Q&As - MBS and PBS changes

These questions and answers are designed to inform pregnant women, new mothers and families about important changes to give greater choice in and access to maternity services in Australia.

Page last updated: 14 November 2012

PDF printable version of the Q&A - MBS and PBS changes (PDF 444 KB)

If you have any difficulty in accessing the PDF, please contact PACD Web for an alternate version to be sent to you.

General

What do the reforms mean to you?

The reforms mean more choice in and access to maternity services for pregnant women, new mothers and families. You can now claim Medicare rebates for specific services provided by an eligible, privately practising midwife. As well, an authorised midwife can prescribe to you subsidised medicines listed on the Pharmaceutical Benefits Scheme.

How will these reforms improve the maternity care I receive?

The reforms support continuity of care. You can be confident that your health care providers, including midwives and obstetricians, will work together to help you receive safe, high quality care throughout your pregnancy, birth and after your baby is born.

The reforms give you more choice in the type of care you wish to receive when having a baby i.e. making the services provided by eligible privately practising midwives more affordable.

What is the purpose of these reforms?

The Australian Government has committed $120.5 million over four years to reform maternity services – improving choice and access for pregnant women, new mothers and families.

Of this, $66 million will fund changes to the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) to make maternity care more affordable.

The reforms respond to the growing pressure on the nation’s maternity services due to the rising number of births and workforce shortages – by making better use of the midwifery workforce working collaboratively with doctors, while maintaining current high standards of safety and quality.

The reforms recognise the important role played by midwives in the birthing experience of many Australian women.

How do these reforms fit in with the National Maternity Services Plan?

These reforms reflect the Government’s commitment to improving maternity services across Australia and represent a significant investment towards the National Maternity Services Plan (the Plan).

The National Maternity Services Plan (the Plan) sets out a five year vision for maternity care across Australia. The Plan recognises the importance if maternity services within the health system and provides a strategic national framework to guide policy and program development. The implementation of the Plan is a collaborative effort between all Australian Governments.

Pregnancy, Birth and Baby Helpline

What services/advice will the Pregnancy, Birth and Baby Helpline be able to give me and when will it be available?

The Pregnancy, Birth and Baby Helpline (the Helpline) is a national 24 hour helpline, operating seven days a week. You, your partner and family can call 1800 882 436 for advice and information about pregnancy, birth and the first 12 months of your baby’s life.

The Helpline will provide information and direction on services available for women and families for all aspects of pregnancy, including information on the range of services that may be available in your local area.

Funding will also be provided to specialist telephone-based peer support organisations. If you are seeking assistance for perinatal depression or grief through the loss of a child in the perinatal period, the Helpline can refer you to these organisations.

The Helpline has been operating since 1 July 2010.

Where can I get more help?

For more information, call the Helpline on 1800 882 436, or visit the Health Direct website.

Safety and quality

How can I be certain care is safe and of high quality?

For midwives to be eligible to provide services under this new arrangement, they will need to have the required credentials to ensure high standard midwifery care involving collaborative arrangements with GPs/obstetricians and hospitals.

The Australian Government has developed the National Guidance on Collaborative Maternity Care to support all health professionals on implementing reforms, particularly the requirement for collaborative arrangements. This document will be available on the National Health and Medical Research Council’s website. For more information, visit the National Health and Medical Research Council's website.
To ensure safety and quality of PBS prescribing, activities such as the quality use of medicines as provided by the National Prescribing Service, will be implemented.

As well, the reforms provide Australian Government-supported professional indemnity insurance for midwives so that you and your family are protected.

MBS changes

How/when can I access this?

Under the new MBS arrangements, you will be able to claim Medicare rebates from 1 November 2010. From this date, suitably qualified and experienced midwives who have obtained a Medicare provider number will be able to provide specified antenatal, birthing and postnatal services to private patients under Medicare.

What services are covered by the new MBS changes?

The services covered by Medicare are:
    • antenatal services;
    • delivery in a hospital setting – including a hospital birth centre; and
    • postnatal services.

PBS changes

Is it safe to allow midwives to prescribe PBS-subsidised medicines?

The safety of mothers and babies will be paramount.

Only appropriately qualified and experienced midwives who meet the requirements of the amendments to the National Health Act 1953 and are registered with Medicare Australia will be able to prescribe PBS-subsidised medicines.

Prescribing will only be within the scope of their practice, and in accord with the state and territory legislation under which they work.

Medicines required to treat more complicated pregnancies will be prescribed by patients’ medical practitioners.

To ensure safety and quality of PBS prescribing, activities such as the quality use of medicines as provided by the National Prescribing Service, will be implemented.

Collaborative arrangements

What is a collaborative arrangement?

A collaborative arrangement is an arrangement between an eligible midwife and a medical practitioner that must provide for:
    • consultation with a specified medical practitioner;
    • referral of a patient to a specified medical practitioner; and
    • transfer of the patient’s care to a specified medical practitioner, as clinically relevant, to ensure safe, high quality health care.

What does collaborative care mean?

Collaborative care involves health professionals in the maternity workforce working together to provide seamless care in accordance with your clinical needs, including backup, referral and transition to other care providers, as required.

It recognises the different roles, knowledge, skills and experiences that all members of the maternity care team contribute towards providing you with the best possible care throughout your pregnancy, birth and the postnatal period.

Midwives participating in the new arrangements will not be limited to providing care on behalf of medical practitioners but will be able to treat their own patients who will have access to MBS and PBS benefits. As part of the collaborative approach, midwives will have to demonstrate that they have appropriate referral pathways in place with hospitals, obstetricians and tertiary care, in order to obtain a Medicare provider number and PBS prescriber number.

Why do midwives have to work collaboratively?

Maintaining Australia’s strong record of safety and quality in maternity care for all Australian women, regardless of their health status throughout their pregnancy, is an important consideration of this reform package.

Currently, clinical practice in maternity care requires that midwives and other health professionals collaborate to ensure that women receive access to appropriate expertise and treatment as clinical needs arise. Working flexibly within collaborative teams also encourages and enables the development of new, innovative models of care tailored to local needs.

Collaborative practice will be further supported by the development of the National Guidance on Collaborative Maternity Care, through the National Health and Medical Research Council. Midwives will also refer their patients to an obstetrician for assessment around 34 weeks gestation, to ensure there are no potential or evident complications.

Australian Government funding for an expanded role for appropriately qualified and experienced midwives, working in collaborative arrangements, represents a significant step forward for maternity care in Australia.

Private health insurance

I have private health insurance. Can I still claim benefits from my private health insurer for midwifery services?

For Medicare Benefits Schedule (MBS) items for in-hospital treatment, insurers must pay benefits of at least 25 per cent of the MBS fee. For MBS items for out-of-hospital treatment, insurers are not permitted to pay any benefits. Many insurers currently pay benefits for services provided by midwives. Insurers will have to restructure their products to ensure they are compliant with the Private Health Insurance Act 2007 and proposed changes to MBS items.

Questions relating to benefits and services covered by private health insurance policies should be directed to your private health insurer.

Rural health

What is the Government doing for maternity services in rural and regional Australia?

Pregnant women, new mothers and their families who live in parts of rural and remote Australia will benefit from:
    • an expansion of the Government’s Medical Specialist Outreach Assistance Program (MSOAP); and
    • scholarships for GPs to undertake additional training to become GP obstetricians or GP anaesthetists, and for midwives to improve their skills and prescribe PBS-subsidised medicines.

    What is the Medical Specialist Outreach Assistance Program (MSOAP)?

    Under MSOAP, assistance will be available for obstetricians, registered midwives, maternal and child health nurses, and allied health professionals as members of multidisciplinary service teams to deliver outreach maternity services.

    How will the rural initiatives/ expansion of MSOAP help?

    Visits by the multidisciplinary maternity service teams will mean less disruption to family life – as there will be less need for pregnant women to travel long distances for maternity services.

    The outreach teams will help alleviate the pressure on existing health professionals and services in these regions. They will also boost existing rural and remote health services – as local health professionals will be able to increase their skills as a result of working alongside the outreach teams.

    For more information, visit the Department of Health and Ageing website or call 1800 678 636. Top of page

    Document help

    When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:

    1. Click the link with the RIGHT mouse button
    2. Choose "Save Target As.../Save Link As..." depending on your browser
    3. Select an appropriate folder on a local drive to place the downloaded file

    Attempting to open large documents within the browser window (by left-clicking) may inhibit your ability to continue browsing while the document is opening and/or lead to system problems.

    To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.