according to a new study published in the Australian Health Review. The study found that there is significant variation in utilisation between the states and territories and people may have limited access to the subsidized services on the basis of where they live.

"The growth in chronic illnesses is a key challenge to the future of our health system with three out of every four Australians likely to experience a chronic illness at some stage in their life. The Medicare Chronic Disease Management (CDM) program was established in 2004 in order to improve prevention and management of chronic diseases by enhancing the capacity of the primary care sector to provide continuity of care with multidisciplinary input. The program offers 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," said study leader, Dr Robyn Cant, Research Fellow, School of Nursing and Midwifery, Monash University.

"Although some evaluation has been undertaken during the early period of the Medicare EPC program of GPs’ use, there is little published evaluation of the Medicare allied health services, particularly from a multidisciplinary perspective. There is also little known about the demographics of referred patients or which allied health services are utilised.

"This study aimed to examine: (i) Medicare statistics for allied health services over 4 years (2006–09) with a view to describing the frequency and type of allied health services utilised under the CDM items and utilisation by State or Territory and by patient demography; and (ii) the Medicare statistics for multidisciplinary care plans and case conferences to describe utilisation by GPs.

"The research found that there were 1.9 million individual allied health services (consultations) provided nationwide under the CDM items in the 2008–09 financial year, at a cost of almost AU$92 million to Medicare. There were also almost 18 000 Group Medicare services for small group education of patients with type 2 diabetes.

"Medicare CDM statistics for allied health services show that podiatry, physiotherapy and dietetics provided 82% of all services in 2008–09. There was wide variation in service utilisation by State and Territory and also unique patterns of referral and service according to allied health speciality, as shown by age and sex mix.

"There was only limited use of multidisciplinary care plans and low case conference uptake by GPs which suggests that the investment in allied health services is not yet being translated into effective team care that incorporates shared care and decision-making. Rather, it is more likely providing opportunity for additional disciplinary input into the management of patients with chronic disease. It may be that multidisciplinary care planning is better coordinated in comprehensive primary health care centres, such as Super Clinics.

"A review of Medicare CDM policy is warranted to understand these differences and to account for public expenditure. Research is also required to identify the extent the policy is meeting the needs of GPs, allied health providers and their chronic disease patients," Dr Cant said.

For more information and comment: Dr Robyn Cant 0438 363 634