The diabetes care measure announced in the 2009 Budget was one of the true reform measures in the whole health reform agenda. It was informed by extensive evidence about best practice in the management of chronic diseases.

The measure as announced in 2009 included a voluntary enrolment incentive so that patients would sign up with a particular practice to ensure continuity of care and an annual lump sum payment to the practice to provide that care, including capacity within that to fund support care from health professionals outside the practice (e.g. podiatrists).

The measure had a long lead time — implementation from July 2012 — and an expert committee under the chairmanship of the chief Commonwealth medical officer was established to advise on detailed implementation.

It was a surprise therefore that, unexpectedly, the Government announced on November 12 that there would be a trial of the measure to take 3-4 years and cost several millions of dollars before any implementation would occur.

This announcement was most odd, particularly as little detail was made available as to the nature of the trial and what it would be designed to demonstrate.

In its welcoming announcement, the AMA clearly envisages a “clinical trial”, which suggests that it is intended to demonstrate the efficacy of management of diabetes patients in primary care — which seems to have been well demonstrated already.

At the time, there was considerable professional disquiet about some aspects of the program, principally how such a measure might fit into the existing Medicare arrangements and how care for patients’ diabetes could be isolated from their overall health needs.

These are important concerns and might well need further analysis and some on the ground testing.

However, a full-blown clinical trial would not necessarily be the best means of responding to these concerns.

It is disappointing that the Government has, in effect, deferred indefinitely this important innovation at a time when chronic disease, diabetes in particular, is one of the major health risks for Australia.

It is to be hoped that there will be a transparent process for progressing the new approach and the possibility of that being staged so some elements of the original measure might be put back on the agenda earlier than the 3-4 years’ time horizon.

*Robert Wells is director of the Menzies Centre for Health Policy and director of the Australian Primary Health Care Research Institute at the ANU.

Peter Fray

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