Submissions to a parliamentary inquiry say rebates do not support proper assessment of obesity, comorbidities and prevention strategies.
Diabetes is both common and relatively expensive – it affects one in 20 Australians and accounts for 2.2% of total disease expenditure – but the best weapons in the MBS arsenal are chronic disease management items for obese patients.
The chronic disease is the focus of a new review by the House of Representatives’ standing committee on health and aged care. So far, it has received 242 submissions from a range of stakeholders.
Commissioned by Health Minister Mark Butler in May, the inquiry aims to look at the causes of type 1, type 2 and gestational diabetes as well as the broader impacts of diabetes on the health system and economy.
Evaluating the relationship between obesity and diabetes, including the underlying causes of obesity, forms a big chunk of the terms of reference.
While obesity is very strongly associated with the development of type 2 diabetes – around 80% of people diagnosed with type 2 are overweight or obese – it’s also among the environmental factors which are proven to be associated with type 1 diabetes.
“[Type one diabetes] is becoming more common, worldwide, at about 3% per year,” the Westmead Institute of Medical Research centre for diabetes research wrote in a submission to the inquiry.
“This … rate of increase cannot be due to genetic changes, as the increase is too fast.”
Vitamin D deficiency in early life and certain viruses are also thought to play a key role in the development of type 1 diabetes.
Despite the known links between obesity and diabetes, the federal government hasn’t always delivered meaningful change.
The AMA noted in its submission that while systemic action to reduce obesity and improve nutrition is “fundamentally important” to preventing the onset of diabetes, previous commitments by the government have fallen flat.
“AMA supports the National Obesity Strategy (2022) and the National Preventive Health Strategy (2021); however, we are concerned about the lack of direction on how both strategies are being implemented,” the association said.
The AMA also criticised inaction on the $50 million wounds consumable scheme for general practice that was announced as part of the May budget.
TMR has contacted the department for an update.
As the Royal Australasian College of Physicians pointed out, the Department of Health and Aged care currently has 20 active strategies that relate to the current inquiry, not counting the additional four that are currently in development.
Both the RACP and the AMA called on the government to fund and implement the preventive health and obesity strategies as a priority.
The RACP also recommended new MBS items for obesity management to be used in primary care and said fee-for-service payments did not incentivise many of the elements of good chronic disease care.
Dedicated items would cover appropriate weight assessment, examination for common complications and psychological support.
“Medicare’s Chronic Disease Management (CDM) items are not used to their full capacity for obesity,” the college said.
“When used, they do not allow for appropriate assessment of obesity, related comorbidities and suitable secondary prevention strategies.
“Inconsistent understandings of eligible conditions for CDM management and gaps in knowledge of services that can be subsidised for people with obesity are key barriers to CDM use.”
The Primary Care Diabetes Society of Australia, a non-profit spanning general practice, pharmacy and allied health, also argued that fee for service was not appropriate for long-term management of diabetes.
Its submission contends diabetes management is only effective through an integrated multidisciplinary team.
“To note, a GP alone is not a team,” the submission said.
Currently, the society said, there was no incentive for primary care team members to train up in diabetes management.
Its suggestion for fixing this is providing additional funding to allied health professionals that would be conditional on them creating and developing high-functioning multidisciplinary care teams serving people with diabetes.
In its own submission to the inquiry, the Department of Health and Aged Care lists the only MBS initiatives for diabetes as being time-tiered general attendance items and CDM items.
Under the CDM items, overweight patients can access a total of five subsidised allied health appointments per year and patients with type 2 diabetes can access up to eight MBS-rebated group therapy sessions.
“If clinically necessary, GPs can also refer patients to relevant specialists for treatment,” DoHAC advised.