Jane O'Connell works as a part of Australia's health system. She belongs to the new breed of nurses who are trained to attend to patients without the guidance of the doctors. She can order diagnostic tests such as X-rays, treat them for minor problems, prescribe them drugs or refer them to a specialist.
A lot of such health care workers are to be seen in action in the US and UK, but their role in Australia is not well recognized. Statistics reveal that there are about 100 nurse practitioners in this country out of which two-thirds are place in the public sector of New South Wales (NSW). Her role is well recognized in the NSW state legislation, But outside the Hornsby Hospital were she is currently working her status is unrecognized by Medicare.
This is due to the simple fact that Medicare is run by federal government and not by the state laws and the Pharmaceutical Benefits Scheme-PBS (federal program).
O'Connell can prescribe to the patients and they get the money covered by the Medicare if it is dispensed from the hospital's drugs cupboard, but not if it is got from normal High Street pharmacy. So the patients go in for another GP, which would consume more time for the patient as well as the system. Then the patient pays no more than the maximum PBS co-payment of $28.60.
Similarly in case of reference, if she refers a specialist who is in the public hospital system, then the Medicare would cover the expenses. In case if the patient wants to see a specialist in his rooms or in the private hospital, then the patient is charged over $100 for the private consultation and the rebate is as little as $17.85 and not the usual $62.95.
O'Connell is the president of the Australian Nurse Practitioner Association.
The Australian Medical Association vice-president Choong-Siew Yong said that it would be considered as inferior care if health workers were substituted for doctors and it is unacceptable.
But according to O'Connell, it is double work, which put down our capacity and negates our capability. The 450-page report, which is to be discussed, by the federal Government and the Council of Australian Governments has included a number of amendments such as assigning individual review committee.
These will determine which services and health workers should be included under Medicare and also the issue on rebate. The report said that it clearly acknowledges the fact that health professional provides services that are equal to that of the doctors in both quality and safety.
It is also said in the report that due to this Medicare benefits schedule there is a possibility of hampering the development of new modes of care.
One such instance is that of the Physiotherapist Trish Neumann. He specializes in pelvic floor problems and treats stress urinary incontinence. This condition is very common and affects one in three Australian women. It is frequent among middle and old age people.
He said in 1998 the treatment costed about $339 million and is expected to increase in the next 20 years with 88 per cent of those costs going on surgery.
Neumann conducted a survey questioning 274 women in 35 centers across the country. He found that the surgical treatment for stress urinary incontinence costed about $4500 to $6000 per patient. In case the surgery is conducted in a public hospital Medicare covers the bills of the patient.
On the other hand five physiotherapy sessions which would cost $300 and assures 80% cure is not covered by Medicare and has limited coverage under private health insurance. Since Medicare covers surgery patient assumes that it is the treatment and results in complete cure but physiotherapy does not result in complete cure.
But US standards bodies have recommended non-surgical treatment like physiotherapy, which has a high success rate and is cost effective. Statistics show that 86 per cent of the 274 women in Neumann's study were very satisfied with their treatment, and remained so for the next one year. On the other hand surgery carries risks, including infection and bladder perforation.
Support and funds to such treatments would facilitate an effective way of allocating health resources.