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Wednesday, 5 March 2014
Page: 1796


Dr SOUTHCOTT (Boothby) (19:40): There are one million Australians who have been diagnosed with diabetes and diabetes is the fastest-growing chronic condition in Australia. Up to half of the cases of type 2 diabetes remain undiagnosed. By 2031—just 17 years away—it is estimated that there will be more than three million Australians who have type 2 diabetes. This is a challenge for policymakers. It is going to be a challenge for future health budgets for state and federal governments.

There are two areas we can focus on. The first one is the area of prevention. Up to 58 per cent of the cases of type 2 diabetes are preventable. The Baker IDI Heart and Diabetes Institute have developed an AusDrisk tool. It is a risk assessment tool for diabetes. It is based on a Finnish one but adapted for Australia. It is a useful tool and it is available online. It is a test which all adults should take especially those over 40. There are some things which you cannot change, like your age, your sex, your genetics, your family history. But there are many other things that you can change, such as your diet and whether you have 2½ hours of moderate physical activity each week. Being overweight or having excess weight around the waistline increases the risk of progressing to type 2 diabetes. Losing even as little as five to 10 per cent of your body weight and keeping it off, can help reduce the risk. There is enormous potential if we can focus on these people who have pre-diabetes or who are at risk of developing diabetes, because delay or even preventing the onset of diabetes is possible with early intervention and is critical to ensuring that state and federal governments are able to pay their health budgets into the future.

The second area where I think there is great potential concerns the incentives which are available to treat diabetes under Medicare. At present there is a practice incentive payment. There is a sign-on payment of $1 for practices who have a register of diabetic patients. There is an outcomes payment of $20 where 50 per cent of diabetic patients have completed a cycle of care, and there is a service incentive payment of $40 per patient for each cycle completed.

When you have a look at the results, they are pretty dismal. The percentage of people with diabetes who received the diabetes annual cycle of care were only about a quarter on the most recent figures, and less than half of general practices even participate in the PIP Diabetes program. Numerous studies have shown that between 22 and 50 per cent of Australians with diabetes do not undergo eye examinations at the recommended frequency. Only 12 per cent have consulted a chiropodist or podiatrist in the last 12 months and only 10 per cent of those have consulted an optician or optometrist in the last 12 months.

The way it is structured, the practice incentive payment is focused on encouraging a process without measuring results. We need to look at introducing a genuine quality measure into Medicare and into the PIP. Part of the cycle of care involves measuring the HbA1c for each diabetic. My concern with the PIP, as it is structured at the moment, is that it rewards process over results and it is not necessarily a quality measure. The UK has more than 20 years experience of something called the Quality and Outcomes Framework. It is a detailed payment system which rewards clinical outcomes. In Australia we could use the existing framework of the practice incentives payment to reward GPs on the level of diabetic control they achieve. It would be a first step but it would be a genuine quality measure, and having a true measurable quality objective would be a good way to make Medicare even better.