Pubdate: Wed, 22 Jul 1998 
Source: Sydney Morning Herald (Australia) 
Contact:  http://www.smh.com.au/ 
Author: Marion Downey, Health Writer

METHADONE CLINICS MAY BE FORCED TO CUT BACK

Sydney doctors who specialise in prescribing methadone to treat heroin
addicts say there will be major cuts in the service if a Government proposal
to pay doctors a flat fee of $700 a year for each methadone patient is
introduced in NSW.

The flat fee, to cover all visits and diagnostic tests, will be piloted in
Western Australia and South Australia in September, before being introduced
nationwide.

Sydney methadone specialists say the scheme stigmatises heroin addicts
receiving treatment, and predict that private methadone clinics will be
wound back if fees are slashed.

At present, methadone patients are treated the same as other Medicare
patients. Doctors charge a fee for each consultation and additional fees for
random urine-testing.

The new funding arrangements, which are detailed in the 1997-98 Budget
papers, are expected to save $19.3 million from 1998 to 2001.

The papers say that the arrangements will "remove the scope for
over-servicing inherent in the existing fee-for-service Medicare Benefits
structure".

They are also intended to stop States cost-shifting methadone treatment by
"unlimited approval" of private doctors to prescribe methadone as an
alternative to public clinics.

The president of the Private Methadone Association in Sydney, Dr John
Sivewright, said the proposals would force doctors to cut back on their
level of service to patients.

"This produces a situation where there is a ceiling to the amount of money
which can be spent on the patient's treatment," said Dr Sivewright. "Either
the patient has to pay, the doctor has to pay or it does not get done."

Dr Sivewright dispenses methadone in his central Sydney clinic from behind
bullet-proof glass.

"This is the toughest end of medicine - now we have the Government trying to
screw us for a few bob."

Dr John Smart, a GP in Hornsby, says a third of his practice is made up of
methadone patients.

"We treat everyone here from children of professors of medicine to various
derelicts and psychopaths. But mainly they are ordinary people who are
working or studying.

"Why should a particular group of people be singled out to have their right
to Medicare taken away from them? They are a already a marginalised group."

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Checked-by: Melodi Cornett