Dear Mrs Irwin

Thank you for your letter of 18 March 2010 regarding a petition to the House of Representatives about the diagnosis, treatment and management of lymphoedema as a chronic medical condition.

The petition has a number of specific requests to assist in the treatment and management of lymphoedema, including funding for trained lymphoedema therapists, and financial assistance for travel to services to treat lymphoedema. The Australian Government recognises that chronic diseases represent a major challenge for our health system. Chronic diseases are estimated to be responsible for more than 80 per cent of the burden of disease and injury in Australia, and more than half of all general practice consultations are with people who have a chronic condition.

On 20 April 2010, the Prime Minister, Premiers and Chief Ministers of states and territories, with the exception of Western Australia, reached an historic agreement at the Council of Australian Governments, on health and hospitals reform—the establishment of a National Health and Hospitals Network, to improve the health system for all Australians. In particular, the reforms to general practice and primary health care are aimed at improving access to GP services, tackling chronic disease and keeping Australians healthy and out of hospital. The Government will also continue to address chronic disease management through the National Primary Health Care Strategy, as well as the National Preventive Health Agency and the National Partnership Agreement on Preventive Health.

The petition raised the provision of training for GPs in the detection, assessment and treatment of lymphoedema, in accordance with the Lymphoedema Framework Best Practice for the Management of Lymphoedema—International Consensus. The Government acknowledges the need for primary care practitioners including GPs and community nurses to have the necessary knowledge and skills to manage chronic conditions such as lymphoedema. To progress this, the petitioners should consider forwarding their framework document to the Royal College of General Practitioners and the Deans of Nursing for consideration of this issue as part of their curriculum and training reviews.

The petition asks about treatment regimes for patients with lymphoedema. Lymphoedema has not been recognised specifically as a chronic medical condition for the purposes of the Chronic Disease Management (CDM) items on the Medicare Benefits Schedule (MBS), but this does not preclude it being considered as such. The MBS does not list all possible medical conditions that are regarded as chronic medical conditions. It is up to GPs to use their clinical judgement, taking into account the eligibility criteria and the general guidance to determine whether a patient with lymphoedema is eligible for treatment under the Medicare CDM items.

Under the CDM items, patients with a chronic medical condition and complex care needs are being managed by their GP under a GP management plan (GPMP) and team care arrangements (TCA), and can be referred for up to five Medicare-rebatable allied health service items each calendar year. Specific categories of allied health professionals, including physiotherapists and occupational therapists who meet specific eligibility requirements, and who are registered with Medicare Australia and in private practice, are able to provide these CDM (individual) health services.

The allied health services available under Medicare are not intended to fully cater for patients who require more intensive ongoing treatments. Instead, these Medicare services complement services provided by state and territory governments, and increase access to private allied health services by making them more affordable.

The Australian Government also supports access to allied health services more generally through subsidies on private health insurance premiums and through targeted non-Medicare initiatives such as the Rural Primary Health Services program funded through the Divisions of General Practice and other primary health care providers in rural and remote communities.

In addition, patients with lymphoedema may be eligible for Medicare benefits for monitoring and support services provided by a practice nurse (or registered Aboriginal Health Worker) on behalf of a GP (MBS item 10997). This item is available to patients who have a chronic or terminal medical condition and are being managed by their GP under a GPMP, TCA or a multidisciplinary care plan. Activities that a practice nurse or other health professional may undertake on behalf of or under the supervision of a GP are not prescribed, but must be within the nurse’s professional competencies. A maximum of five services can be claimed per patient per calendar year.

The petition asks that funding be provided for the cost of compression garments. The Government acknowledges that the cost of necessary medical aids and appliances can be a significant financial burden, particularly for people living with a chronic medical condition. Medical aids and appliances are provided by the states and territories as part of their responsibilities for the provision of health services. Under the current health funding arrangements, the Australian Government’s role is to provide health grants to state and territory governments. All state and territory governments operate aids and appliance programs to assist residents with the cost and/or provision of appropriate equipment, aids and appliances in the community setting.

In addition, some private health insurers provide benefits for aids and appliances, but are free to determine the nature of health related goods that attract benefits and any conditions or restrictions on such benefits. The payment of benefits usually depends on the insured person holding a policy that covers aids and appliances.

The petition also sought financial assistance for transport where travel of more than 40 kilometres is necessary to access services. Access to health care for people in rural and remote Australia is an important issue. Funding and administration of patient assisted travel schemes is the responsibility of state and territory governments. The schemes in each state and territory vary in relation to eligibility requirements, distance thresholds, subsidy levels and administrative arrangements. Even basic issues are impacted on by a range of factors including geography, demography, population density, locally available health services, public transport and infrastructure investments in each jurisdiction.

While it is the states and territories which have funding and administrative responsibility for the patient assisted travel schemes within their jurisdictions, the Australian Government is committed to working with them on the effectiveness of the schemes, particularly in developing as much national consistency as possible. Under the National Health and Hospitals Network Agreement the Commonwealth, states and territories agreed to undertake further work in regard to patient assistance transport schemes, with a view to higher and more consistent national standards.

I trust that the above information is of assistance.

from the Minister for Health and Ageing, Ms Roxon