Navigating the Australian Health System

Guest Post from David Mapletoft, Diabetes Educator

Health care in Australia is divided between Federal and State responsibility.

To make the most of the system it is wise to understand how to navigate these systems, so you can get the best ‘value’ to enable your diabetes self care plan to be most efficiently and affordably implemented.

The International Diabetes Foundation recognises that “People with diabetes have the right to understand their disease, make informed choices and receive care based on best practice. They must be part of the team that manages their condition.This can only be achieved if interdisciplinary teams and people with diabetes have the information and tools to make changes based on best practice and recognized improvement strategies are used to support meaningful system change.”

All too often people living with diabetes do not get the opportunity to  have the specialist input from a diabetes educator  or dietitian.

To make your diabetes self care plan most effective it is in your best interest to have an appropriate level of diabetes self management education.

diabetes educator provides diabetes self-management education for people with diabetes. They play a major role in self-empowering the person with  diabetes by focusing on an individual’s needs, providing knowledge, motivation and support to aid the prevention of diabetes related health complications.

Diabetes Educators have many years experience (some living with diabetes themselves) and can provide you with tailored education, upon the following: 
  • Self blood glucose monitoring.
  • Oral hypoglycaemic agents.
  • Insulin initiation and titration.
  • Sick day guidelines.
  • Hypoglycaemia recognition and management.
  • Complication risk management.
Accredited Practising Dietitians can, in addition, provide you with a nutritional assessment and advice tailored to your individual needs, in addition to education upon the following:
  • Influence of nutrition on blood glucose control.
  • Carbohydrate counting and information.
  • Weight management.
  • Blood lipid management.
  • Related health issues.
  • Complication management.
  • Hypoglycaemia recognition and management.

State Health Systems:

State health systems often provide services such a diabetes self management education courses at community health centres or in public hospitals.

These courses may be a combination of individual and group self management education sessions, usually run by a diabetes educator  and a dietitian. These diabetes self management programs are usually free.

Whatever type of diabetes you have been diagnosed with, this is a good place to start.

To find out more about what is available in your area make contact with your local hospital or community health service.

Another way to find your local diabetes self management programs is via Diabetes Australia or ADEA.

What’s Next

By initially connecting with these state funded health care professionals, you can then navigate the Medicare system with your GP to connect in an affordable manner with other members of your health care team. e.g. podiatrist, exercise physiologist, psychologist/counsellor etc (ALL of whom are covered by the Medicare system).

Medicare – Federal Government Funding

Talk with your GP about the Medicare system, whats available to people with chronic health issues like diabetes.

The Chronic Disease Management (formerly Enhanced Primary Care or EPC) — GP services on the Medicare Benefits Schedule (MBS) enable GPs to plan and coordinate the health care of patients with chronic or terminal medical conditions, including patients with these conditions who require multidisciplinary, team-based care from a GP and at least two other health or care providers.

A chronic medical condition is one that has been (or is likely to be) present for six months or longer, for example, asthma, cancer, cardiovascular disease, diabetes, musculoskeletal conditions and stroke. There is no list of eligible conditions; however, the CDM items are designed for patients who require a structured approach, including those requiring ongoing care from a multidisciplinary team.

Whether a patient is eligible for CDM services is a clinical judgement for the GP, taking into account the patient’s medical condition and care needs, as well as the general guidance set out in the MBS.

Patients who have a chronic medical condition and complex care needs and are being managed by their GP under a GP Management Plan (item 721) and Team Care Arrangements (item 723) are eligible for Medicare rebates for certain allied health services on referral from their GP.

In summary:
  • Maximum of five (5) services per patient each calendar year
  • Medicare rebate of $48.95 per service, with out-of-pocket costs counting towards the extended Medicare safety net
  • Patient must have an Enhanced Primary Care (EPC) plan prepared by their GP (your GP is paid to produce this for you)
  • GP refers to allied health professional (referral NOT required if that health care professionals happens to be available for free in the State health care system)
  • Allied health professional must report back to the referring GP

CAUTION: In creating the Chronic Disease Management Plan ensure YOU and your GP knows who is available in the State health system for you to enable the best use of this plan.

Team Care Arrangements (item 723)

  • Provides a rebate for a GP to coordinate the preparation of TCAs for a patient who has a chronic or terminal medical condition and also requires ongoing care from a multidisciplinary team of at least three health or care providers.
  • In most cases the patient will already have a GPMP in place (but this is not mandatory).
  • The minimum claiming period is once every twelve months, supported by regular review services.
  • Involves the GP collaborating with the other participating providers on required treatment/services, agreeing to arrangements with the patient, documenting the arrangements and a review date in the patient’s TCAs, and providing copies of the relevant document to the collaborating providers.

 

Kind Regards,

David, Diabetes Educator

 

 

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